The AHRQ Academy has released two new resources: a guidebook and a literature review for the integrated care workforce. These products are the result of a qualitative study that aimed to assist the field of primary care and behavioral health in identifying core professional practices for successful integration of behavioral health in primary care.
The report, A Guidebook of Professional Practices for Behavioral Health and Primary Care Integration: Observations from Exemplary Sites, profiles eight primary care organizations that have successfully integrated behavioral health services. Findings are based on phone interviews, observation during site visits, key informant interviews, and document examination. The exemplary practices include four federally qualified health centers, two hospital systems, a government-run facility, and a private practice that are all multispecialty groups serving urban or rural communities. The report identifies key competencies exhibited by these organizations in their efforts to deliver effective integrated care.
The study team organized findings into organization-level practices and interpersonal and individual practices that supported integrated care. Key findings include:
Organization-Level Professional Practices
- Focus on organizational mission and values
- Build in quality improvement practices
- Advocate for integration
- Manage finances to support patient access to integration
- Emphasize the value of qualified staff to deliver integrated care
- Dedicate resources to training
- Structure clinical workflow to accommodate staff interdependence
- Establish an information infrastructure to support integrated care tasks
Interpersonal and Individual Professional Practices
- Develop clinical workflows to ensure patients receive the level of integrated care they need, from the right clinicians, at the right time
- Use the EHR system to document and share information
- Supervise clinicians closely to provide training and problem-solving
- Collaborate with others, regardless of discipline
- Communicate clearly to generally coordinate care
- Communicate with patients to encourage positive behaviors
- Share professional practices on how to engage patients
The Executive Summary of the report concludes by summarizing ways in which the report can be used, and some of the research questions that emerge from this work:
“Organizations can use this guidebook to work toward achieving a level of integrated care seen in some of the best primary care organizations in the country. Moreover, policymakers may find this guidebook useful to identify benchmarks for assessing integrated care in primary care organizations.
With such rich data, many interesting research questions emerge from this work. Areas for exploration could include examining how communication among professionals and patients differs in integrated settings and non-integrated settings, how the professional practices identified here are connected to clinical outcomes, and how these practices can be best implemented and disseminated to primary care organizations motivated to integrate care for the patients they serve.”
The literature review highlights a set of competencies, practices, providers, and staff required to advance integration efforts and provide comprehensive care to improve patient outcomes. Competencies are organized into provider and staff competencies and practice-level competencies.
The study was led by Deborah Cohen, PhD and co-authored by Melinda M. Davis PhD; Jennifer D. Hall, MPH; Emma C. Gilchrist, MPH; and Benjamin F. Miller, PsyD. It was guided by an Expert Panel that included Alexander Blount, EdD; Hilary Bogner, MD; Becky Boober, PhD; Roger Kathol, MD; Parinda Khatri, PhD; Neil Korsen, MD; Karen Linkins, PhD; C.J. Peek, PhD; Patti Robinson, PhD; Christine Runyan, PhD; and Jürgen Unützer, MD.
We gratefully acknowledge the following primary care organizations whose participation made this project possible:
- Cherokee Health Systems, Knoxville, TN
- Edward Hines, Jr. VA Hospital – Primary Care Behavioral Health Program, Hines, IL
- Fairview Clinics – Integrated Primary Care, Fairview Health Services, Minneapolis, MN
- Golden Valley Health Centers, Merced, CA
- Institute for Family Health, New York, NY
- Penobscot Community Health Care – Summer Street Health Center, Bangor, ME
- Southcentral Foundation, Anchorage, AK
- Swift River Family Medicine, working in collaboration with Tri-County Mental Health Services, Rumford, ME
Posted March 2015