Written by: Matthew Hile 2/11/2008 6:02 PM
In my continued report from NRI's State Mental Health Agency Services Research, Program Evaluation and Policy in DC I am listening to the presentation, The Impact of Chronic Medical Disorders Among Persons with Serious Mental Illness and a Model for Change. It is reporting on the experiences of Vermont and Maine as they explore this difficult area. Vermont - Michael Hartman, John A. Pandiani, Richard Surles Guiding principles Data are everywhere (don't think about what can I ask but rather what can we gather from what is already colleted) Build a learning community Expect the unexpected Sends out a weekly data report.from the data sets that they are evaluating. (Send John an email, jpandiani@vdh.state.vt.us, to get on the list) "If you report the data it will get better." John Pandiani did a very nice job of presenting the data. I am always interested in the effective use of graphics and his bar charts were particularly clear as they graphically drew themselves (which served to highlight the differences in the data). Maine - Nona Tsotseria, Elsie Freeman, James Yoe People with Serious Mental Illness (SMI) do not have the same frequency of treatment for their diabetes as do others. The SMI have twice the rate of diabetes of those in the general population and higher rates of some risk factors. The have higher risks of obesity and smoking (both of which seem to be related to their diagnoses and typical medications). More significantly, SMI are tested less often for diabetes and receive therefore less treatment. Even so, more $s are spent on diabetes care for individuals with SMI (perhaps because the lack of assessment, early diagnosis, and treatment has lead to more physical problems when it is finally identified). Vermont - Michael Hartman Focus on increasing the power of consumers in a client centered approach to physical health treatment Integration of primary care and community mental health providers Improving mental health providers' understanding of health care needs Based on Improving chronic illness care (by Edward Wagner, MacColl Institute for Healthcare Innovation, Center for Health Studies in Seattle, WA) Individuals develop a self-management manual to let them plan for the needs. Nurses in the program can bill under the medical side of their waiver which supports the project. These individuals also served as the mental health agency physician practice go-between which was quite popular with the medical practices. They use the readiness to change (RTC) process and motivational interviewing as part of the process. [One of the things that I found to be most innovative was the use of RTC to help nursing staff understand what the patient was saying and to develop supports for the individual based on that understanding. In a side conversation with Michael before the presentation he did mention that the results from this approach are not yet clear with some being positive affected and other not so impacted. But with an N of 20 this is really a pilot where they can begin to understand how to increase the impact of these interventions.] Wrap-up - Ken Thompson The federal agencies see the increased risk of morbidity and mortality among those with mental illness as a "crisis issue" and something that "we have to start doing something about". Was involved in closing a mental hospital (Harrisburg, PA) placing people who were getting good medical care into centers were they get good mental health care but into the general medical community with no training or experience dealing with the unique physical problems of these individuals. Many of the people we serve are living in poverty which is a very large risk factor and contributor to physical problems. Need to promote electronic medical records to allow the collaboration between various agencies.
In my continued report from NRI's State Mental Health Agency Services Research, Program Evaluation and Policy in DC I am listening to the presentation, The Impact of Chronic Medical Disorders Among Persons with Serious Mental Illness and a Model for Change. It is reporting on the experiences of Vermont and Maine as they explore this difficult area.
Guiding principles Data are everywhere (don't think about what can I ask but rather what can we gather from what is already colleted) Build a learning community Expect the unexpected Sends out a weekly data report.from the data sets that they are evaluating. (Send John an email, jpandiani@vdh.state.vt.us, to get on the list) "If you report the data it will get better." John Pandiani did a very nice job of presenting the data. I am always interested in the effective use of graphics and his bar charts were particularly clear as they graphically drew themselves (which served to highlight the differences in the data).
Guiding principles
Sends out a weekly data report.from the data sets that they are evaluating. (Send John an email, jpandiani@vdh.state.vt.us, to get on the list) "If you report the data it will get better."
John Pandiani did a very nice job of presenting the data. I am always interested in the effective use of graphics and his bar charts were particularly clear as they graphically drew themselves (which served to highlight the differences in the data).
People with Serious Mental Illness (SMI) do not have the same frequency of treatment for their diabetes as do others. The SMI have twice the rate of diabetes of those in the general population and higher rates of some risk factors. The have higher risks of obesity and smoking (both of which seem to be related to their diagnoses and typical medications). More significantly, SMI are tested less often for diabetes and receive therefore less treatment. Even so, more $s are spent on diabetes care for individuals with SMI (perhaps because the lack of assessment, early diagnosis, and treatment has lead to more physical problems when it is finally identified).
[One of the things that I found to be most innovative was the use of RTC to help nursing staff understand what the patient was saying and to develop supports for the individual based on that understanding. In a side conversation with Michael before the presentation he did mention that the results from this approach are not yet clear with some being positive affected and other not so impacted. But with an N of 20 this is really a pilot where they can begin to understand how to increase the impact of these interventions.]
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