title: Implementation of Integrated Health Homes and Health Outcomes for Persons With Serious Mental Illness in Los Angeles County.
abstract: The Medicaid health home option of the Affordable Care Act provides a new opportunity to address the fragmented system of care for persons with serious mental illness. This study examined the implementation of integrated health homes in Los Angeles County.
  
  
  
  Longitudinal data on client-reported physical health status, clinician-reported mental health recovery, and screening for common chronic conditions among 1,941 persons enrolled in integrated care programs for serious mental illness and chronic general medical illness were combined with site visit data measuring the level of integration of general medical and mental health care among ten integrated care programs. Various analyses were used to compare outcomes by level of program integration (generalized estimating equations for physical health status and mental health recovery and logistic regression and chi-square tests for screening for common chronic conditions and clinical risk factors).
  
  
  
  Clients in more highly integrated programs had greater improvements in physical health status and mental health recovery and higher rates of screening for common chronic conditions compared with clients in less integrated programs. They also had greater reductions in hypertension but a worrisome increase in prediabetes and diabetes.
  
  
  
  Highly integrated mental health and general medical programs were associated with greater improvements in health outcomes compared with less integrated programs. Additional research is necessary to identify predictors of integration, to determine which aspects of integration drive improvements in health outcomes, and to identify strategies to increase integration within less integrated programs. Efforts are needed to coordinate pharmacotherapy, including increased consideration of the metabolic effects of antipsychotic medication.
authors.affiliation: Dr. Gilmer, Ms. Goode, and Dr. Sarkin are with the Department of Family Medicine and Public Health, University of California, San Diego, La Jolla (e-mail: tgilmer@ucsd.edu ). Dr. Henwood is with the School of Social Work, University of Southern California, Los Angeles. Dr. Innes-Gomberg is with the Los Angeles County Department of Mental Health, Los Angeles.
authors.forename: Todd P
authors.initials: TP
authors.lastname: Gilmer
authors.affiliation: Dr. Gilmer, Ms. Goode, and Dr. Sarkin are with the Department of Family Medicine and Public Health, University of California, San Diego, La Jolla (e-mail: tgilmer@ucsd.edu ). Dr. Henwood is with the School of Social Work, University of Southern California, Los Angeles. Dr. Innes-Gomberg is with the Los Angeles County Department of Mental Health, Los Angeles.
authors.forename: Benjamin F
authors.initials: BF
authors.lastname: Henwood
authors.affiliation: Dr. Gilmer, Ms. Goode, and Dr. Sarkin are with the Department of Family Medicine and Public Health, University of California, San Diego, La Jolla (e-mail: tgilmer@ucsd.edu ). Dr. Henwood is with the School of Social Work, University of Southern California, Los Angeles. Dr. Innes-Gomberg is with the Los Angeles County Department of Mental Health, Los Angeles.
authors.forename: Marissa
authors.initials: M
authors.lastname: Goode
authors.affiliation: Dr. Gilmer, Ms. Goode, and Dr. Sarkin are with the Department of Family Medicine and Public Health, University of California, San Diego, La Jolla (e-mail: tgilmer@ucsd.edu ). Dr. Henwood is with the School of Social Work, University of Southern California, Los Angeles. Dr. Innes-Gomberg is with the Los Angeles County Department of Mental Health, Los Angeles.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Sarkin
authors.affiliation: Dr. Gilmer, Ms. Goode, and Dr. Sarkin are with the Department of Family Medicine and Public Health, University of California, San Diego, La Jolla (e-mail: tgilmer@ucsd.edu ). Dr. Henwood is with the School of Social Work, University of Southern California, Los Angeles. Dr. Innes-Gomberg is with the Los Angeles County Department of Mental Health, Los Angeles.
authors.forename: Debbie
authors.initials: D
authors.lastname: Innes-Gomberg
mesh_terms: D019033:Delivery of Health Care, Integrated / Q000706:statistics & numerical data*; D006304:Health Status; D006801:Humans; D008137:Longitudinal Studies; D015141:Los Angeles; D008484:Medicaid / Q000706:statistics & numerical data*; D001523:Mental Disorders / Q000628:therapy*; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D058991:Patient Protection and Affordable Care Act / Q000706:statistics & numerical data*; D014481:United States