Enhanced Primary Care for People With Serious Mental Illness: A Propensity Weighted Cohort Study

Alex K. Gertner
Lexie R. Grove
Karen E. Swietek
Ching-Ching Claire Lin
Neepa Ray
Tyler L. Malone
David L. Rosen
Theodore R. Zarzar
Marisa Elena Domino
Beat D. Steiner
Peer-Reviewed Article
April 2023
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Implementation of enhanced primary care can improve cardiometabolic health for people with serious mental illness.


Adults with serious mental illness (SMI), defined as any mental illness that results in serious functional impairments, have a higher prevalence of cardiometabolic health conditions when compared to the general population. They also often receive a lower quality of care to address their health-related needs and thus have worse health outcomes. This also drives high-cost health care use in this population. With more than 14 million adults living with SMI in the U.S., this has large implications for the health system more broadly. The authors of this study examine the impacts of an enhanced primary care intervention on cardiometabolic screen rates and overall health outcomes for adults with SMI compared to usual care.


The authors used 2014-2018 electronic health record data to conduct a retrospective cohort analysis and compared cardiometabolic screening and health outcomes across people with SMI who received enhance primary care versus usual primary care. Enhanced primary care services included comprehensive primary care services, care coordination, peer support and self-management programs adapted specifically for people with SMI. Service use data and clinical outcomes, including vital signs and laboratory results, were examined. Patients who received the enhanced primary care service were more likely to receive cardiometabolic screening and had improved chronic health measures when compared to patients who received traditional primary care services.


Given study results demonstrating that enhanced primary care increases cardiometabolic screening rates, improves chronic health measures, and previous research demonstrating reduced inpatient hospital use and overall cost savings, enhanced primary care exhibits moderate evidence as an effective model of integrated care for people with SMI.

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