Literature Collection

81

Behavioral health service utilization: Trends in utilization within a patient-centered medical home for low-income children and women

Type: Journal Article

Authors: A. Abu-Ghname, M. Clementi, S. A. Marton, H. Schwarzwald, E. Giwa, L. Hollier, S. G. Chapman

Year: 2019

Publication Place: India

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82

Behavioral Health/Primary Care Integration and the Person-Centered Healthcare Home

Type: Report

Authors: B. Mauer

Year: 2009

Topic(s):

,

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This grey literature reference is included in the Academy's Literature Collection in keeping with our mission to gather all sources of information on integration. Grey literature is comprised of materials that are not made available through traditional publishing avenues. Often, the information from unpublished resources can be limited and the risk of bias cannot be determined.

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83

Behavioral interventions for office-based care: interventions in the family medicine setting

Type: Journal Article

Authors: M. M. Larzelere

Year: 2014

Publication Place: United States

Abstract: The practice of family medicine includes the care of many patients with mental health or behavior change needs. Patients in mild to moderate distress may benefit from brief interventions performed in the family physician's office. Patients in more extreme distress may be helped by referral to behavioral health clinicians for short-term or open-ended therapies. Electronic therapy programs and bibliotherapy are also useful resources. The transition to the patient-centered medical home model may allow for more widespread integration of behavioral health care clinicians into primary care, in person and through telemental health care. Integrated care holds the promise of improved access, greater effectiveness of behavioral health service provision, and enhanced efficiency of primary care for patients with behavioral health care needs.

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84

Being Uninsured Is Bad for Your Health: Can Medical Homes Play a Role in Treating the Uninsurance Ailment?

Type: Journal Article

Authors: J. E. DeVoe

Year: 2013

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85

Bending the cost curve? Results from a comprehensive primary care payment pilot.

Type: Journal Article

Authors: Sonal Vats, Arlene S. Ash, Randall P. Ellis

Year: 2013

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86

Beyond checkboxes: A qualitative assessment of physicians' experiences providing care in a patient‐centred medical home

Type: Journal Article

Authors: Marisa Sklar, Chariz Seijo, Roberta E. Goldman, Charles B. Eaton

Year: 2019

Publication Place: Malden, Massachusetts

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87

Building a medical home around the patient: What it means for behavior

Type: Journal Article

Authors: C. J. Peek

Year: 2010

Publication Place: United States

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88

Building a primary care/research partnership: lessons learned from a telehealth intervention for diabetes and depression

Type: Journal Article

Authors: A. D. Naik, B. Lawrence, L. Kiefer, K. Ramos, A. Utech, N. Masozera, R. Rao, N. J. Petersen, M. E. Kunik, J. A. Cully

Year: 2014

Abstract: INTRODUCTION: Evidence-based interventions are often poorly translated into primary care settings due to inadequate integration into organizational cultures and clinical workflows. Study designs that blend evaluation of effectiveness and implementation may enhance uptake of interventions into primary care settings. Community-Based Participatory Research (CBPR) models are useful for developing partnerships between research teams and primary care clinical partners to test blended study designs. METHODS: We conducted a formative evaluation of partnership building between a health services research team and a primary care community in US Veterans Affairs Health System to conduct a randomized effectiveness trial of an intervention embedded in routine primary care. The formative evaluation used qualitative data drawn from research/clinical partnership meetings. Data were coded and analysed using qualitative framework analysis. RESULTS: The CBPR model guided development of a research/clinical partnership based on a facilitation team consisting of 'external facilitators' (research team), 'internal facilitators' (primary care leadership) and a 'clinical advisory committee' drawn from the primary care community. Qualitative themes focused on: how the intervention components ('evidence') aligned with local clinical cultures, barriers and facilitators to acceptance and adoption of the intervention processes within the context of clinical workflows and identified 'facilitators' of intervention uptake and sustainability. CONCLUSION: A CBPR model can guide the development of research/clinical partnerships. Partnerships can identify barriers and craft modifications to intervention procedures that promote integration and into primary care workflows. Formative research/clinical partnerships are critical for designing and testing interventions focused on implementation and sustainability of new evidence within routine primary care.

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89

Building Behavioral Health Homes: Clinician and Staff Perspectives on Creating Integrated Care Teams

Type: Journal Article

Authors: T. Anastas, E. N. Waddell, S. Howk, M. Remiker, G. Horton-Dunbar, L. J. Fagnan

Year: 2019

Publication Place: United States

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90

Building Health Information Exchanges to Support Accountable Care Organizations and Medical Homes: Delaware's Experience [Video]

Type: Web Resource

Authors: AHRQ Health Care Innovations Exchange

Year: 2013

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Disclaimer:

This grey literature reference is included in the Academy's Literature Collection in keeping with our mission to gather all sources of information on integration. Grey literature is comprised of materials that are not made available through traditional publishing avenues. Often, the information from unpublished resources can be limited and the risk of bias cannot be determined.

