Literature Collection

461

Screening families in primary care for social and economic needs: Patients’ urgency and activation for social care navigation

Type: Journal Article

Authors: Sarah D. Ronis, Marie Masotya, Genevieve M. Birkby, Kurt C. Stange

Year: 2022

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462

Screening for Diabetes and Self-Care in Patients With Severe Mental Illness

Type: Journal Article

Authors: Crawford Atyabi, Evans Kreider

Year: 2020

Publication Place: Philadelphia

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463

Screening, brief intervention, and referral to treatment (SBIRT) implementation in urban underserved family medicine

Type: Journal Article

Authors: H. Bednar, K. Bergs, M. Serdarevic

Year: 2023

Abstract:

Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence based practice that provides early integrated intervention and treatment to patients with Alcohol Use Disorder (AUD) and/or Substance Use Disorders (SUD). Three Primary Care Medical Homes (PCMHs) in North Texas were selected as pilot sites for a SAMHSA grant designed to integrate SBIRT into existing services. The goal of this program is to support the stabilization and community reintegration of individuals who present with SUD in our community by providing them with a continuum of care from screening, brief intervention, brief treatment, and referral to services. Specific aims of the grant included: provide SBIRT services to eligible participants, decrease in substance and alcohol use at 6-month follow-up, improve patient physical and behavioral health measured at 6 months, and decrease in Emergency Department visits and costs for program participants. This brief report examines project design, outlines our implementation strategies and offers preliminary results.

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464

Secure, obligated and coordinated collaboration in health care for the patient-centered medical home

Type: Journal Article

Authors: S. Berhe, S. Demurjian, R. Saripalle, T. Agresta, J. Liu, A. Cusano, A. Fequiere, J. Gedarovich

Year: 2010

Publication Place: United States

Abstract: In the patient-centered medical home, PCMH, patient care is overseen by a primary care physician leading a team of health care providers, who collaborate to optimize treatment. To facilitate interactions in PCMH, secure collaboration will be needed to: control access to information; dictate who can do what when; and promote sharing and concurrent access. This contrasts approaches such as the National Institute of Standard and Technology (NIST) role-based access control (RBAC), where the emphasis is on controlling access and separating responsibilities. This paper investigates secure collaboration within an application such as PCMH, through: a futuristic scenario for patient care; proposed collaboration extensions to the NIST RBAC standard with a fine-grained obligated mechanism and workflow; and a prototype of PCMH via the Google Wave real-time collaboration platform.

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465

Serving Persons With Severe Mental Illness in Primary Care-Based Medical Homes

Type: Journal Article

Authors: M. E. Domino, R. Wells, J. P. Morrissey

Year: 2015

Abstract: Objective: Primary care-based medical homes are rapidly disseminating through populations with chronic illnesses. Little is known about how these models affect the patterns of care for persons with severe mental illness who typically receive much of their care from mental health specialists. This study examined whether enrollment in a primary care medical home alters the patterns of care for Medicaid enrollees with severe mental illness. Methods: The authors conducted a retrospective secondary data analysis of medication adherence, outpatient and emergency department visits, and screening services used by adult Medicaid enrollees with diagnoses of schizophrenia (N=7,228), bipolar disorder (N=13,406), or major depression (N=45,000) as recorded in North Carolina Medicaid claims from 2004-2007. Participants not enrolled in a medical home (control group) were matched by propensity score to medical home participants on the basis of demographic characteristics and comorbidities. Those dually enrolled in Medicare were excluded. Results: Results indicate that medical home enrollees had greater use of both primary and specialty mental health care, better medication adherence, and reduced use of the emergency department. Better rates of preventive lipid and cancer screening were found only for persons with major depression. Conclusions: Enrollment in a medical home was associated with substantial changes in patterns of care among persons with severe mental illness. These changes were associated with only a modest set of incentives, suggesting that medical homes can have large multiplier effects in primary care of persons with severe mental illness.

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466

Setting the stage for success: Implementation of developmental and behavioral screening and surveillance in primary care practice -- the North Carolina Assuring Better Child Health and Development (ABCD) Project

Type: Journal Article

Authors: M. F. Earls, S. S. Hay

Year: 2006

Abstract: Early identification of children with developmental and behavioral delays is important in primary care practice, and well-child visits provide an ideal opportunity to engage parents and perform periodic screening. Integration of this activity into office process and flow is necessary for making screening a routine and consistent part of primary care practice. In the North Carolina Assuring Better Child Health and Development Project, careful attention to and training for office process has resulted in a significant increase in screening rates to >70% of the designated well-child visits. The data from the project prompted a change in Medicaid policy, and screening is now statewide in primary practices that perform Early Periodic Screening, Diagnosis, and Treatment examinations. Although there are features of the project that are unique to North Carolina, there are also elements that are transferable to any practice or state interested in integrating child development services into the medical home. Included here are lessons learned and a listing of practical tools for implementation.

