Date of Completion


Embargo Period



Joseph Burleson, PhD; William Rabitaille, MD

Field of Study

Public Health


Master of Public Health

Open Access

Open Access


Persons diagnosed with serious mental illness (SMI) suffer from significant health disparities with respect to mortality, morbidity and health care access. The SMI population frequently over-utilizes hospital services, especially emergency department care, and often lacks adequate primary care. This retrospective longitudinal study investigated whether SMI patients changed their hospital utilization patterns when enrolled in an integrated primary care and behavioral health program and how these changes affected hospital costs. The study tracked the hospital utilization of 343 patients for up to 12 months before and after their enrollment. Results showed a significant decrease in total ED visits and the number of patients who over-utilized the ED, although the number and length of inpatient visits remained stable. The analysis of costs associated with changes in ED utilization indicated that integrated primary and behavioral health care can reduce Medicaid costs but may result in greater costs to hospitals under a fee-for-service model. These findings suggest that integrated care can effectively decrease ED utilization for the SMI population, as well as reduce Medicaid spending.

Major Advisor

Jane Ungemack, DrPH