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91

Building integrated mental health and medical programs for vulnerable populations post-disaster: Connecting children and families to a medical home

Type: Journal Article

Authors: P. A. Madrid, H. Sinclair, A. Q. Bankston, S. Overholt, A. Brito, R. Domnitz, R. Grant

Year: 2008

Publication Place: United States

Abstract: INTRODUCTION: Hurricane Katrina, a Category 3 hurricane, made landfall in August 2005. Approximately 1,500 deaths have been directly attributed to the hurricane, primarily in Louisiana and Mississippi. In New Orleans, Louisiana, most of the healthcare infrastructure was destroyed by flooding, and > 200,000 residents became homeless. Many of these internally displaced persons received transitional housing in trailer parks ("villages") under the auspices of the [US] Federal Emergency Management Agency (FEMA). PROBLEM: The FEMA villages are isolated from residential communities, lack access to healthcare services, and have become unsafe environments. The trailers that house families have been found to be contaminated with formaldehyde. METHODS: The Children's Health Fund, in partnership with the Mailman School of Public Health at Columbia University, began a program ("Operation Assist") to provide health and mental health services within a medical home model. This program includes the Baton Rouge Children's Health Project (BRCHP), which consists of two mobile medical units (one medical and one mental health). Licensed professionals at the FEMA villages and other isolated communities provide care on these mobile units. Medical and psychiatric diagnoses from the BRCHP are summarized and case vignettes presented. RESULTS: Immediately after the hurricane, prescription medications were difficult to obtain. Complaints of headache, nosebleeds, and stomachache were observed at an unusually frequent degree for young children, and were potentially attributable to formaldehyde exposure. Dermatological conditions included eczema, impetigo, methicillin-resistant staphylococcus aureus (MRSA) abscesses, and tinea corporis and capitis. These were especially difficult to treat because of unhygienic conditions in the trailers and ongoing formaldehyde exposure. Signs of pediatric under-nutrition included anemia, failure to thrive, and obesity. Utilization of initial mental health services was low due to pressing survival needs and concern about stigma. Once the mental health service became trusted in the community, frequent diagnoses for school-age children included disruptive behavior disorders and learning problems, with underlying depression, anxiety, and stress disorders. Mood and anxiety disorders and substance abuse were prevalent among the adolescents and adults, including parents. CONCLUSIONS: There is a critical and long-term need for medical and mental health services among affected populations following a disaster due to natural hazards. Most patients required both medical and mental health care, which underscores the value of co-locating these services.

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92

Building Quality Improvment Capacity in Primary Care: Supports and Resources

Type: Government Report

Authors: E. F. Taylor, J. Genevro, D. Peikes, K. Geonnotti, W. Wang, D. Meyers

Year: 2013

Abstract: Primary care is the cornerstone of health care that is effective and efficient and meets the needs of patients and families. To strengthen primary care, and thereby strengthen the larger health care system, the orientation and commitment of primary care practices to quality and safety must be enhanced and supported. Some practitioners, purchasers, and quality improvement organizations are focused on improving quality and safety in primary care. Promising models, such as the patient-centered medical home (PCMH), have been developed to transform the delivery of primary care and achieve the triple aim of improved patient experience, improved population health, and reduced costs.

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Disclaimer:

This grey literature reference is included in the Academy's Literature Collection in keeping with our mission to gather all sources of information on integration. Grey literature is comprised of materials that are not made available through traditional publishing avenues. Often, the information from unpublished resources can be limited and the risk of bias cannot be determined.

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93

Can Home-Based Primary Care Drive Integration of Medical and Social Care for Complex Older Adults?

Type: Journal Article

Authors: B. Leff, A. Lasher, C. S. Ritchie

Year: 2019

Publication Place: United States

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94

Can the Medical Home eliminate racial and ethnic disparities for transition services among youth with special health care needs?

Type: Journal Article

Authors: N. E. Richmond, T. Tran, S. Berry

Year: 2011

Abstract: The Medical Home (MH) is shown to improve health outcomes for Youth with Special Health Care Needs (YSHCN). Some MH services involve Transition from pediatric to adult providers to ensure YSHCN have continuous care. Studies indicate racial/ethnic disparities for Transition, whereas the MH is shown to reduce health disparities. This study aims to (1) Determine the Transition rate for YSHCN with a MH (MH Transition) nationally, and by race/ethnicity (2) Identify which characteristics are associated with MH Transition (3) Determine if racial/ethnic disparities exist after controlling for associated characteristics, and (4) Identify which characteristics are uniquely associated with each race/ethnic group. National survey data were used. YSCHN with a MH were grouped as receiving Transition or not. Characteristics included race, ethnicity (Non-Hispanic (NH), Hispanic), sex, health condition effect, five special health care need categories, education, poverty, adequate insurance, and urban/rural residence. Frequencies, chi-square, and logistic regression were used to calculate rates and define associations. Alpha was set to 0.05. About 57.0% of YSHCN received MH Transition. Rates by race/ethnicity were 59.0, 45.5, 60.2, 41.9, and 44.6% for NH-White, NH-Black, NH-Multiple race, NH-Other, and Hispanic YSHCN, respectively. Disparities remained between NH-White and NH-Black YSHCN. All characteristics except urban/rural status were associated. Adequate insurance was associated for all race/ethnic groups, except NH-Black YSHCN. Almost 57.0% of YSHCN received MH Transition. Disparities remained. Rates and associated characteristics differed by race/ethnic group. Culturally tailored interventions incorporating universal factors to improve MH Transition outcomes are warranted.

