Welcome to the November Research Report. This is the post where I, your friendly neighborhood blog editor, save you time and keep you informed of the latest and greatest in integrated care research.
The studies you see below represent some of the best research coming out. I organized them into categories for easier reading and hope you find one that can make an immediate impact on your work. The categories are Implementation (evidence- and practice-based guidelines), Interventions (patient treatments), Informatics and Health Technology (innovative uses of EMR), Attitudes and Perceptions (what people think of integrated care), Workforce Development (preparing the next generation of providers), and Outcome Research (end results of care delivery research).
Each category includes an abstract from the article that seems most impactful and then links to other research articles. If you found a recent article that is not listed here and want to right that wrong, please contact me and I will make sure we highlight it in a future blog post.
Let’s see what the latest research is saying.
Approaches to Behavioral Health Integration at High Performing Primary Care Practices
Abstract: Behavioral health (BH) integration has been proposed as an important strategy to help primary care practices meet the needs of their patient population, but there is little research on the ways in which practices are integrating BH services. Methods: We conducted a qualitative analysis of BH integration at 30 US primary care practices that had been selected for the Learning from Effective Ambulatory Practices (LEAP) project following an interview-based assessment and rating process. Most LEAP practices looked to BH integration to help them provide timely BH care for all patients, share the work of providing BH-related care, meet the full spectrum of patient needs, and improve the capacity and functioning of care teams. Practices operationalized these goals in various ways, including universal BH screening and involving BH specialists in chronic illness care. As they worked toward their BH integration goals, LEAP practices faced common challenges related to staffing, health information technology, funding, and community resources.
1. Scaling Integrated Behavioral Health Rapidly
2. Enhancing implementation of measurement-based mental health care in primary care: a mixed-methods randomized effectiveness evaluation of implementation facilitation
3. Assessing Collaborative Care in Mental Health Teams: Qualitative Analysis to Guide Future Implementation
4. Empowering frontline providers to deliver universal primary healthcare using the Practical Approach to Care Kit
PACK Child: the development of a practical guide to extend the scope of integrated primary care for children and young adolescents
Abstract: Pioneering strategies like WHO’s Integrated Management of Childhood Illness (IMCI) have resulted in substantial progress in addressing infant and child mortality. However, large inequalities exist in access to and the quality of care provided in different regions of the world. In many low-income and middle-income countries, childhood mortality remains a major concern, and the needs of children present a large burden upon primary care services. The capacity of services and quality of care offered require greater support to address these needs and extend integrated curative and preventive care, specifically, for the well child, the child with a long-term health need and the child older than 5 years, not currently included in IMCI. In response to these needs, we have developed an innovative method, based on experience with a similar approach in adults, that expands the scope and reach of integrated management and training programs for pediatric primary care. This paper describes the development and key features of the PACK Child clinical decision support tool for the care of children up to 13 years, and lessons learnt during its development.
INFORMATICS AND HEALTH TECHNOLOGY
Evaluation of an Electronic Health Record (EHR) Tool for Integrated Behavioral Health in Primary Care
Abstract: Integrating behavioral health into primary care can improve care quality; however, most electronic health records are not designed to meet the needs of integrated teams. We worked with practices and behavioral health (BH) clinicians to design a suite of electronic health record tools to address these needs (“BH e-Suite”). We conducted a convergent mixed-methods proof-of-concept study, implementing the BH e-Suite across 6 Oregon federally qualified community health centers (“intervention clinics”). Implementation improved process of care (PHQ-9 screening). During the course of the study, change in intermediate outcomes was not observed. Degree of BH e-Suite implementation varied: 2 clinics fully implemented, 2 partially implemented, and 2 practices did not implement at all. Initial practice conditions (eg, low resistance to change, higher capacity), process characteristics (eg, thoughtful planning), and individual characteristics (eg, high self-efficacy) were related to degree of implementation.