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467

Sexuality of children and adolescents with developmental disabilities

Type: Journal Article

Authors: N. A. Murphy, E. R. Elias

Year: 2006

Publication Place: United States

Abstract: Children and adolescents with developmental disabilities, like all children, are sexual persons. However, attention to their complex medical and functional issues often consumes time that might otherwise be invested in addressing the anatomic, physiologic, emotional, and social aspects of their developing sexuality. This report discusses issues of puberty, contraception, psychosexual development, sexual abuse, and sexuality education specific to children and adolescents with disabilities and their families. Pediatricians, in the context of the medical home, are encouraged to discuss issues of sexuality on a regular basis, ensure the privacy of each child and adolescent, promote self-care and social independence among persons with disabilities, advocate for appropriate sexuality education, and provide ongoing education for children and adolescents with developmental disabilities and their families.

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468

Shared decision making among parents of children with mental health conditions compared to children with chronic physical conditions

Type: Journal Article

Authors: A. M. Butler, S. Elkins, M. Kowalkowski, J. L. Raphael

Year: 2015

Publication Place: United States

Abstract: High quality care in pediatrics involves shared decision making (SDM) between families and providers. The extent to which children with common mental health disorders experience SDM is not well known. The objectives of this study were to examine how parent-reported SDM varies by child health (physical illness, mental health condition, and comorbid mental and physical conditions) and to examine whether medical home care attenuates any differences. We analyzed data on children (2-17 years) collected through the 2009/2010 National Survey of Children with Special Health Care Needs. The sample consisted of parents of children in one of three child health categories: (1) children with a chronic physical illness but no mental health condition; (2) children with a common mental health condition but no chronic physical condition; and (3) children with comorbid mental and chronic physical conditions. The primary dependent variable was parent-report of provider SDM. The primary independent variable was health condition category. Multivariate linear regression analyses were conducted. Multivariate analyses controlling for sociodemographic variables and parent-reported health condition impact indicated lower SDM among children with a common mental health condition-only (B = -0.40; p < 0.01) and children with comorbid conditions (B = -0.67; p < 0.01) compared to children with a physical condition-only. Differences in SDM for children with a common mental health condition-only were no longer significant in the model adjusting for medical home care. However, differences in SDM for children with comorbid conditions persisted after adjusting for medical home care. Increasing medical home care may help mitigate differences in SDM for children with mental health conditions-only. Other interventions may be needed to improve SDM among children with comorbid mental and physical conditions.

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469

Small and medium-size physician practices use few patient-centered medical home processes

Type: Journal Article

Authors: D. R. Rittenhouse, L. P. Casalino, S. M. Shortell, S. R. McClellan, R. R. Gillies, J. A. Alexander, M. L. Drum

Year: 2011

Publication Place: United States

Abstract: The patient-centered medical home has become a prominent model for reforming the way health care is delivered to patients. The model offers a robust system of primary care combined with practice innovations and new payment methods. But scant information exists about the extent to which typical US physician practices have implemented this model and its processes of care, or about the factors associated with implementation. In this article we provide the first national data on the use of medical home processes such as chronic disease registries, nurse care managers, and systems to incorporate patient feedback, among 1,344 small and medium-size physician practices. We found that on average, practices used just one-fifth of the patient-centered medical home processes measured as part of this study. We also identify internal capabilities and external incentives associated with the greater use of medical home processes.

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470

Specialists/subspecialists and the patient-centered medical home

Type: Journal Article

Authors: N. Kirschner, M. S. Barr

Year: 2010

Publication Place: United States

Abstract: This article provides an overview of the Patient-Centered Medical Home (PCMH) care model. It provides a history and definition of the concept, a discussion of its growing acceptance by the health-care community, and a review of current public and public-private demonstration projects testing the concept. The role of specialty/subspecialty practices within the PCMH model is described, with a focus on the potential for these practices to serve as a PCMH for a subgroup of patients or, alternatively, as a PCMH "neighbor" that interfaces effectively with PCMH practices. The authors conclude that the model for effective connections between the PCMH and specialty/subspecialty practices requires further development, including the cross-specialty establishment of guidelines and processes regarding referrals, information flow, transitions in care, and accountability. The efforts of the American College of Physicians' Council of Subspecialty Societies PCMH Workgroup to further develop this model are described. The authors encourage involvement from all interested stakeholders to ensure that the issues and challenges identified are addressed through collaboration and consensus based on available evidence.

