Date of Conferral



Doctor of Nursing Practice (DNP)




Mattie Burton


The Affordable Care Act of 2010 proposed a new integrated care model for individuals with chronic mental illness and multiple medical comorbidities by using Behavioral Health Homes (BHH). The purpose of this doctoral project was to evaluate the effectiveness of the BHH in reducing emergency department (ED) use in the community mental health outpatient setting. Guided by the American Association for Critical Care Nurses synergy model for patient care a cross-sectional, post-test only with comparison group quasi-experimental research design was used. A de-identified data set of 68 patient records in the BHH group and 73 patient records in non-BHH as a control group were analyzed using logistic regression. The analysis revealed that participants in the BHH were statistically less likely to visit the ED. Sensitivity was 16.2%, specificity was 95.2%, positive predictive value was 54.5%, and negative predictive value was 76.2%. The Homer-Lemeshow and omnibus test of model coefficients showed the model was a good fit (p=.726, p=.007). Participants in BHH were .225 less likely to visit the ED. For every year of reduction in age, the odds of visiting the ED increased by a factor of 1.0. Females had a 1.8 higher odds of visiting the ED than males. This study provides evidence for the effectiveness of the BHH in reducing visits to the ED. Standard measures to track ED use in BHH are essential to understanding reasons for ED use and reducing nonurgent use. The BHH has the potential to transform health care delivery toward an all-inclusive model of care. Providers can utilize the findings of this project to promote social change by targeting patients with serious mental illness and reducing health disparities by emphasizing preventive care and eliminating barriers to care.

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