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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
481
Team functioning as a predictor of patient outcomes in early medical home implementation
Type: Journal Article
Year: 2018
Publication Place: United States
Abstract: BACKGROUND: New models of patient-centered primary care such as the patient-centered medical home (PCMH) depend on high levels of interdisciplinary primary care team functioning to achieve improved outcomes. A few studies have qualitatively assessed barriers and facilitators to optimal team functioning; however, we know of no prior study that assesses PCMH team functioning in relationship to patient health outcomes. PURPOSE: The aim of the study was to assess the relationships between primary care team functioning, patients' use of acute care, and mortality. METHODOLOGY/APPROACH: Retrospective longitudinal cohort analysis of patient outcomes measured at two time points (2012 and 2013) after PCMH implementation began in Veterans Health Administration practices. Multilevel models examined practice-level measures of team functioning in relationship to patient outcomes (all-cause and ambulatory care-sensitive condition-related hospitalizations, emergency department visits, and mortality). We controlled for practice-level factors likely to affect team functioning, including leadership support, provider and staff burnout, and staffing sufficiency, as well as for individual patient characteristics. We also tested the model among a subgroup of vulnerable patients (homeless, mentally ill, or with dementia). RESULTS: In adjusted analyses, higher team functioning was associated with lower mortality (OR = 0.92, p = .04) among all patients and with fewer all-cause admissions (incidence rate ratio [IRR] = 0.90, p < 0.01), ambulatory care-sensitive condition-related admissions (IRR = 0.91, p = .04), and emergency department visits (IRR = 0.91, p = .03) in the vulnerable patient subgroup. CONCLUSION: These early findings give support for the importance of team functioning within PCMH models for achieving improved patient outcomes. PRACTICE IMPLICATIONS: A focus on team functioning is important especially in the early implementation of team-based primary care models.
Topic(s):
Medical Home
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Reference Links: 
View the DOI record for Team functioning as a predictor of patient outcomes in early medical home implementation
View DOI Record
View the PubMed citation for Team functioning as a predictor of patient outcomes in early medical home implementation482
Team functioning as a predictor of patient outcomes in early medical home implementation
Type: Journal Article
Year: 2018
Publication Place: United States
Abstract: BACKGROUND: New models of patient-centered primary care such as the patient-centered medical home (PCMH) depend on high levels of interdisciplinary primary care team functioning to achieve improved outcomes. A few studies have qualitatively assessed barriers and facilitators to optimal team functioning; however, we know of no prior study that assesses PCMH team functioning in relationship to patient health outcomes. PURPOSE: The aim of the study was to assess the relationships between primary care team functioning, patients' use of acute care, and mortality. METHODOLOGY/APPROACH: Retrospective longitudinal cohort analysis of patient outcomes measured at two time points (2012 and 2013) after PCMH implementation began in Veterans Health Administration practices. Multilevel models examined practice-level measures of team functioning in relationship to patient outcomes (all-cause and ambulatory care-sensitive condition-related hospitalizations, emergency department visits, and mortality). We controlled for practice-level factors likely to affect team functioning, including leadership support, provider and staff burnout, and staffing sufficiency, as well as for individual patient characteristics. We also tested the model among a subgroup of vulnerable patients (homeless, mentally ill, or with dementia). RESULTS: In adjusted analyses, higher team functioning was associated with lower mortality (OR = 0.92, p = .04) among all patients and with fewer all-cause admissions (incidence rate ratio [IRR] = 0.90, p < 0.01), ambulatory care-sensitive condition-related admissions (IRR = 0.91, p = .04), and emergency department visits (IRR = 0.91, p = .03) in the vulnerable patient subgroup. CONCLUSION: These early findings give support for the importance of team functioning within PCMH models for achieving improved patient outcomes. PRACTICE IMPLICATIONS: A focus on team functioning is important especially in the early implementation of team-based primary care models.
