Integrating Behavioral and Physical Health Care in the Real World: Early Lessons from Advancing Care Together

Davis, Melinda M.; Balasubramanian, Bijal A.; Waller, Elaine; Miller, Benjamin F.; Green, Larry A.; Cohen, Deborah J.

doi:10.3122/jabfm.2013.05.130028

Cited by 84 publications

(70 citation statements)

References 53 publications

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“…15,16 Table 1 provides additional details about data collection process for this study. Online diary data were collected among ACT practices only because this data collection method was designed to understand and prospectively collect implementation experiences.…”

Section: Data Collectionmentioning

confidence: 99%

Understanding Care Integration from the Ground Up: Five Organizing Constructs that Shape Integrated Practices

Cohen

Balasubramanian

Davis

et al. 2015

The Journal of the American Board of Family Medicine

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105

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Purpose: To provide empirical evidence on key organizing constructs shaping practical, real-world integration of behavior health and primary care to comprehensively address patients' medical, emotional, and behavioral health needs.Methods: In a comparative case study using an immersion-crystallization approach, a multidisciplinary team analyzed data from observations of practice operations, interviews, and surveys of practice members, and implementation diaries. Practices were drawn from 2 studies of practices attempting to integrate behavioral health and primary care: Advancing Care Together, a demonstration project of 11 practices located in Colorado, and the Integration Workforce Study, a study of 8 practices across the United States.Results: We identified 5 key organizing constructs influencing integration of primary care and behavioral health: 1) Integration REACH (the extent to which the integration program was delivered to the identified target population), 2) establishment of continuum of care pathways addressing the location of care across the range of patient's severity of illness, 3) approach to patient transitions: referrals or warm handoffs, 4) location of the integration workforce, and 5) participants' mental model for integration. These constructs intertwine within an organization's historic and social context to produce locally adapted approaches to integrating care. Contextual factors, particularly practice type, influenced whether specialty mental health and substance use services were colocated within an organization.Conclusion: Interaction among 5 organizing constructs and practice context produces diverse expressions of integrated care. These constructs provide a framework for understanding how primary care and behavioral health services can be integrated in routine practice. (J Am Board Fam Med 2015;28: S7-S20.)

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Section: Data Collectionmentioning

confidence: 99%

Understanding Care Integration from the Ground Up: Five Organizing Constructs that Shape Integrated Practices

Cohen

Balasubramanian

Davis

et al. 2015

The Journal of the American Board of Family Medicine

Self Cite

105

View full text Add to dashboard Cite

show abstract

“…[13][14][15][16][17] However, there are significant challenges to this approach. 18,19 Seamless integration demands a complete system redesign, including the blending of separate practice cultures, shared medical records, introduction of new workflows, an integrated, team-based approach to treatment, and consideration of available reimbursement options. 3,20 For practices that are not yet ready to take these steps or are not supported by an appropriate reimbursement system, the initial steps to coordinate or colocate behavioral health can serve as progressive steppingstones.…”

mentioning

confidence: 99%

The Medical Home and Integrated Behavioral Health: Advancing the Policy Agenda

et al. 2015

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There has been a considerable expansion of the patient-centered medical home model of primary care delivery, in an effort to reduce health care costs and to improve patient experience and population health. To attain these goals, it is essential to integrate behavioral health services into the patientcentered medical home, because behavioral health problems often first present in the primary care setting, and they significantly affect physical health. At the 2013 Patient-Centered Medical Home Research Conference, an expert workgroup convened to determine policy recommendations to promote the integration of primary care and behavioral health. In this article we present these recommendations: Build demonstration projects to test existing approaches of integration, develop interdisciplinary training programs to support members of the integrated care team, implement population-based strategies to improve behavioral health, eliminate behavioral health carve-outs and test innovative payment models, and develop population-based measures to evaluate integration.

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“…Davis et al 2 describe the challenges of implementing a more intensive depression screening program that requires additional staff. Even with beneficial clinical outcomes in a research study, difficulties often arise when implemented in an actual practice setting without support for such services from external funding.…”

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confidence: 99%