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Service Use by Medicaid Recipients With Serious Mental Illness During an RCT of the Bridge Peer Health Navigator
Erin L Kelly1, Benjamin Hong1, Lei Duan1
1Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, and Jane and Terry Semel Institute for Neuroscience and Human Behavior, Center for Social Medicine and Humanities, University of California, Los Angeles (Kelly); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (Hong); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Duan, Cohen, Brekke); Pacific Clinics, Arcadia, California (Pancake).
Objective:
Integration of general medical care and mental health care is a high priority for individuals with serious mental illnesses because of their high risk of morbidity and early mortality. The Bridge is a peer-led, health navigator intervention designed to improve access to and use of health care and self-management of medical services by individuals with serious mental illnesses. This study expands on a previous study in which the authors examined participants' self-reported outcomes from a 12-month randomized controlled trial of the Bridge. In the study reported here, Medicaid data were used to assess the impact of the intervention on service use during that trial.
Methods:
Medicaid data on use of general medical services (emergency room, outpatient, and inpatient) for 6 months were compared for 144 individuals with serious mental illnesses-Bridge participants (N=72) and a waitlist control group (N=72). An intent-to-treat approach was used, with regression models controlling for general medical services in the 6 months before baseline.
Results:
Zero-inflated negative binomial analyses, controlling for service use 6 months before baseline, found that the intervention group used the emergency room significantly less frequently, compared with the control group (adjusted mean±SD number of visits, 0.72±0.19 versus 1.59±0.42). No between-group differences were found in use of general medical inpatient or outpatient services.
Conclusions:
The Bridge was effective in decreasing emergency room use among individuals with serious mental illnesses.
