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The Literature Collection contains over 10,000 references for published and grey literature on the integration of behavioral health and primary care. Learn More
Use the Search feature below to find references for your terms across the entire Literature Collection, or limit your searches by Authors, Keywords, or Titles and by Year, Type, or Topic. View your search results as displayed, or use the options to: Show more references per page; Sort references by Title or Date; and Refine your search criteria. Expand an individual reference to View Details. Full-text access to the literature may be available through a link to PubMed, a DOI, or a URL. References may also be exported for use in bibliographic software (e.g., EndNote, RefWorks, Zotero).
598 Results
221
Fostering evidence-based quality improvement for patient-centered medical homes: Initiating local quality councils to transform primary care
Type: Journal Article
Year: 2018
Publication Place: United States
Abstract: BACKGROUND: Although the patient-centered medical home endorses quality improvement principles, methods for supporting ongoing, systematic primary care quality improvement have not been evaluated. We introduced primary care quality councils at six Veterans Health Administration sites as an organizational intervention with three key design elements: (a) fostering interdisciplinary quality improvement leadership, (b) establishing a structured quality improvement process, and (c) facilitating organizationally aligned frontline quality improvement innovation. PURPOSE: Our evaluation objectives were to (a) assess design element implementation, (b) describe implementation barriers and facilitators, and (c) assess successful quality improvement project completion and spread. METHODOLOGY/APPROACH: We analyzed administrative records and conducted interviews with 85 organizational leaders. We developed and applied criteria for assessing design element implementation using hybrid deductive/inductive analytic techniques. RESULTS: All quality councils implemented interdisciplinary leadership and a structured quality improvement process, and all but one completed at least one quality improvement project and a toolkit for spreading improvements. Quality councils were perceived as most effective when service line leaders had well-functioning interdisciplinary communication. Matching positions within leadership hierarchies with appropriate supportive roles facilitated frontline quality improvement efforts. Two key resources were (a) a dedicated internal facilitator with project management, data collection, and presentation skills and (b) support for preparing customized data reports for identifying and addressing practice level quality issues. CONCLUSIONS: Overall, quality councils successfully cultivated interdisciplinary, multilevel primary care quality improvement leadership with accountability mechanisms and generated frontline innovations suitable for spread. Practice level performance data and quality improvement project management support were critical. PRACTICE IMPLICATIONS: In order to successfully facilitate systematic, sustainable primary care quality improvement, regional and executive health care system leaders should engage interdisciplinary practice level leadership in a priority-setting process that encourages frontline innovation and establish local structures such as quality councils to coordinate quality improvement initiatives, ensure accountability, and promote spread of best practices.
Topic(s):
Medical Home
See topic collection
222
Free child passenger restraints for patients in an urban pediatric medical home: Effects on caregiver behavior
Type: Journal Article
Year: 2009
Publication Place: United States
Abstract: CONTEXT: Motor vehicle crashes are a leading cause of death in children despite the availability of effective child passenger restraints that reduce morbidity and mortality. Inappropriate restraint is more common in minority and low-income populations. Removing barriers by distributing child passenger restraint systems (CPRS) and providing education has been 1 approach to improve child safety. The objective of this study was to evaluate the efficacy of providing no-cost CPRS in combination with targeted education to improve restraint use for low-income, minority, and urban children in a medical home. DESIGN: This prospective, non-randomized, community-based cohort study used a certified car seat technician to provide CPRS and training to the caregivers of 101 children when those caregivers reported not owning the appropriate type of restraint system during the index clinic visit. RESULTS: In the first 3 months of follow-up, caregivers were 2.4 times more likely to report appropriate use of CPRS: relative risk 2.4 (95% confidence interval [CI] 1.7 to 3.5). Reported improvement declined slightly between months 4 and 9. CONCLUSIONS: Appropriate restraint significantly improved, yet rates remained suboptimal. Multifactoral approaches are needed to understand why the set of patients studied and other at-risk populations may not use child restraints properly even when given access and information.
Topic(s):
Medical Home
See topic collection
Reference Links: View the PubMed citation for Free child passenger restraints for patients in an urban pediatric medical home: Effects on caregiver behavior
224
Fully-integrated medical home for people with severe and persistent mental illness: A description and outcome analysis of a Medicare Advantage Chronic Special Needs Program
Type: Journal Article
Year: 2018
Publication Place: Italy
Abstract: People with severe persistent mental illness pose a significant challenge to managed care organizations and society in general. The financial costs are staggering as is the community impact including homelessness and incarceration. This population also has a high incident of chronic comorbid disorders that not only drives up healthcare costs but also significantly shortens longevity. Traditional case management approaches are not always able to provide the intense and direct interventions required to adequately address the psychiatric, medical and social needs of this unique population. This article describes a Medicare Advantage Chronic Special Needs Program that provides a Medical Home, Active Community Treatment, and Integrated Care. A comparison of utilization and patient outcome measures of this program with fee for service Medicare found significant reduction in utilization and costs, as well as increased adherence to the management of chronic medical conditions and preventative services.