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95

Care Coordination and Population Health Management Strategies and Challenges in a Behavioral Health Home Model

Type: Journal Article

Authors: G. L. Daumit, E. M. Stone, A. Kennedy-Hendricks, S. Choksy, J. A. Marsteller, E. E. McGinty

Year: 2019

Publication Place: United States

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96

Care coordination for children with special health care needs: Evaluation of a state experiment

Type: Journal Article

Authors: K. A. Lawson, S. R. Bloom, M. Sadof, C. Stille, J. M. Perrin

Year: 2011

Publication Place: United States

Abstract: Care coordination (CC), a component of the medical home, may aid families who have children with special health care needs (CSHCN). Few data link CC to individual patient outcomes. To compare parent-reported outcomes for CSHCN receiving practice-based care coordination with those receiving standard care. This cross-sectional study examined two groups of CSHCN: one that received the services of a care coordinator for a year and one that did not. Parental surveys assessed: access to medical care, practice help and support, satisfaction with services, and parental mental and physical health. Associations between group status and parent-reported outcomes were assessed via regression analyses controlling for sociodemographic and health status variables. We also examined whether CC households who reported higher satisfaction with care had higher scores in the four domains. Parents in the care coordination group reported higher utilization of both primary care and specialist physicians, but did not report better practice help and support, better satisfaction with care, or better overall parental health. Parents in the care coordination group who reported being satisfied with their care rated their PCPs as more helpful than did the comparison families. Parents in this subgroup also reported significantly higher levels of care coordination than did parents in the comparison group. CSHCN appear to have higher PCP and specialist utilization when they receive supplemental care coordination. Additionally, those who are more satisfied with the care coordination they receive are happier with the assistance from their PCP and the overall care coordination provided.

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97

Care coordination in a medical home in post-Katrina New Orleans: Lessons learned

Type: Journal Article

Authors: S. Berry, E. Soltau, N. E. Richmond, R. L. Kieltyka, T. Tran, A. Williams

Year: 2011

Publication Place: United States

Abstract: This is a prospective study to evaluate ability of a nurse care coordinator to: (1) improve ability of a pediatric clinic to meet medical home (MH) objectives and (2) improve receipt of services for families of children with special health care needs (CSHCN). A nurse was hired to provide care coordination for CSHCN in an urban, largely Medicaid pediatric academic practice. CSHCN were identified using a CSHCN Screener. Ability to meet MH criteria was determined using the MH Index (MHI). Receipt of MH services was measured using the MH Family Index (MHFI). After baseline surveys were completed, Hurricane Katrina destroyed the clinic. Care coordination was implemented for the post-disaster population. Surveys were repeated in the rebuilt clinic after at least 3 months of care coordination. The distribution of demographics, diagnoses and percent CSHCN did not significantly change pre and post Katrina. Psychosocial needs such as food, housing, mental health and education were markedly increased. Essential strategies included developing a new tool for determining complexity of needs and involvement of the entire practice in care coordination activities. MHFI showed improvement in receipt of services post care coordination and post-Katrina with P < 0.05 for 13 of 16 questions. MHI demonstrated improvement in care coordination and community outreach domains. Average cost was $36.88 per CSHCN per year. There was significant improvement in the ability of the clinic to meet care coordination and community outreach MH criteria and in family receipt of services after care coordination, despite great increase in psychosocial needs. This study provides practical strategies for implementing care coordination for families of high risk CSHCN in underserved populations.

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98

Care coordination: Reducing care fragmentation in primary care

Type: Report

Year: 2013

Abstract: This Implementation Guide begins with an introduction that defines care coordination and the recommended key changes for safety net practices, including a focus on behavioral health integration. It is followed by Reducing Care Fragmentation, a toolkit that includes a detailed discussion of the four basic elements of effective referral or transition management. The toolkit's recommendations are exemplified in a series of case studies and through links to specific tools (e.g., job descriptions and staff training curricula).

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Disclaimer:

This grey literature reference is included in the Academy's Literature Collection in keeping with our mission to gather all sources of information on integration. Grey literature is comprised of materials that are not made available through traditional publishing avenues. Often, the information from unpublished resources can be limited and the risk of bias cannot be determined.

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99

Care Experiences of Patients with Multiple Chronic Conditions in a Payer-Based Patient-Centered Medical Home

Type: Journal Article

Authors: Debora Goetz Goldberg, Gilbert Gimm, Sriteja R. Burla, Len M. Nichols

Year: 2020

Publication Place: New Rochelle, New York

Topic(s):

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