title: Integrating Primary Care Into Community Mental Health Centers: Impact on Utilization and Costs of Health Care.
abstract: This evaluation was designed to assess the impact of providing integrated primary and mental health care on utilization and costs for outpatient medical, inpatient hospital, and emergency department treatment among persons with serious mental illness.
  
  
  
  Two safety-net, community mental health centers that received a Substance Abuse and Mental Health Services Administration Primary and Behavioral Health Care Integration (PBHCI) grant were the focus of this study. Clinic 1 had a ten-year history of providing integrated services whereas clinic 2 began integrated services with the PBHCI grant. Difference-in-differences (DID) analyses were used to compare individuals enrolled in the PBHCI programs (N=373, clinic 1; N=389, clinic 2) with propensity score-matched comparison groups of equal size at each site by using data obtained from medical records.
  
  
  
  Relative to the comparison groups, a higher proportion of PBHCI clients used outpatient medical services at both sites following program enrollment (p<.003, clinic 1; p<.001, clinic 2). At clinic 1, PBHCI was also associated with a reduction in the proportion of clients with an inpatient hospital admission (p=.04) and a trend for a reduction in inpatient hospital costs per member per month of $217.68 (p=.06). Hospital-related cost savings were not observed for PBHCI clients at clinic 2 nor were there significant differences between emergency department use or costs for PBHCI and comparison groups at either clinic.
  
  
  
  Investments in PBHCI can improve access to outpatient medical care for persons with severe mental illness and may also curb hospitalizations and associated costs in more established programs.
authors.affiliation: Dr. Krupski, Ms. West, and Dr. Snowden are with the Department of Psychiatry and Behavioral Sciences, University of Washington at Harborview Medical Center, Seattle (e-mail: krupski@uw.edu ). Dr. Scharf is with the RAND Corporation, Pittsburgh. Dr. Hopfenbeck and Mr. Andrus are with the Downtown Emergency Service Center, Seattle. Dr. Joesch is with the King County Office of Performance, Strategy, and Budget, Seattle.
authors.forename: Antoinette
authors.initials: A
authors.lastname: Krupski
authors.affiliation: Dr. Krupski, Ms. West, and Dr. Snowden are with the Department of Psychiatry and Behavioral Sciences, University of Washington at Harborview Medical Center, Seattle (e-mail: krupski@uw.edu ). Dr. Scharf is with the RAND Corporation, Pittsburgh. Dr. Hopfenbeck and Mr. Andrus are with the Downtown Emergency Service Center, Seattle. Dr. Joesch is with the King County Office of Performance, Strategy, and Budget, Seattle.
authors.forename: Imara I
authors.initials: II
authors.lastname: West
authors.affiliation: Dr. Krupski, Ms. West, and Dr. Snowden are with the Department of Psychiatry and Behavioral Sciences, University of Washington at Harborview Medical Center, Seattle (e-mail: krupski@uw.edu ). Dr. Scharf is with the RAND Corporation, Pittsburgh. Dr. Hopfenbeck and Mr. Andrus are with the Downtown Emergency Service Center, Seattle. Dr. Joesch is with the King County Office of Performance, Strategy, and Budget, Seattle.
authors.forename: Deborah M
authors.initials: DM
authors.lastname: Scharf
authors.affiliation: Dr. Krupski, Ms. West, and Dr. Snowden are with the Department of Psychiatry and Behavioral Sciences, University of Washington at Harborview Medical Center, Seattle (e-mail: krupski@uw.edu ). Dr. Scharf is with the RAND Corporation, Pittsburgh. Dr. Hopfenbeck and Mr. Andrus are with the Downtown Emergency Service Center, Seattle. Dr. Joesch is with the King County Office of Performance, Strategy, and Budget, Seattle.
authors.forename: James
authors.initials: J
authors.lastname: Hopfenbeck
authors.affiliation: Dr. Krupski, Ms. West, and Dr. Snowden are with the Department of Psychiatry and Behavioral Sciences, University of Washington at Harborview Medical Center, Seattle (e-mail: krupski@uw.edu ). Dr. Scharf is with the RAND Corporation, Pittsburgh. Dr. Hopfenbeck and Mr. Andrus are with the Downtown Emergency Service Center, Seattle. Dr. Joesch is with the King County Office of Performance, Strategy, and Budget, Seattle.
authors.forename: Graydon
authors.initials: G
authors.lastname: Andrus
authors.affiliation: Dr. Krupski, Ms. West, and Dr. Snowden are with the Department of Psychiatry and Behavioral Sciences, University of Washington at Harborview Medical Center, Seattle (e-mail: krupski@uw.edu ). Dr. Scharf is with the RAND Corporation, Pittsburgh. Dr. Hopfenbeck and Mr. Andrus are with the Downtown Emergency Service Center, Seattle. Dr. Joesch is with the King County Office of Performance, Strategy, and Budget, Seattle.
authors.forename: Jutta M
authors.initials: JM
authors.lastname: Joesch
authors.affiliation: Dr. Krupski, Ms. West, and Dr. Snowden are with the Department of Psychiatry and Behavioral Sciences, University of Washington at Harborview Medical Center, Seattle (e-mail: krupski@uw.edu ). Dr. Scharf is with the RAND Corporation, Pittsburgh. Dr. Hopfenbeck and Mr. Andrus are with the Downtown Emergency Service Center, Seattle. Dr. Joesch is with the King County Office of Performance, Strategy, and Budget, Seattle.
authors.forename: Mark
authors.initials: M
authors.lastname: Snowden
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data*; D003156:Community Mental Health Services / Q000191:economics / Q000706:statistics & numerical data*; D019033:Delivery of Health Care, Integrated / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008875:Middle Aged; D011320:Primary Health Care / Q000191:economics / Q000706:statistics & numerical data*