Topic(s):
Medical Home
See topic collection
Reference Links:
View the DOI record for Team functioning as a predictor of patient outcomes in early medical home implementation
View DOI Record
View the PubMed citation for Team functioning as a predictor of patient outcomes in early medical home implementation483
Teamwork and Delegation in Medical Homes: Primary Care Staff Perspectives in the Veterans Health Administration
Type: Journal Article
Year: 2014
Abstract: BACKGROUND: The patient-centered medical home (PCMH) relies on a team approach to patient care. For organizations engaged in transitioning to a PCMH model, identifying and providing the resources needed to promote team functioning is essential. OBJECTIVE: To describe team-level resources required to support PCMH team functioning within the Veterans Health Administration (VHA), and provide insight into how the presence or absence of these resources facilitates or impedes within-team delegation. DESIGN: Semi-structured interviews with members of pilot teams engaged in PCMH implementation in 77 primary care clinics serving over 300,000 patients across two VHA regions covering the Mid-Atlantic and Midwest United States. PARTICIPANTS: A purposive sample of 101 core members of pilot teams, including 32 primary care providers, 42 registered nurse care managers, 15 clinical associates, and 12 clerical associates. APPROACH: Investigators from two evaluation sites interviewed frontline primary care staff separately, and then collaborated on joint analysis of parallel data to develop a broad, comprehensive understanding of global themes impacting team functioning and within-team delegation. KEY RESULTS: We describe four themes key to understanding how resources at the team level supported ability of primary care staff to work as effective, engaged teams. Team-based task delegation was facilitated by demarcated boundaries and collective identity; shared goals and sense of purpose; mature and open communication characterized by psychological safety; and ongoing, intentional role negotiation. CONCLUSIONS: Our findings provide a framework for organizations to identify assets already in place to support team functioning, as well as areas in need of improvement. For teams struggling to make practice changes, our results indicate key areas where they may benefit from future support. In addition, this research sheds light on how variation in medical home implementation and outcomes may be associated with variation in team-based task delegation.
Topic(s):
Education & Workforce
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, Medical Home
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Reference Links:
View the DOI record for Teamwork and Delegation in Medical Homes: Primary Care Staff Perspectives in the Veterans Health Administration
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View the PubMed citation for Teamwork and Delegation in Medical Homes: Primary Care Staff Perspectives in the Veterans Health Administration484
Technologies in the patient-centered medical home: Examining the model from an enterprise perspective
Type: Journal Article
Year: 2011
Publication Place: United States
Abstract: Fee-for-service reimbursement has fragmented the healthcare system. Providers are paid based on the number of services rendered instead of quality, leading to the cost of care rising at a faster rate than its value. One approach to counter this is the Patient-Centered Medical Home (PCMH), a primary care model that emphasizes team-based medicine, a partnership between patients and providers, and expanded access and communication. The transition to PCMH is facilitated by innovative technologies, such as telemedicine for additional services, electronic medical records to document patients' health needs, and online portals for electronic visits and communication between patients and providers. Implementing these technologies involves tremendous investment of funds and time from practices and healthcare organizations. Although PCMH does not require such technologies, they facilitate its success, as care coordination and population management necessitated by the model are difficult to do without. This article argues that there is a paradox in PCMH and technology is at its center. Although PCMH intends to be cost effective by reducing hospital admissions and ER visits through providing better preventative services, it is actually a financial risk due to the very real upfront costs of implementing and sustaining technologies needed to carry out the intent of the PCMH model, which may not be made up immediately, if ever. This article delves into the rationale behind why payers, providers, and patients have adopted PCMH regardless of this risk and in doing so, maps out the roles that innovative technologies play in the conversion to PCMH.
Topic(s):
Financing & Sustainability
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, HIT & Telehealth
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, Healthcare Policy
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, Medical Home
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Reference Links:
View the DOI record for Technologies in the patient-centered medical home: Examining the model from an enterprise perspective
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View the PubMed citation for Technologies in the patient-centered medical home: Examining the model from an enterprise perspective487
The Behavioral Health Laboratory: Building a stronger foundation for the patient-centered medical home
Type: Journal Article
Year: 2010
Publication Place: United States
Topic(s):
Medical Home
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Reference Links:
View the DOI record for The Behavioral Health Laboratory: Building a stronger foundation for the patient-centered medical home
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View the PubMed citation for The Behavioral Health Laboratory: Building a stronger foundation for the patient-centered medical home488
The changes involved in patient-centered medical home transformation
Type: Journal Article
Year: 2012
Publication Place: United States
Topic(s):
Medical Home
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Reference Links:
View the DOI record for The changes involved in patient-centered medical home transformation
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View the PubMed citation for The changes involved in patient-centered medical home transformation489
The Columbia-Harlem Homeless Medical Partnership: A new model for learning in the service of those in medical need
Type: Journal Article
Year: 2009
Publication Place: United States
Abstract: Though altruism and patient advocacy are promoted in medical education curricula, students are given few opportunities to develop these skills. Student-run clinics focusing on the health needs of the underserved can provide important health services to needy patients while providing students with career-influencing primary care experiences. The Columbia-Harlem Homeless Medical Partnership (CHHMP)-a project initiated by medical students to provide primary care to Northern Manhattan's homeless population-serves as a new model of service learning in medical education. Unlike many other student-run clinics, CHHMP has developed direct patient outreach, continuous care (stable "student-patient teams" and a weekly commitment for all volunteers), and regular internal data review. Chart review data presented demonstrate the project's success in providing care to the clinic's target population of homeless and unstably housed patients. Targeted outreach efforts among clients have increased rates of patient follow-up at each subsequent review period. Additionally, CHHMP has used review data to develop services concordant with identified patient needs (psychiatric care and social services). CHHMP has recruited a committed group of volunteers and continues to engender an interest in the health needs of the underserved among students. Not only does CHHMP provide a "medical home" for homeless patients, it also provides a space in which students can develop skills unaddressed in large teaching hospitals. This project, a "win-win" for patients and students, serves as a unique model for community health-based service learning in medical education.
