Patients fare better with continuity of care, essential to chronic care management
Executive Update—Two recent Center for Health Research publications report what works best in chronic care delivery for the seriously mentally ill: a trusting and continual bond between provider and patient. The papers discuss findings from CHR’s groundbreaking study STARS (Study of Transitions and Recovery Strategies), which interviewed 177 seriously mentally ill patients about the recovery process. Led by CHR senior investigator Dr. Carla Green, STARS is, to our knowledge, the first study reporting the effects of care continuity on quality of life and recovery from serious mental illness. Dr. Green and colleagues found that people can and do recover from serious mental illness; in fact, study participants told CHR investigators that recovery is largely determined by how well—or how poorly—clinician and patient connect. Statistical analyses confirmed these perceptions.
The two STARS papers—in December’s issue of Psychiatric Services on risk taking and personal growth in recovery and the June issue of the Psychiatric Rehabilitation Journal on the importance of continuity of care—assert the critical importance of the clinician-patient relationship in care delivery for the seriously mentally ill. “When you have a close, trusting relationship between patient and clinician, everything is better—medication adherence, symptoms, quality of life,” says Dr. Green. “For this population, good chronic care management means continuity of care.”
Chronic care management relies on patient-centered and collaborative care, which take time to develop—so it’s no surprise KPNW’s patients in this population do better. KPNW members with serious mental illness have higher rates of employment, education, and marriage than they do in the community. Dr. Green credits Dr. Lauretta Young, director of mental health services at KPNW, for asserting and upholding the clinical importance of continuity of care. “The STARS research confirmed that she was right,” Dr. Green says. “KPNW is exceptional in providing continuity of care. The average patient in CHR’s study had a 5-year relationship with their clinician, and a substantial number had 10-, even 25-year relationships. Compare this to public mental health services—where patients may not see a doctor more than once or twice, for a disease that lasts a lifetime—and you can see how essential these clinician-as-teacher relationships can be.”
If continuity of care works so successfully in one chronic care population, the assumption is that it will yield better outcomes in other areas—kidney disease and COPD, for example. Because KPNW has an integrated, closed health care delivery system, continuity and coordination of care may be delivered more efficiently.