Latest News

New Research Opportunities

Date: 
Mon, 01/12/15

Take a look at the following funding opportunities:

Substance Abuse and Mental Health Services Administration (SAMHSA)

Primary and Behavioral Health Care Integration (PBHCI) Grant

SAMHSA has issued a request for applications from community-based projects that provide integrated medical and behavioral services to adults with serious mental illness (SMI), who may have co-occurring substance use disorders or be at risk for co-morbid primary care conditions and chronic diseases. The program is intended to “improve the health of individuals with SMI, enhance the consumer experience of care, and reduce the per capita cost of care.”

For more information about PBHCI and SAMHSA see: http://www.integration.samhsa.gov/about-us/pbhci

Health IT Literacy Guide Evaluation

Date: 
Mon, 01/12/15

The (AHRQ) Health IT Portfolio has a public Web (http://healthit.ahrq.gov/) that offers more than 10,000 documents, presentations, articles, and tools to health information technology (IT) researchers, implementers, and policymakers. The National Resource Center of Health IT (NRC) Web site offers over 20 tools and resources to support health IT research and evaluation. The Health IT Literacy Guide has been available through the NRC since 2007.

More recently, AHRQ contracted with the Research Triangle Institute (RTI International) to evaluate this report. The report notes:

  • health literacy remains a significant challenge;
  • health information is increasingly accessed through health IT; and
  • an important aim is usable health IT for individuals with limited literacy.

The evaluation report summarized findings and presents recommendations based on an environmental scan, expert interviews, and focus groups conducted with the intended developers and purchasers of health IT, who are the intended audience of the Health IT Literacy Guide.

The four chapters of the report include:

  • Chapter 1: Background, context, and identification of the research questions;
  • Chapter 2: Summary of approach used in the evaluation;
  • Chapter 3: Summary of findings; and
  • Chapter 4: Recommendations based on research findings.

Key findings of the evaluation are:

  • developers and purchasers were largely unaware of the Guide;
  • developers and purchasers had limited agreement on definitions of health literacy or the role of health IT in supporting individuals with low literacy;
  • information in the Guide appeared to be outdated;
  • experts and focus group participants were highly interested in the “checklist intended to help purchasers and developers identify best practices when purchasing or designing systems that support patients”; and
  • the Guide could be useful during system development or product evaluation if it was used at appropriate points during product testing or system selection.

See the evaluation report in its entirety at: http://www.ahrq.gov/research/findings/final-reports/healthitresources/index.html .

Massachusetts Child Psychiatry Access Project – Improving Outcomes for Children

Date: 
Mon, 01/12/15

Having access to behavioral health care is essential to positive health outcomes for children. Primary care providers have the responsibility of identifying and treating behavioral health issues in children, but they often lack the proper training and resources. The Massachusetts Child Psychiatry Access Project addressed this problem by providing child psychiatry consultations and specialized care coordination by telephone to over 95% of pediatric primary care physicians (PCPs) in Massachusetts.

In 2013, the project served 10,553 children. Pediatric PCPs who were enrolled in the project reported improved ability to meet the behavioral health needs of their patients. Similar projects have spread across the country, providing telephone access to behavioral health for children and PCPs in many states. This article may be accessed via: http://www.ncbi.nlm.nih.gov/pubmed/25489033

A case study on this project by the Commonwealth Foundation may be found at:  http://www.commonwealthfund.org/~/media/Files/Publications/Case%20Study/2010/Mar/1378_Holt_MCPAP_case_study_32.pdf

A PowerPoint presentation by one of the co-authors may be found at: http://www.google.com/url?sa=t&rct=j&q=&esrc=s&frm=1&source=web&cd=17&ved=0CF0QFjAGOAo&url=http%3A%2F%2Fwww.pcmhri.org%2Ffiles%2Fuploads%2FMCPAP%2520Rhode%2520Island%2520Presentation%25202-6-14.ppt&ei=QwK0VNy1EKjGsQT854L4Cg&usg=AFQjCNHTGn69b-KAI1bKEdUI-4VBZ_lSAQ

Serious Mental Illness: Integrating Behavioral Health and Primary Care Review

Date: 
Mon, 01/12/15

This report examined the evidence regarding the integration of behavioral health and primary care services for individuals with serious mental illness (SMI) and/or substance use disorder. Moderate evidence suggests that the use of fully integrated services or care management with enhanced collaboration improves mental health outcomes and the use of preventative services for adult patients with bipolar disorder and other SMIs. Such interventions often require additional staff, training, and ongoing support of care managers.

