Enhanced Primary Care for Severe Mental Illness Reduces Inpatient Admission and Emergency Room Utilization Rates

Area of Science:

• Cardiology
• Psychiatry
• Health Services Research

Background:

• Cardiovascular disease (CVD) significantly contributes to premature mortality in individuals with severe mental illness (SMI).
• There is a critical need for innovative care delivery models to bridge the gap in health outcomes for patients with SMI and CVD.

Purpose of the Study:

• To evaluate the impact of an enhanced primary care (PC) program, Medicine in Psychiatry Service-Primary Care (MIPS-PC), on acute care utilization among patients with SMI and CVD.
• To compare the effectiveness of MIPS-PC against standard PC for managing cardiovascular health in this population.

Main Methods:

• Utilized multipayer claims data from Western New York (2016-2021) to identify patients with SMI and CVD.
• Employed propensity score matching to create comparable cohorts of patients treated by MIPS-PC and standard PC providers.
• Applied a difference-in-difference analysis to assess the effect of MIPS-PC on emergency department (ED) visits and hospitalization rates.

Main Results:

• The MIPS-PC group demonstrated a significant downtrend in acute care utilization over three years.
• Hospitalization rates were reduced by 25% in the first year post-index date (P < 0.001).
• Emergency department visit rates decreased by 18% in the third year (P = 0.021).

Conclusions:

• The MIPS-PC model is associated with a reduction in acute care utilization for patients with SMI and CVD.
• Enhanced primary care integration shows potential for improving health outcomes and reducing healthcare costs in this high-risk group.
• Further prospective studies are warranted to confirm these findings and support broader implementation.