Prise en charge intégrée des maladies mentales : l’exemple d’ Intermountain Healthcare (USA)

Briot, Pascal; Bréchat, Pierre-Henri; Reiss-Brennan, Brenda; Cannon, W. H.; Bréchat, Nathalie; Teil, Alice

doi:10.3917/spub.150.0199

Cited by 4 publications

(27 citation statements)

References 16 publications

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“…76 A narrative case study of mental health integration in a CCM showed that this co-support across disciplinary boundaries helps members of each profession not to feel alone in the face of complex multimorbidity issues about which they are not specialists and to make shared decisions on complex problems. 66 …”

Section: Causal Link 3:7 -Co-support and Decision-makingmentioning

confidence: 99%

“…The support elaborated good practice recommendations and the corresponding indicators, which providers followed and measured. 66 In establishing PCMH, one problem for managers, as for researchers and other interventions too, was that different organisations varied considerably in their definitions of a PCMH, so in practice they were not all trying to implement the same intervention. 67 Some health systems have pursued the functions for which MCPs were designed through organisational integration, that is, amalgamating the separate components of primary care (i.e.…”

Section: Chaptermentioning

confidence: 99%

“…A narrative case study of an integrated mental health service in the USA 66 found that MDTs allow better territorial planning of health as a whole regarding:…”

Section: Causal Link 3:7 -Inclusion Of New Roles In Multidisciplinarymentioning

confidence: 99%

“…One aim of the Utah Mental Health Integration (MHI) programme was to orient patients towards support by a MDT (general physician, care manager, psychiatrist and psychologist) in ambulatory care, or hospital for the most severe cases. 66 The Versailles geriatrics network brought multidisiciplinary expertise together at the local information and co-ordination centres (Centres Locaux d'Information et de Coordination), Homes for the Autonomy and Integration of Alzheimers' Patients (Maisons pour l'Autonomie et l'Intégration des malades d'Alzheimer), and the mobile geriatrics teams (Équipes Mobiles Gériatriques), which worked with local hospitals and doctors to avoid hospitalisation. 74 In general, MDTs require clear boundaries, a need to be collectively accountable for patient care, a need to be highly interdependent and a stable membership.…”

Section: Interorganisational Network Managementmentioning

confidence: 99%

“…56 In Utah, MHI's co-ordinating approach allowed it to replace the traditional model of partitioned-off, sectorised psychiatry with a co-ordinated combination of ambulatory care, specialist secondary, and first-recourse care, which, in turn, allowed territory-wide, whole-population planning of its services (reducing 'medical deserts'), organising support networks to promote preventative care, and developing ambulatory services that linked hospital, medicosocial work and social care. 66 Lewis et al 56 describes two main approaches to overcoming the traditional separation of primary and mental health carei. expanding primary care to cover mental health conditions (9 out of 16 PCMHs in that study) ii.…”

mentioning

confidence: 99%

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From programme theory to logic models for multispecialty community providers: a realist evidence synthesis

Sheaff

Brand

Lloyd

et al. 2018

Health Serv Deliv Res

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Background The NHS policy of constructing multispecialty community providers (MCPs) rests on a complex set of assumptions about how health systems can replace hospital use with enhanced primary care for people with complex, chronic or multiple health problems, while contributing savings to health-care budgets. Objectives To use policy-makers’ assumptions to elicit an initial programme theory (IPT) of how MCPs can achieve their outcomes and to compare this with published secondary evidence and revise the programme theory accordingly. Design Realist synthesis with a three-stage method: (1) for policy documents, elicit the IPT underlying the MCP policy, (2) review and synthesise secondary evidence relevant to those assumptions and (3) compare the programme theory with the secondary evidence and, when necessary, reformulate the programme theory in a more evidence-based way. Data sources Systematic searches and data extraction using (1) the Health Management Information Consortium (HMIC) database for policy statements and (2) topically appropriate databases, including MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Applied Social Sciences Index and Abstracts (ASSIA). A total of 1319 titles and abstracts were reviewed in two rounds and 116 were selected for full-text data extraction. We extracted data using a formal data extraction tool and synthesised them using a framework reflecting the main policy assumptions. Results The IPT of MCPs contained 28 interconnected context–mechanism–outcome relationships. Few policy statements specified what contexts the policy mechanisms required. We found strong evidence supporting the IPT assumptions concerning organisational culture, interorganisational network management, multidisciplinary teams (MDTs), the uses and effects of health information technology (HIT) in MCP-like settings, planned referral networks, care planning for individual patients and the diversion of patients from inpatient to primary care. The evidence was weaker, or mixed (supporting some of the constituent assumptions but not others), concerning voluntary sector involvement, the effects of preventative care on hospital admissions and patient experience, planned referral networks and demand management systems. The evidence about the effects of referral reductions on costs was equivocal. We found no studies confirming that the development of preventative care would reduce demands on inpatient services. The IPT had overlooked certain mechanisms relevant to MCPs, mostly concerning MDTs and the uses of HITs. Limitations The studies reviewed were limited to Organisation for Economic Co-operation and Development countries and, because of the large amount of published material, the period 2014–16, assuming that later studies, especially systematic reviews, already include important earlier findings. No empirical studies of MCPs yet existed. Conclusions Multidisciplinary teams are a central mechanism by which MCPs (and equivalent networks and organisations) work, provided that the teams include the relevant professions (hence, organisations) and, for care planning, individual patients. Further primary research would be required to test elements of the revised logic model, in particular about (1) how MDTs and enhanced general practice compare and interact, or can be combined, in managing referral networks and (2) under what circumstances diverting patients from in-patient to primary care reduces NHS costs and improves the quality of patient experience. Study registration This study is registered as PROSPERO CRD42016038900. Funding The National Institute for Health Research (NIHR) Health Services and Delivery Research programme and supported by the NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula.