Interventions that included care management for bipolar disorder patients demonstrated improved mania, mental health-related quality of life measures, and access to medical care over 12 months. These interventions were found to be cost neutral over 36 months. Integrated care enhanced by trained nurse care managers improved mental health-related quality of life measures and use of preventive services.

Among studies examining patients with chemical dependency, moderate evidence suggested that on-site integrated medical care including team meetings and joint treatment playing improved abstinence rates and chemical dependency symptoms. Interventions that used colocation of primary care and behavioral health services without enhanced coordination and collaboration had little association with improved patient outcomes among patients with substance use disorder.

This report was compiled by the Milbank Memorial Fund for the Reforming States Group.

The full report may be accessed at: http://www.milbank.org/uploads/documents/papers/Integrating-Primary-Care-Report.pdf

 

 

 

 

Rutgers Study Concludes Improved Integration Can Lower Hospital Utilization and Cost

Date: 
Thu, 12/04/14

A new Rutgers study, Role of Behavioral Health Conditions in Avoidable Hospital Use and Cost, focuses on the role of behavioral health (BH) conditions in potentially avoidable hospital use and cost.  The study builds on a series of publications, funded by The Nicholson Foundation, which examined opportunities provided by the Medicaid ACO Demonstration Program to improve health and lower costs in low-income New Jersey communities. Study authors found 

“Patients who are high users of hospital care and those with avoidable/preventable IP hospital use are disproportionately affected by BH conditions, and that BH conditions are associated with a substantial share of hospital costs.”

Further, they concluded that

“Improved integration of BH services with medical services among complex patients can lead to lower avoidable hospital utilization and cost savings.”

A news story mentioned the Federal initiative on behavioral health in primary care initiated by the Agency for Healthcare Research and Quality (AHRQ).  That initiative is The Academy for Integrating Behavioral Health in Primary Care.  Charlotte Mullican, AHRQ Senior Advisor for Mental Health Research and Contract Officer Representative (COR) for the Academy, stated that research increasingly shows that integration is cost effective.  She further said there are still a number of barriers to implementation of this model, including payment structures, varied provider perspectives, and the need to change the perception of patients about what kind of care they should ask for from their primary care provider.

Read the related report:

http://www.cshp.rutgers.edu/Downloads/10530.pdf

New York Studies Three Models of Integrated Care

Date: 
Thu, 12/04/14

The New York Health Foundation, through its Advancing Primary Care Initiative, recently funded a report by the RAND Corporation to examine the strategies used by New York State Community Mental Health Centers to improve integration of behavioral health and primary care services for adults with serious mental illness (SMI).  The 3 integrated care initiatives operating in the State system include:

  • Substance Abuse and Mental Health Services Administration’s  (SAMHSA’s) Primary and Behavioral Health Care Integration grants program;
  • New York State Office of Mental Health’s Medicaid incentives for health monitoring and health physicals; and
  • New York’s Medicaid health homes.

The three models are characterized, compared, and contrasted in the report.

The purpose of undertaking this project

“was to generate information that will help state policymakers streamline the adoption of strategies for improving the overall wellness and physical health status of people with serious mental illness by making primary medical services available in, or coordinated by, staff in settings where the population already receives mental health care.”

According to the most recent National Surveys on Drug Use and Health (NSDUH) Report, those with SMI account for only about 3.6 percent of the total population in New York State. However, they have significant behavioral health and medical problems, and require a broad range of services.  Integrated behavioral health care and primary care is an important strategy for seeing that those needs are met.

