Abstract
Objectives
As many as 40% of those with serious mental illness (SMI) do not attend any outpatient visits in the 30 days following discharge. We examined engagement-focused care (EFC) versus treatment as usual in a university-based transitional care clinic (TCC) with a 90-day program serving individuals with SMI discharged from hospitals and emergency rooms. EFC included a unique group intake process (access group) designed to get individuals into care rapidly and a shared decision-making coach.
Methods
Assessments of quality of life, symptomatology, and shared decision-making preferences were conducted at baseline, at 3 months corresponding to the end of TCC treatment and 6 months after TCC discharge. Communication among the patients and providers was assessed at each visit as was service utilization during and after TCC.
Results
Subjective quality of life improved in EFC. Prescribers and patients saw communication more similarly as time went on. Ninety-one percent of patients wanted at least some say in decisions about their treatment.
Conclusions
SDM coaching and improved access improve quality of life. Most people want a say in treatment decisions.
Acknowledgments
This work was (partially) supported through a Patient-Centered Outcomes Research Institute (PCORI) Pilot Project Program Award (IH-1304–6506) and funding from the Methodist Healthcare Ministries and the Texas Health and Human Services Commission Delivery System Reform Incentive Payment (DSRIP) 1115 Waiver. All statements in this report, including its findings and conclusions, are solely those of the authors and do not necessarily represent the views of the (PCORI), its Board of Governors, or Methodology Committee. Dr John Kliewer will be missed by all who knew him.
Disclosure
The authors report no conflicts of interest in this work.