1. Adoption of Social Determinants of Health EHR Tools by Community Health Centers
2. Using Telepsychiatry to Enrich Existing Integrated Primary Care
3. Tele-Behavioral Health, Collaborative Care, and Integrated Care
4. Designing health information technology tools for behavioural health clinicians integrated within US-based primary care teams
5. Exploring the potential of a risk stratification tool to move forward in integrated, person-centered primary care
A Curriculum for an Interprofessional Seminar on Integrated Primary Care: Developing Competencies for Interprofessional Collaborative Practice
Abstract: Health care is increasingly delivered through team-based, collaborative strategies with interprofessional education as an important mechanism for building interprofessional practice competencies. This paper describes an Interprofessional Seminar on Integrated Primary Care (IS-IPC) designed to meet this educational need with interprofessional team-based learning as the foundation of an iterative process such that education and practice inform one another. The IS-IPC can be used to educate an interprofessional group of learners about key topics relevant to working together in integrated primary care. The IS-IPC describes steps in developing an interprofessional seminar, common challenges, and their solutions in creating interprofessional learning experiences, and eight foundational content modules containing an outline and curricular resources. The IS-IPC facilitates interprofessional educator partnerships at the local level and can be customized to fit the local environment, pedagogical philosophy, and learning objectives.
1. Behavioral Health Assessments and Interventions of Psychology Trainees and Residents During Dual Interviewing: Replication and Extension
2. Training the Doctors: A Scoping Review of Interprofessional Education in Primary Care Behavioral Health (PCBH)
Medical Cost Savings After One Year of Integrated Behavioral Health Services in a Rural Pediatric Primary Care Clinic
Abstract: Introduction: Behavioral health problems are pervasive in primary care and can impede efficient delivery of medical care. Primary care pediatricians PCPs address behavioral health issues during roughly 1 in 3 visits 1, and these visit require an average of twice as much time than those with only medical concerns 2. The present study examined how IBH impacted medical visit costs after its first year of implementation. All patients who presented for an initial behavioral health visit in Michigan Medicine’s first integrated pediatric primary care clinic between August 2013 and August 2014 were included in the sample N= 134. Patients in the sample averaged 3.11 primary care medical visits before initial IBH treatment and 2.96 visits afterward. The mean per patient cost of primary care medical treatment was $326 per patient in the year prior to initiating IBH treatment and $254 in the year following. Primary care medical visits were an average of $19.80 less expensive for patients after they initiated IBH services. This resulted in an average cost savings of $71.90 per patient based on the 134 patients who received services in the 1-year period.
1. Effectiveness and cost-effectiveness of proactive and multidisciplinary integrated care for older people with complex problems in general practice: an individual participant data meta-analysis
2. A Scoping Review of Facilitators of Multi-Professional Collaboration in Primary Care
3. Understanding usual care for patients with multimorbidity: baseline data from a cluster-randomized trial of the 3D intervention in primary care
4. Team communication within integrated primary care in the context of suicide prevention: A mixed methods preliminary examination
ATTITUDES AND PERSPECTIVES
Interdisciplinary Perspectives on an Integrated Behavioral Health Model of Psychiatry in Pediatric Primary Care: A Community-Based Participatory Research Study
Abstract: Integrated behavioral health services have positive outcomes for patients and providers, but little is known about providers’ perspectives on implementing these services. This community-based participatory research collaboration with a Federally Qualified Health Center examined provider perspectives on implementing a collaborative psychiatry consultation program in pediatric primary care. We interviewed providers (N = 14) from psychiatry, social work, primary care, and psychology regarding their experiences implementing the program, and their recommendations for its sustainability. Providers described interdisciplinary integration arising from the program, with accompanying benefits (e.g., increased access to care for patients with complex diagnostic profiles, increased learning and role satisfaction among providers), and challenges (e.g., increased burden on primary care providers, potential patient discomfort with team-based care). Our results highlight the complexities of implementing collaborative psychiatry consultation in pediatric primary care, and suggest the importance of supporting primary care providers and patients within this context.
1. To go or not go: Patient preference in seeking specialty mental health versus behavioral consultation within the primary care behavioral health consultation model
2. Occupational Therapy Perspective on Integrated Care