For more information on the NY State perspective on integrated care, see the Academy for Integrating Behavioral Health and Primary Care at: http://integrationacademy.ahrq.gov/node/5832

Staffing for Depression Care in Primary Care Clinics

Date: 
Thu, 12/04/14

The Depression Improvement Across Minnesota, Offering A New Direction (DIAMOND) collaborative care initiative, supported by the Institute for Clinical Systems Improvement, provided similar training and support for 87 primary care clinics but varied staffing and care manager positions. Care managers were registered nurses, certified medical assistants, or licensed practice nurses.

New published research indicates that clinics with care managers, regardless of type, that were solely dedicated to depression care had significantly higher enrollment rates and marginally significant higher remission rates than clinics with care managers with multiple roles. However, type of care manager was not associated with differing outcomes, suggesting that more highly trained and costly managers may not be necessary to provide cost-effective collaborative care.

 

For additional resources on the DIAMOND initiative, see the Academy for Integrating Behavioral Health and Primary Care at:

http://integrationacademy.ahrq.gov/search/node/DIAMOND

Integrated Care for Cancer Patients

Date: 
Thu, 12/04/14

Several leading medical organizations, including the Institute of Medicine and the American College of Surgeons, have issued reports to recommend access to behavioral health support for cancer patients. These recommendations are based on a variety of clinical research results that suggest cancer patients with depression care exhibit improved outcomes. For instance, one randomized control trial in Scotland, called SMaRT Oncology-2, compared cancer patients with integrated collaborative depression care delivered by a team of cancer nurses, psychiatrists and primary care physicians to standard care delivered by primary care physicians alone. The results indicated significant improvement in treatment response, depression, anxiety, pain, fatigue, general functioning, quality of life and perceived quality of depression care with the collaborative model. Similar results were reported by the SMaRT Oncology-3 program, which focused care on patients with lung cancer.

 

For recent features on integrated collaborative depression care for patients with cancer, see the Academy Integrating Behavioral Health and Primary Care at:

http://integrationacademy.ahrq.gov/search/node/depression%20care%2C%20cancer

Staffing for Depression Care in Primary Care Clinics

Date: 
Thu, 12/04/14

The Depression Improvement Across Minnesota, Offering A New Direction (DIAMOND) collaborative care initiative, supported by the Institute for Clinical Systems Improvement, provided similar training and support for 87 primary care clinics but varied staffing and care manager positions. Care managers were registered nurses, certified medical assistants, or licensed practice nurses.

New published research indicates that clinics with care managers, regardless of type, that were solely dedicated to depression care had significantly higher enrollment rates and marginally significant higher remission rates than clinics with care managers with multiple roles. However, type of care manager was not associated with differing outcomes, suggesting that more highly trained and costly managers may not be necessary to provide cost-effective collaborative care.

 

Additional resources on the DIAMOND initiative may be found on the portal of the Academy for Integrating Behavioral Health and Primary Care at:

http://integrationacademy.ahrq.gov/search/node/DIAMOND

Academy’s Products Featured in Robert Wood Johnson Foundation-Funded Program on Team-Based Care

Date: 
Thu, 12/04/14

Effective collaboration within the practice team is essential in becoming a Patient-Centered Medical Home and improving overall health and efficiency. The Primary Care Team Guide ensures practices achieve improved care, productivity, and career satisfaction when shifting toward a team-based approach. The guide provides practice team members with advice, case studies, and necessary tools, such as modules and assessments to self-measure practices’ current status on team-based care. Topics cover the roles of care team members and essential functions of the team to meet patient needs.

The Academy’s products were referenced in the team guide as toolkits and resources:

  • Framework for Measuring Integration of Behavioral Health and Primary Care: “This website presents a framework for understanding what behavioral health integration involves. Functional domains include care team expertise, clinical workflow, patient identification, patient and family engagement, treatment monitoring, data collection and use, and desired outcomes.”
  • IBHC Atlas: “Find tools for measurement and tracking, compiled by the Atlas of Integrated Behavioral Health Care Quality Measures.”
  • The Lexicon: This resource is used to describe examples of collaborative care role functions.

The guide is a program of the Primary Care Team: Learning from Effective Ambulatory Practices (LEAP) project, funded by the Robert Wood Johnson Foundation.

 

See an overview of the resources and tools: http://www.improvingprimarycare.org/work/behavioral-health-integration

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