Integrated Care, Rainey et al. 2017 Flashcards
Chapter 1: Elements of Effective Design and Implementation
With effective implementation there is an urgency to do it correctly and to group practice implementation in the research on effectiveness
Incorporating research on implementation is critical to the long-term success of current health care reforms efforts such as patient-care medical homes (PCMHs), accountable care organizations (ACOs), and other developing approaches to healthcare system transformation
Collaborative Care Model (CoCM)
Collaborative Care Model (CoCM) as an effective method of integrating primary care and behavioral health
CoCM follows a systematic approach of measurement based care and intervention for patients not improving as expected
It follows a population-guided approach that tracks all patients in the defined group in a data management tool call registry, allowing accountability to the system for outcomes for a designated subset.
This approach allows an extension of limited psychiatric expertise to larger populations in need
Primary Care Behavioral Health or Behavioral Health Consultant Model (PCBH)
Primary Care Behavioral Health or Behavioral Health Consultant Model (PCBH) approach to a integrated care places a behavioral health consultant on the primary care team to provide immediate intervention for acute life stressors, crisis, mh and su disorders, and stress related physical symptoms and ineffective patterns of health care utilization and to provide higher level of specialty behavior.
It doesn’t really measure, but has BH provider extender
Blended Model an ideal approach might be to use a “blended method that combines the PCBH model and CoCM.
The model is appropriate when there are enough behavioral health resources to address patients with episodic stressors in an immediate fashion, as well as subset of this population
It incorporates components of PCBH model for addressing issues such as acute stressors, and it includes elements of CoCM, when a defined diagnosis such as depression or anxiety will be treated and tracked until outcomes are reached.
research
While implementation research continues, the goal is to use existing knowledge to develop an effective system of care.
CoCM
The CoCM was conceptualized by Wayne Katon M.D. at the University of Washington, and over time has evolved into a model with an extensive evidence base.
There have been over 80 randomized controlled trials have been conducted using the structure of the IMPACT model
Core principles of effective collaborative care
Core principles of effective collaborative care: TEMPA
Team based and patient centered
Evidence based
Measurement based
Population based
Accountable
Measurement-based care (MBC)
Measurement-based care (MBC) is defined as the systematic use of validated measurement tools to adjust treatment to reach desired outcomes
Studies have found that MBC dramatically improved both treatment response, time to response, and improvement in rates of remission
Effective approaches have also included frequent administration of the measurement tools and timely feedback of results of the founder
Ineffective approaches include one time screening, infrequent assessment, and giving the results to providers outside the current clinical situation
Stepped Care Approach
Stepped Care Approach- is based on the notions
that different people need different levels of care for the same problem.
Monitoring outcomes helps determine the right level
Moving along the stepped care continuum from lower to higher levels can improve outcomes and contain costs
Subsyndromal symptoms and progressing up the stepped care ladder
Organizational leadership and culture change
Healthcare leaders are facing unprecedented change in the way that care is delivered, the goals of the delivery system, and the role of leaders in leading these changes
unlike other traditional clinical program additions, collaborative care Alters historical and professional identities and well established and purposeful program boundaries
because of immense pressure and day-to-day operational challenges that require leadership attention, the time and attention needed for culture change are all too frequently viewed as of secondary importance
culture change
organizations often Overlook the culture change required to create a fully collaborative care team with a new model of care
the merging of two distinct and Silo cultures—- Behavioral Health and Primary Care— is complex in a necessary component for building a successful model
most providers are not trained in team-based care and thus do not have the attitude or skills to naturally team
Collective values
Collective values across an organization and team providers are required for integrated models to be successful and sustainable
values-based leadership is the relational form of leadership that focuses on influencing Behavior through values
creating a vision is a way to operationalize core values for followers
the value is what drives the behavior
the vision is the picture or story that provides the path for change
A core principle of the Collaborative Care Model (CoCM)
A core principle of the Collaborative Care Model (CoCM) is that treatment occurs through patient-centered team-based care
The collaboration between team members and patients is at the heart of the model and central to the broader mission of achieving improved team outcomes, improved quality of experiences, reduced costs, and ultimately population health
National policy
National policy, practice innovation and the desire to contain costs are driving renewed emphasis on health care teams and subsequently a dismantling of hierarchical structures and singular provider practice.
Development of a team
Development of a team entails a shift from individual practice that may be coordinated or in concert with other providers to an authentic team-based approach at each phase of the treatment process
Group norms consist of the formal (clearly articulated) and informal rules (unconscious and unspoken but known) of the team.