Topic(s):
Financing & Sustainability
See topic collection
, Healthcare Disparities
See topic collection
, Medical Home
See topic collection
225
Fully-integrated medical home for people with severe and persistent mental illness: A description and outcome analysis of a Medicare Advantage Chronic Special Needs Program
Type: Journal Article
Year: 2018
Publication Place: Italy
Abstract: People with severe persistent mental illness pose a significant challenge to managed care organizations and society in general. The financial costs are staggering as is the community impact including homelessness and incarceration. This population also has a high incident of chronic comorbid disorders that not only drives up healthcare costs but also significantly shortens longevity. Traditional case management approaches are not always able to provide the intense and direct interventions required to adequately address the psychiatric, medical and social needs of this unique population. This article describes a Medicare Advantage Chronic Special Needs Program that provides a Medical Home, Active Community Treatment, and Integrated Care. A comparison of utilization and patient outcome measures of this program with fee for service Medicare found significant reduction in utilization and costs, as well as increased adherence to the management of chronic medical conditions and preventative services.
Topic(s):
Financing & Sustainability
See topic collection
, Healthcare Disparities
See topic collection
, Medical Home
See topic collection
226
Functional concerns and treatment priorities among veterans receiving VHA Primary Care Behavioral Health services
Type: Journal Article
Year: 2019
Publication Place: United States
Topic(s):
Medical Home
See topic collection
Reference Links:
View the DOI record for Functional concerns and treatment priorities among veterans receiving VHA Primary Care Behavioral Health services
View DOI Record
View the PubMed citation for Functional concerns and treatment priorities among veterans receiving VHA Primary Care Behavioral Health services228
Guidelines for the development of comprehensive care centers for congenital adrenal hyperplasia: Guidance from the CARES Foundation Initiative
Type: Journal Article
Year: 2010
Publication Place: Egypt
Abstract: Patients with rare and complex diseases such as congenital adrenal hyperplasia (CAH) often receive fragmented and inadequate care unless efforts are coordinated among providers. Translating the concepts of the medical home and comprehensive health care for individuals with CAH offers many benefits for the affected individuals and their families. This manuscript represents the recommendations of a 1.5 day meeting held in September 2009 to discuss the ideal goals for comprehensive care centers for newborns, infants, children, adolescents, and adults with CAH. Participants included pediatric endocrinologists, internal medicine and reproductive endocrinologists, pediatric urologists, pediatric surgeons, psychologists, and pediatric endocrine nurse educators. One unique aspect of this meeting was the active participation of individuals personally affected by CAH as patients or parents of patients. Representatives of Health Research and Services Administration (HRSA), New York-Mid-Atlantic Consortium for Genetics and Newborn Screening Services (NYMAC), and National Newborn Screening and Genetics Resource Center (NNSGRC) also participated. Thus, this document should serve as a "roadmap" for the development phases of comprehensive care centers (CCC) for individuals and families affected by CAH.
Topic(s):
Medical Home
See topic collection
231
Health care quality-improvement approaches to reducing child health disparities
Type: Journal Article
Year: 2009
Publication Place: United States
Abstract: Relatively few quality-improvement efforts have been aimed at reducing differences in children's care and outcomes across race and ethnicity, socioeconomic status, and insurance status. To inform quality-improvement efforts to reduce child health disparities, we summarize lessons learned from the adult disparities-intervention literature, identify interventions that have reduced disparities in pediatric asthma outcomes and immunization rates, and outline special considerations for child disparity interventions. Key recommendations for providers, health care organizations, and researchers include: (1) examine your performance data stratified according to insurance status, race/ethnicity, language, and socioeconomic status; (2) measure and improve childhood health-related quality of life, development, and condition-specific targets (such as asthma and immunizations); (3) measure and improve anticipatory guidance for early prevention of conditions (such as injuries, violence, substance abuse, and sexually transmitted diseases) and efforts to promote positive growth (such as readership programs to improve low literacy); (4) measure and improve structural aspects of care that affect child health outcomes and can reduce disparities, such as patient-centered medical-home elements; (5) incorporate families into interventions; (6) use multidisciplinary teams with close tracking and follow-up of patients; (7) integrate non-health care partners into quality-improvement interventions; and (8) culturally tailor quality improvement. A key recommendation for payers is to align financial incentives to reduce disparities. The National Institutes of Health and other funders should support (1) disparity-intervention studies on these recommendations that analyze clinical outcomes, intervention-implementation processes, and costs, and (2) creation of new child health services researchers who can find effective quality-improvement approaches for reducing disparities.
