TY - JOUR
KW - Adolescent
KW - Adult
KW - Aged
KW - Community Mental Health Services/organization & administration
KW - Cooperative Behavior
KW - Delivery of Health Care, Integrated/organization & administration
KW - Female
KW - Humans
KW - Implementation Research
KW - integrated care
KW - Interprofessional Relations
KW - Leadership
KW - Male
KW - Mental Health
KW - Middle Aged
KW - Mixed Methods
KW - Organizational Culture
KW - Personnel Staffing and Scheduling
KW - Primary Health Care
KW - Primary Health Care/organization & administration
KW - Program Evaluation
KW - United States
KW - Young Adult
AU - M. Davis
AU - B. A. Balasubramanian
AU - E. Waller
AU - B. F. Miller
AU - L. A. Green
AU - D. J. Cohen
A1 - 
AB - BACKGROUND: More than 20 years ago the Institute of Medicine advocated for integration of physical and behavioral health care. Today, practices are integrating care in response to recent policy initiatives. However, few studies describe how integration is accomplished in real-world practices without the financial or research support available for most randomized controlled trials. METHODS: To study how practices integrate care, we are conducting a cross-case comparative, mixed-methods study of 11 practices participating in Advancing Care Together (ACT). Using a grounded theory approach, we analyzed multiple sources of data (eg, documents, practice surveys, field notes from observation visits, semistructured interviews, online diaries) collected from each ACT innovator. RESULTS: Integration requires making changes in organization and interpersonal relationships. During early integration efforts, challenges related to workflow and access, leadership and culture change, and tracking and using data to evaluate patient- and practice-level improvement emerged for ACT innovators. We describe the strategies innovators are developing to address these challenges. CONCLUSION: Integrating care is a fundamental and difficult change for practices and health care professionals. Research identifying common challenges that manifest in early efforts can help others attempting integration and inform state, local, and federal policies aimed at achieving wide-spread implementation.
BT - Journal of the American Board of Family Medicine : JABFM
C5 - Education & Workforce
CP - 5
CY - United States
DO - 10.3122/jabfm.2013.05.130028
IS - 5
JF - Journal of the American Board of Family Medicine : JABFM
N2 - BACKGROUND: More than 20 years ago the Institute of Medicine advocated for integration of physical and behavioral health care. Today, practices are integrating care in response to recent policy initiatives. However, few studies describe how integration is accomplished in real-world practices without the financial or research support available for most randomized controlled trials. METHODS: To study how practices integrate care, we are conducting a cross-case comparative, mixed-methods study of 11 practices participating in Advancing Care Together (ACT). Using a grounded theory approach, we analyzed multiple sources of data (eg, documents, practice surveys, field notes from observation visits, semistructured interviews, online diaries) collected from each ACT innovator. RESULTS: Integration requires making changes in organization and interpersonal relationships. During early integration efforts, challenges related to workflow and access, leadership and culture change, and tracking and using data to evaluate patient- and practice-level improvement emerged for ACT innovators. We describe the strategies innovators are developing to address these challenges. CONCLUSION: Integrating care is a fundamental and difficult change for practices and health care professionals. Research identifying common challenges that manifest in early efforts can help others attempting integration and inform state, local, and federal policies aimed at achieving wide-spread implementation.
PP - United States
PY - 2013
SN - 1557-2625; 1557-2625
SP - 588
EP - 602
EP - 
T1 - Integrating behavioral and physical health care in the real world: early lessons from advancing care together
T2 - Journal of the American Board of Family Medicine : JABFM
TI - Integrating behavioral and physical health care in the real world: early lessons from advancing care together
U1 - Education & Workforce
U2 - 24004711
U3 - 10.3122/jabfm.2013.05.130028
VL - 26
VO - 1557-2625; 1557-2625
Y1 - 2013
ER -