Kansas is piloting a software program that led to improved health for people with serious mental illnesses in Missouri.
The Association of Community Mental Health Centers of Kansas received a $40,000 grant from the Tower Mental Health Foundation to begin using Care Management Technologies software with Medicaid- eligible patients who receive mental health care and primary care for a chronic condition at one of their centers. Eight community mental health centers are participating in the pilot.
The transition to electronic medical records has created an opening for entrepreneurs interested in creating software to identify inefficiencies in care and suggest standard treatment protocols -- which medical professionals can choose to accept, or not, based on their judgment of the patient's situation. Applications range from the relatively simple functions of recommending screenings based on a patient's age, gender and health history, to more complex questions like determining what might be the most effective treatment for a heart failure patient based on a database of cardiology research.
Pam Evans, spokeswoman for Family Service & Guidance Center, which is one of the participating centers, said having additional health data about the young people they work with will help them make better recommendations for their treatment.
"It's going to help us to serve our clients who are in need quicker and more efficiently," she said. "It gives us a better view of the big picture."
Carol Clayton, CEO of North Carolina-based CMT, said their program allows health care systems to use data from multiple perspectives. Agencies can get a high-level view of how many of the people they serve have a specific condition or have received certain kinds of recommended care, and can compare that data over time to see if they are better meeting their patients' needs, she said.
On the level of a health center, care coordinators can use the software to examine whether patients have gotten the right preventative care, if their medications are appropriate and if there are any gaps or overlap when they receive care from multiple sources, based on research about the best way to care for chronic conditions, Clayton said. They focus on heart disease, asthma and other lung diseases, hypertension, diabetes and gastroesophageal reflux disease, which are estimated to affect 60 to 70 percent of people with severe mental health conditions, she said.
"When we're digging into the data, it's evidence-based," she said.
Care coordinators can take different approaches for working with the 200 metrics the system includes, Clayton said. For example, one may decide to focus on one metric at a time, such as contacting every patient with diabetes who is due for a foot exam, while another may have several patients assigned to him or her and work with them on whatever health needs the system flags, she said.
"In practice in the field, it's a little of both," she said.
Brent McGinty, president and CEO of the Missouri Coalition for Community Behavioral Healthcare, said they have worked with CMT for close to three years now. The idea was that they could get a systemwide view of how well they were serving clients, and also determine which people needed help managing chronic conditions. People with serious mental illnesses die an average of 25 years earlier than the general population, and most don't die by suicide, but from conditions like diabetes or heart disease, he said.
Looking at mental and physical health together has led to a 1- point drop in average blood sugar among their patients, as well as drops in blood pressure and the kind of cholesterol most associated with heart disease, McGinty said. While it is too soon to know whether those improvements will be permanent, they have noticed that metrics continued to improve into the second and third years from their levels at the end of the first year, he said.
"The research says if you can drop A1C (blood sugar) levels one point, you get a 21 percent drop in diabetes-related deaths," he said.
As an added bonus, clients who are receiving treatment for their chronic conditions and support with making changes like eating healthier foods and exercising have reported they feel better and are seeing improvements in their mental health, McGinty said.
"It's become a part of their recovery," he said. "You've got to treat the whole body, the whole person."
A separate grant from the Tower Foundation went to Pathways Family Services. Kameron Labahn-Patrick, executive director of Pathways, said they received about $6,000 to train employees on "creating a culture of care," and ways to work with children living in a psychiatric residential treatment facility due to serious mental health conditions. Three staff members will go to Oklahoma for training in March, and when they return they will train other staff who work with children during their activities outside of therapy in the facility, she said.
The staff will learn about child development and ways to spot signs that children are becoming agitated, so they can de-escalate the situation and work with the children on healthy ways to manage their emotions, which often stem from a previous traumatic experience, Labahn-Patrick said. The children they work with often show physical aggression toward others, and were sent to a residential facility because they represented a danger to themselves or others in a less restrictive setting, she said.
"It's not about punishment," she said. "They help the children learn new coping skills, healthy coping, to replace those maladaptive behaviors."
The goal is to increase the percentage of children who can return to their homes or a less-restrictive setting and be successful there. Between 85 and 87 percent of children are discharged successfully, Labahn-Patrick said, but some need inpatient treatment again later.
"We'd like to do even better," she said.