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Section: Causal Link 3:7 -Co-support and Decision-makingmentioning

confidence: 99%

Section: Chaptermentioning

confidence: 99%

“…A narrative case study of an integrated mental health service in the USA 66 found that MDTs allow better territorial planning of health as a whole regarding:…”

Section: Causal Link 3:7 -Inclusion Of New Roles In Multidisciplinarymentioning

confidence: 99%

Section: Interorganisational Network Managementmentioning

confidence: 99%

mentioning

confidence: 99%

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From programme theory to logic models for multispecialty community providers: a realist evidence synthesis

Sheaff

Brand

Lloyd

et al. 2018

Health Serv Deliv Res

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Commodification and healthcare in the third sector in England: from gift to commodity—and back?

Sheaff

Paine

Exworthy

et al. 2023

Public Money & Management

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IMPACT This article suggests why a different approach may be required for commissioning services from third sector providers than from, say, corporate or public providers. English systems for commissioning third sector providers contain both commodified elements (for example formal procurement, provider competition, commissioner–provider separation) and collaborative, relational elements (for example long-term collaboration, reliance on inter-organizational networks). When the two elements conflicted, commissioners and third sector organizations tended to try to work around the commodified elements in order to preserve and develop the collaborative aspects, which suggests that, in practice, they find de-commodified, collaborative methods better adapted to the commissioning of third sector organizations. ABSTRACT When publicly-funded services are outsourced, governments still use multiple governance structures to retain some control over the services provided. Using realist methods the authors systematically compared this aspect of community health activities provided by third sector organizations in six English localities during 2020–2022. Two modes of commissioning coexisted. Commodified commissioning largely embodied Washington consensus models of formal, competitive procurement. A contrasting, collaborative mode of commissioning relied more upon relational, long-term co-operation and networking among organizations. When the two modes conflicted, commissioners often favoured the collaborative mode and sought to adjust their commissioning to make it less commodified.

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La qualité des soins, un nouvel outil de régulation de l’hôpital sous contrainte budgétaire ? Un modèle pourtant propose par Feldstein des 1977

Castiel¹,

Bréchat²

2019

Marché Et Organisations

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Le métier de directeur d’hôpital en France prend peu en compte le modèle de Feldstein publié en 1977. Alors que ce modèle a depuis favorisé le développement de l’efficience des soins, des organisations et des systèmes de soins et de santé aux États-Unis, en France la qualité semble être reléguée bien après la réduction des coûts. L’hôpital y est resté une entreprise comme une autre, dont l’objectif est de maximiser son profit alors qu’ailleurs il participe à la production de santé en intégrant la qualité dans le financement des soins hospitaliers, la qualité étant alors considérée comme un investissement avec un retour sur investissement. La prise en compte des travaux fondamentaux de Feldstein peut et doit permettre à la France de rattraper son retard conceptuel en la matière, afin de mieux prendre en compte la contrainte budgétaire qui pèse et pèsera de plus en plus sur le financement de l’hôpital. La prise en compte de la qualité des soins apparaît alors comme une réponse adaptée à la lutte contre les ressources rares dans le système de soins, en particulier sur le marché de la médecine hospitalière. L’hôpital entreprise français évolue peu, alors que les modèles depuis 42 ans font aujourd’hui partie d’un système de santé et d’assurance maladie et participent avec de plus en plus de réussite, à l’amélioration de l’état de santé de la population, à l’accroissement de la qualité des soins à un coût acceptable (comme le propose le Triple Aim). JEL Codes : H51, I12, I18, L11, L15, L32.

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Prise en charge intégrée des maladies mentales : l’exemple d’ Intermountain Healthcare (USA)

Cited by 4 publications

References 16 publications

From programme theory to logic models for multispecialty community providers: a realist evidence synthesis

From programme theory to logic models for multispecialty community providers: a realist evidence synthesis

Commodification and healthcare in the third sector in England: from gift to commodity—and back?

La qualité des soins, un nouvel outil de régulation de l’hôpital sous contrainte budgétaire ? Un modèle pourtant propose par Feldstein des 1977

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