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471

Specialty care and the patient-centered medical home

Type: Journal Article

Authors: J. M. Hollingsworth, S. Saint, R. A. Hayward, M. A. Rogers, L. Zhang, D. C. Miller

Year: 2011

Publication Place: United States

Abstract: BACKGROUND: The medical home's success depends, in part, on the degree to which primary care physicians (PCPs) and specialists collaborate to create "medical neighborhoods" based on collective accountability. Such collaboration may require a new equilibrium in chronic disease care, with some of the routine follow-up currently provided by specialists reallocated to PCPs and their medical home teams. OBJECTIVES: To measure the care delivered by specialists for 7 chronic conditions, and to estimate the implications associated with reallocating half among the PCP workforce. RESEARCH DESIGN: Cross-sectional. SUBJECTS: Physicians from the 2007 National Ambulatory Medical Care Survey. MEASURES: We identified adult ambulatory visits for chronic obstructive pulmonary disease/asthma, low back pain, diabetes mellitus, coronary artery disease/congestive heart failure, chronic kidney disease, and depression. We calculated the time spent by specialists in direct and indirect care for established patients with these conditions. We summed individual physician estimates across specialists and converted the total into annual work weeks. After reducing this figure by half, we divided by the number of active PCPs. RESULTS: Most specialty visits (76.8%; 95% confidence interval [CI]: 73.6%-79.7%) were made by established patients. Specialists spent 552,844 (95% CI: 454,660-651,029) and 108,113 (95% CI: 86,103-130,122) cumulative work weeks providing direct and indirect follow-up care, respectively. Reallocating half of this care would generate 3.2 (95% CI: 2.6-3.8) additional work weeks for each PCP. CONCLUSIONS: The cumulative time spent by specialists in routine chronic disease follow-up is nontrivial. Reallocation of this care to PCP-directed medical homes may require multidimensional efforts to expand the primary care workforce.

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472

Specialty care medical homes for people with severe, persistent mental disorders

Type: Journal Article

Authors: V. Alakeson, R. G. Frank, R. E. Katz

Year: 2010

Publication Place: United States

Abstract: The patient-centered medical home concept is central to discussions about the reform of the health care delivery system. Most descriptions of the concept assume that a primary care practice would serve as the hub of the medical home. However, for people with severe and persistent mental disorders, specialty health care settings serve as the principal point of contact with the health care system. For them, a patient-centered medical home in a specialty setting would be the most expedient way to address their urgent health care needs. Among other issues, implementing this idea would mean reimbursement strategies to support the integration and coordination of primary care in specialty settings.

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473

Specialty Physician Designation in Referrals from a Vertically Integrated PCMH

Type: Journal Article

Authors: A. D. Schreiner, K. T. Holmes-Maybank, J. Zhang, J. Marsden, P. D. Mauldin, W. P. Moran

Year: 2019

Publication Place: United States

Abstract: Introduction: Primary care referrals to specialty physicians once relied upon the medical skill of the specialist, the quality of past communication, and previous consultative experiences. As health systems vertically integrate, patterns of specialty physician referral designation are not known. Methods: This cross-sectional study from a patient-centered medical home (PCMH) evaluated the proportion of referrals with named specialists. All outpatient specialty referrals from the PCMH between July and December of 2014 were eligible for inclusion, and 410 patients were randomly selected for chart review. The outcome of interest was specialty physician designation. Other variables of interest included PCMH provider experience, the reason for referral, and time to specialty visit. Univariate analysis was performed with Fisher exact tests. Results: Of 410 specialty referrals, 43.7% were made to medical specialties, 41.7% to surgical specialties, and 14.6% to ancillary specialties. Resident physicians placed 224 referrals (54.6%), faculty physicians ordered 155 (37.8%), and advanced practice providers ordered 31 (7.6%). Only 11.2% of the specialty referral orders designated a specific physician. No differences appeared in the reason for referral, the referral destination, the proportion of visits scheduled and attended, or the time to schedule between those referrals with and without specialty physician designation. Faculty physicians identified a specific specialist in 21.4% of referrals compared to residents doing so in 4.9% (P < .0001). Conclusion: Patient-centered medical home referrals named a specific specialty physician infrequently, suggesting a shift from the historical reliance on the individual characteristics of the specialist in the referral process.

