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Peer health navigation: reducing disparities in health outcomes for the seriously mentally ill
Investigator (PI): Brekke, John Sinclair
Performing Organization (PO): (Current): University of Southern California, Suzanne Dworak-Peck School of Social Work / (213) 740-8311
Supporting Agency (SA): Patient-Centered Outcomes Research Institute (PCORI)
Initial Year: 2013
Final Year: 2017
Record Source/Award ID: PCORI/AD-1304-6650
Funding: Total Award Amount: $1,239,970
Award Type: Contract
Award Information: PCORI: More information and project results (when completed)
Abstract: The mortality rate among people with serious mental illness (SMI) is 2 to 3 times that of the general population (DeHert et al., 2011), meaning that those with a serious mental illness die, on average, 25 years earlier than those without a SMI (Parks et al., 2006). There is evidence that these deaths are largely attributed to preventable medical conditions, many of which are more common in the SMI population. System bifurcation, or the separation of mental and physical health services, has been identified as a critical factor that leads to significant health disparities for those with SMI (Bazelon Center for Mental Health Law, 2004). Grounded in patients' experiences, needs, and voices, we seek to generate knowledge about effective interventions, use outcomes that are central to patients and caregivers, attend to issues of implementation and dissemination, and optimize outcomes in the context of factors such as burden, technology, and stakeholder perspectives. Based on pilot work funded by the UniHealth Foundation, the goal of this PCORI proposal is to test the effectiveness of a peer health navigation intervention (The Bridge) in comparison to usual treatment. The Bridge is a peer-staffed comprehensive health care engagement and self-management model, situated in an outpatient mental health clinic, where clients are taught the skills to access and manage their health care for any condition. Our goal is train clients to successfully engage and navigate the primary health care system as well as other needed health care services (specialty care, lab, and pharmacy). Guided by a version of Gelberg, Andersen, and Leake's (2000) behavioral model of health service use for vulnerable populations that we adapted for the seriously mentally ill (Brekke et al., in press), the Bridge combines three approaches: integrated care, patient education, and cognitive-behavioral skill building with an in vivo (real world) focus. We will conduct a randomized controlled trial comparing two groups: a) a treatment as usual waitlist (n =73), and b) the Bridge peer navigator intervention (n=73). We will compare these groups across three time points (baseline, 6 months, 1 year) to examine the Bridge's effectiveness at improving health care service use, satisfaction with care, health knowledge, health status, health related self-efficacy, and quality of life. Outcomes will be measured through patient self-report and according to objective measures of health (medical records and insurance claims data). This PCORI proposal relies on significant stakeholder involvement in the intervention development, project development and management, and in the plans for dissemination and implementation. The ultimate goal is to provide the field a peer-delivered intervention that significantly reduces disparities in the utilization and outcome of health services for the seriously mentally ill and thereby reduce morbidity and mortality in this highly vulnerable population.
MeSH Terms:
  • Cognition
  • Health Behavior
  • Health Services Accessibility
  • Healthcare Disparities
  • Humans
  • Insurance Claim Review
  • Medical Records
  • Mental Disorders /*therapy
  • * Outcome Assessment, Health Care
  • Outpatients
  • Patient Education as Topic
  • Patient Navigation /*methods
  • Peer Group
  • Quality of Life
  • Randomized Controlled Trials as Topic
  • United States
  • Vulnerable Populations
Country: United States
State: California
Zip Code: 90089
UI: 20143388
CTgovId: NCT02022462
Project Status: Completed
Record History: ('2017: Project extended to 2017',)