Topic(s):
Medical Home
See topic collection
, Healthcare Policy
See topic collection
Reference Links: View the PubMed citation for Health care quality-improvement approaches to reducing child health disparities
232
Health care reform and care at the behavioral health--primary care interface
Type: Journal Article
Year: 2010
Publication Place: United States
Abstract: The historic passage of the Patient Protection and Affordable Care Act in March 2010 offers the potential to address long-standing deficits in quality and integration of services at the interface between behavioral health and primary care. Many of the efforts to reform the care delivery system will come in the form of demonstration projects, which, if successful, will become models for the broader health system. This article reviews two of the programs that might have a particular impact on care on the two sides of that interface: Medicaid and Medicare patient-centered medical home demonstration projects and expansion of a Substance Abuse and Mental Health Services Administration program that colocates primary care services in community mental health settings. The authors provide an overview of key supporting factors, including new financing mechanisms, quality assessment metrics, information technology infrastructure, and technical support, that will be important for ensuring that initiatives achieve their potential for improving care.
Topic(s):
Financing & Sustainability
See topic collection
, HIT & Telehealth
See topic collection
, Healthcare Policy
See topic collection
, Medical Home
See topic collection
Reference Links:
View the DOI record for Health care reform and care at the behavioral health--primary care interface
View DOI Record
View the PubMed citation for Health care reform and care at the behavioral health--primary care interface233
Health care savings with the patient-centered medical home: Community Care of North Carolina's experience
Type: Journal Article
Year: 2014
Publication Place: United States
Abstract: This study evaluated the financial impact of integrating a systemic care management intervention program (Community Care of North Carolina) with person-centered medical homes throughout North Carolina for non-elderly Medicaid recipients with disabilities during almost 5 years of program history. It examined Medicaid claims for 169,676 non-elderly Medicaid recipients with disabilities from January 2007 through third quarter 2011. Two models were used to estimate the program's impact on cost, within each year. The first employed a mixed model comparing member experiences in enrolled versus unenrolled months, accounting for regional differences as fixed effects and within physician group experience as random effects. The second was a pre-post, intervention/comparison group, difference-in-differences mixed model, which directly matched cohort samples of enrolled and unenrolled members on strata of preenrollment pharmacy use, race, age, year, months in pre-post periods, health status, and behavioral health history. The study team found significant cost avoidance associated with program enrollment for the non-elderly disabled population after the first years, savings that increased with length of time in the program. The impact of the program was greater in persons with multiple chronic disease conditions. By providing targeted care management interventions, aligned with person-centered medical homes, the Community Care of North Carolina program achieved significant savings for a high-risk population in the North Carolina Medicaid program.
Topic(s):
Medical Home
See topic collection
Reference Links:
View the DOI record for Health care savings with the patient-centered medical home: Community Care of North Carolina's experience
View DOI Record
View the PubMed citation for Health care savings with the patient-centered medical home: Community Care of North Carolina's experience236
Health information technology and the medical home
Type: Journal Article
Year: 2011
Publication Place: United States
Abstract: The American Academy of Pediatrics (AAP) supports development and universal implementation of a comprehensive electronic infrastructure to support pediatric information functions of the medical home. These functions include (1) timely and continuous management and tracking of health data and services over a patient's lifetime for all providers, patients, families, and guardians, (2) comprehensive organization and secure transfer of health data during patient-care transitions between providers, institutions, and practices, (3) establishment and maintenance of central coordination of a patient's health information among multiple repositories (including personal health records and information exchanges), (4) translation of evidence into actionable clinical decision support, and (5) reuse of archived clinical data for continuous quality improvement. The AAP supports universal, secure, and vendor-neutral portability of health information for all patients contained within the medical home across all care settings (ambulatory practices, inpatient settings, emergency departments, pharmacies, consultants, support service providers, and therapists) for multiple purposes including direct care, personal health records, public health, and registries. The AAP also supports financial incentives that promote the development of information tools that meet the needs of pediatric workflows and that appropriately recognize the added value of medical homes to pediatric care.
Topic(s):
HIT & Telehealth
See topic collection
, Healthcare Policy
See topic collection
, Medical Home
See topic collection
237
Health IT-Enabled Care Coordination: A National Survey of Patient-Centered Medical Home Clinicians
Type: Journal Article
Year: 2015
Publication Place: United States
Topic(s):
Medical Home
See topic collection
, HIT & Telehealth
See topic collection
Reference Links:
View the DOI record for Health IT-Enabled Care Coordination: A National Survey of Patient-Centered Medical Home Clinicians
View DOI Record
View the PubMed citation for Health IT-Enabled Care Coordination: A National Survey of Patient-Centered Medical Home Clinicians240
Homelessness and our most vulnerable patients
Type: Journal Article
Year: 2008
Publication Place: United States
Abstract: The scope of homelessness among children is broad and growing, and its affect on physical and mental health is extensive. It may seem daunting for individual providers to make an impact on the challenges faced by these most vulnerable of patients. However, healthcare providers who care for homeless children can improve more than just their physical health by understanding barriers specific to this population, and addressing them through minor changes in standard practice; education of self, staff, and colleagues; and advocacy. By collaborating with parents and local agencies, clinicians can make tangible progress in improving the health of their homeless patients and can provide parents with the information and support they need to prioritize a child's health needs appropriately. Ultimately, providers should strive to make their practices a true medical home, as it may be the only home a child knows.
Topic(s):
Medical Home
See topic collection