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474

Specialty Physician Designation in Referrals from a Vertically Integrated PCMH

Type: Journal Article

Authors: A. D. Schreiner, K. T. Holmes-Maybank, J. Zhang, J. Marsden, P. D. Mauldin, W. P. Moran

Year: 2019

Publication Place: United States

Abstract: Introduction: Primary care referrals to specialty physicians once relied upon the medical skill of the specialist, the quality of past communication, and previous consultative experiences. As health systems vertically integrate, patterns of specialty physician referral designation are not known. Methods: This cross-sectional study from a patient-centered medical home (PCMH) evaluated the proportion of referrals with named specialists. All outpatient specialty referrals from the PCMH between July and December of 2014 were eligible for inclusion, and 410 patients were randomly selected for chart review. The outcome of interest was specialty physician designation. Other variables of interest included PCMH provider experience, the reason for referral, and time to specialty visit. Univariate analysis was performed with Fisher exact tests. Results: Of 410 specialty referrals, 43.7% were made to medical specialties, 41.7% to surgical specialties, and 14.6% to ancillary specialties. Resident physicians placed 224 referrals (54.6%), faculty physicians ordered 155 (37.8%), and advanced practice providers ordered 31 (7.6%). Only 11.2% of the specialty referral orders designated a specific physician. No differences appeared in the reason for referral, the referral destination, the proportion of visits scheduled and attended, or the time to schedule between those referrals with and without specialty physician designation. Faculty physicians identified a specific specialist in 21.4% of referrals compared to residents doing so in 4.9% (P < .0001). Conclusion: Patient-centered medical home referrals named a specific specialty physician infrequently, suggesting a shift from the historical reliance on the individual characteristics of the specialist in the referral process.

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475

Specialty services for children with special health care needs: supplement not supplant the medical home

Type: Journal Article

Authors: R. J. Graham

Year: 2008

Publication Place: England

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476

State-by-State Health Home State Plan Amendment Matrix: Summary Overview

Type: Web Resource

Year: 2012

Abstract:

This matrix outlines key program design features from draft health home State Plan Amendments (SPAs) submitted to the Centers for Medicare & Medicaid Services (CMS). This document captures what states have proposed in draft or final SPAs submitted as of January 2012.

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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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477

Statement of the American Psychological Association in response to the "Joint principles: Integrating behavioral health care into the patient-centered medical home".

Type: Journal Article

Authors: Norman B. Anderson, Cynthia D. Belar, Barbara A. Cubic, Ellen G. Garrison, Suzanne Bennett Johnson, Nadine J. Kaslow

Year: 2014

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478

Strategies for Achieving Whole-Practice Engagement and Buy-in to the Patient-Centered Medical Home

Type: Journal Article

Authors: W. K. Bleser, M. Miller-Day, D. Naughton, P. L. Bricker, P. F. Cronholm, R. A. Gabbay

Year: 2014

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479

Strategies for Addressing the Challenges of Patient-Centered Medical Home Implementation: Lessons from Oregon

Type: Journal Article

Authors: S. Gelmon, N. Bouranis, B. Sandberg, S. Petchel

Year: 2018

Publication Place: United States

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480

Strengthening the Coordination of Pediatric Mental Health and Medical Care: Piloting a Collaborative Model for Freestanding Practices

Type: Journal Article

Authors: C. A. Greene, J. D. Ford, B. Ward-Zimmerman, L. Honigfeld, A. E. Pidano

Year: 2016

Publication Place: Netherlands

Abstract: BACKGROUND: Collaborative pediatric mental health and primary care is increasingly recognized as optimal for meeting the needs of children with mental health problems. This paper describes the challenges faced by freestanding specialty mental health clinics and pediatric health practices to provide such coordinated mind-and-body treatment. It describes critical elements of a proactive approach to achieving collaborative pediatric care under real-world circumstances using the patient-centered medical home neighborhood (PCMH-N) model. OBJECTIVE: The current study evaluates the field test of the Practitioner-Informed Model to Facilitate Interdisciplinary Collaboration (PIM-FIC), a systematic approach to improving inter-professional collaboration by building relationships and enhancing communication between pediatric mental health and primary care practices. METHODS: Thirty-nine providers at two mental health and two pediatric primary care practices participated in a pilot project and completed surveys prior to and following their participation. Key informant interviews were also conducted prior to the project. RESULTS: Participating practitioners' survey and interview responses indicate that the quantity and quality of communication between pediatric mental and medical health care providers increased post-project, as did satisfaction with overall collaboration. CONCLUSIONS: Improving relationships and communication are first steps in building the infrastructure to support effective coordinated care. Project results highlight practical and easily implemented strategies that pediatric mental health and primary care practices can take to strengthen their collaboration. Findings also suggest a need for collaborative care policies and competencies for child mental health providers working in freestanding practices within the PCMH-N.

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