Research

CNR

Research Overview

CBPS conducts research on topics related to mental health and substance use using rigorous quantitative and qualitative methodologies. Areas of expertise include design and implementation of intervention trials, analysis of surveys and large claims databases, and policy analysis. There is a particular focus on adults and children treated in public safety net settings.

Integrating Primary and Behavioral Healthcare

The Home Project:

The HOME Project is a five-year randomized trial funded by the National Institute of Mental Health.    The project works to create a “medical home” by bringing primary health care  services into the mental health care clinic. The goal of the program is to help participants achieve both improved physical and mental health by addressing these needs together.  This project builds upon our pilot study, The PCARE Project, a description of which and results can be found here: “A randomized trial of medical care management for community mental health settings: the Primary Care Access, Referral, and Evaluation (PCARE) study.”

Mobile Personal Health Record:

The purpose of this research study is to see if using an electronic personal medical record on a cell phone can improve health and healthy habits in patients with a mental illness and a variety of medical conditions. This study will develop and test a mobile Personal Health Record (mPHR) among patients in an behavioral health home. The mPHR will have the capability to access medical and mental health medication and lab data in real time; to help clients set and maintain health and lifestyle goals; to provide medication and appointment prompts and reminders; and to facilitate communication with providers via asynchronous communication with the EHRs. This three-phase study will develop, test, and disseminate the mPHR. During the first phase, we will develop the app building on experience and preliminary data from a PC-based PHR project, and link it to the medical and mental health EHR in a behavioral health home. During the second phase, we will conduct a randomized trial of the mPHR in 300 subjects randomized to the mPHR or usual care. Analyses will examine overall effects of the intervention, and whether there is a change in its benefits across study cohorts.

Mending the Public Safety Net:

A broad literature has demonstrated the effectiveness, and cost effectiveness, of organized models for improving for improving care on the primary/mental health interface.  In this research program, we will develop a model for integrating care between CMHCs and CHCs involving a “staff exchange” between the two sites, with a nurse from the CHC and the CMHC each working at the other’s office ½ day per week.  The CMHC nurse will provide evaluation, development of an individualized treatment plan, facilitated referral and ongoing follow-up for patients with major depression in care at the CHC.  The CHC nurse will provide evaluation, development of an individualized treatment plan, facilitated referral and ongoing follow-up for patients with two highly prevalent cardiac risk factors, hypertension and hyperlipidemia.

This project will comprise two phases.  The first phase will use qualitative methods to understand stakeholder perceptions of onsite and referral arrangements between the CHC and CMHC and use that understanding to refine the intervention for improving care across the two sites.  The second phase  will use a pilot randomized trial, The Depression Study,  to establish the effect sizes for this staff exchange approach.

Engaging Consumers in Health and Wellness

The Health and Recovery Peer Project:

The Health and Recovery Peer Project (HARP) hopes to improve the health of individuals with mental health and chronic conditions through peer-led group sessions. With funding from an R34 intervention development grant from NIMH, the study team has developed and piloted a modified version of the most widely tested and used peer-led self management program, the Chronic Disease Self-Management Program (CDSMP), for persons with serious mental illness.

We are now conducting a fully powered multi-site HARP program. A total of 400 individuals with serious mental illnesses and one or more chronic medical condition will be recruited from four diverse community mental health clinics in the Atlanta metro region and randomized to the HARP program or usual care. For individuals in the HARP program, two peer educators with SMI and one or more chronic medical condition will lead a six-session, six-week manualized intervention, which helps participants become more effective managers of their chronic illnesses. A description of our pilot study  and the results can be found here: “The Health and Recovery Peer (HARP) Program: a peer-led intervention to improve medical self-management for persons with serious mental illness.”

My Health Record:  An electronic personal health record for people with serious mental illness.

Electronic Personal Health Records (PHRs) hold promise in helping reshape healthcare by shifting the ownership and locus of health records from being scattered across multiple providers to an approach that is longitudinal and patient-centered. Given the complex health needs and the fragmentation of care for persons with serious mental illnesses, these individuals could derive particular benefit from a PHR. However, there are currently no established PHRs developed for use in this population. The project adapted an existing, community-based personal health record to patients with serious mental illnesses.  A 12-month randomized trial tested the impact of the record on quality of medical care received in an urban community mental health center.

Transforming Behavioral Health Policy

Mental Comorbidity and Chronic Illness in the National Medicaid System

With the anticipated expansion of Medicaid under health reform, it is critical to identify and understand populations at risk for poor quality of care in that system.  This study provides the first national estimates of the impact of mental disorders on quality of diabetes care across all 50 state Medicaid programs. Our initial results are reported here:  Mental comorbidity and quality of diabetes care under Medicaid: a 50-state analysis.

QUEST Program: Quality Economic Outcomes and Sustainability of Telepsychiatry (QUEST)

Beginning in 2009, the South Carolina Department of Mental Health began implementing a statewide program under which psychiatrists are providing around-the-clock coverage for consultation with hospital emergency departments via high-speed internet video connections.  An initial NIMH-funded grant has provided preliminary data on service utilization for this model of care delivery.  This program will study the effectiveness, costs, and sustainability of a telemedicine initiative for behavioral health services that is currently being implemented in South Carolina.  The project will track service use using South Carolina’s Data Warehouse, a unique, all-payer dataset that makes it possible to track service use between systems including the mental health, health, and social service systems.  

 The overall goal of the study is to assess the cost, quality, and sustainability of this approach using econometric methods that can provide plausibly causal estimates of the impacts of telepsychiatry, to ultimately determine whether this organizational model should be scaled nationally. Using South Carolina’s all-payer data warehouse and regional Medicaid data, the Emory Research Team will examine the effects of ED-based telepsychiatry on costs and quality of care. In addition, we will use South Carolina’s all-payer data warehouse, regional Medicaid data, and reviews of electronic health records, to study patient-level factors predicting quality and costs of ED-based telepsychiatry.