Topic(s):
Education & Workforce
See topic collection
, Healthcare Disparities
See topic collection
, Medical Home
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Reference Links:
View the DOI record for The Columbia-Harlem Homeless Medical Partnership: A new model for learning in the service of those in medical need
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View the PubMed citation for The Columbia-Harlem Homeless Medical Partnership: A new model for learning in the service of those in medical need490
The complexity, diversity, and science of primary care teams
Type: Journal Article
Year: 2018
Publication Place: United States
Topic(s):
Financing & Sustainability
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, Medical Home
See topic collection
Reference Links:
View the DOI record for The complexity, diversity, and science of primary care teams
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View the PubMed citation for The complexity, diversity, and science of primary care teams491
The development of joint principles: integrating behavioral health care into the patient-centered medical home
Type: Journal Article
Year: 2014
Publication Place: United States
Abstract: This article describes the development of the Joint Principles of The Patient-Centered Medical Home (PCMH) by the Working Party Group on Integrated Behavioral Healthcare. The Joint Principles establish the primacy of integrated behavioral health care as a core principle of the PCMH.
Topic(s):
Medical Home
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Reference Links:
View the DOI record for The development of joint principles: integrating behavioral health care into the patient-centered medical home
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View the PubMed citation for The development of joint principles: integrating behavioral health care into the patient-centered medical home492
The development of joint principles: integrating behavioral health care into the patient-centered medical home
Type: Journal Article
Year: 2014
Publication Place: United States
Topic(s):
Medical Home
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Reference Links:
View the DOI record for The development of joint principles: integrating behavioral health care into the patient-centered medical home
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View the PubMed citation for The development of joint principles: integrating behavioral health care into the patient-centered medical home494
The effects of the Maryland Medicaid Health Home Waiver on Emergency Department and inpatient utilization among individuals with serious mental illness
Type: Journal Article
Year: 2019
Publication Place: United States
Topic(s):
Financing & Sustainability
See topic collection
, Healthcare Disparities
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, Medical Home
See topic collection
496
The experience of Patient Aligned Care Team (PACT) members
Type: Journal Article
Year: 2014
Abstract: BACKGROUND:: In April 2010, the Veterans Health Administration (VHA) launched the Patient Aligned Care Team (PACT) initiative to implement a patient-centered medical home (PCMH) model. Few evaluations have addressed the effects of PCMH on health care professionals' experiences. PURPOSES:: The aim of this study was to contribute to evaluation of the PACT initiative and the broader literature on PCMH by assessing respondents' experiences of implementing a PCMH model and becoming a teamlet. METHODOLOGY/APPROACH:: A retrospective qualitative analysis of open-text responses in a survey fielded to all VHA Primary Care personnel (VHA Primary Care physicians, nurse practitioners, physician assistants, nurse care managers, clinical associates, and administrative clerks) in May and June 2012 (approximately 2 years into the 5-year planned implementation of PACT) using deductive and inductive content analysis. The main measures were two open-response fields: "Is there anything else you would like us to relay to the VA leadership in Central Office?" and "Do you have any other comments or feedback on PACT?" The data consisted of free text responses of 3,868 survey participants who provided text for one or both of the open-response fields. FINDINGS:: Although respondents viewed PACT positively as a model and reported it improved relationships with patients and increased patient satisfaction, they described multiple barriers to achieving functioning teamlets and unintended consequences, including reduced time with patients, increased participant burnout, and decreased team efficacy because of low-performing team members. A central theme related to staffing being insufficient for the new model. PRACTICE IMPLICATIONS:: Insufficient staffing of PCMH teams is a critical barrier to realizing the benefits of the new model. Frontline staff have concrete recommendations for other problems, such as using back-up teams to cover during absences, but that will require providing more opportunities for feedback from staff to be heard.
Topic(s):
Education & Workforce
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, Medical Home
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Reference Links: View the PubMed citation for The experience of Patient Aligned Care Team (PACT) members
497
The future of pediatrics: Mental health competencies for pediatric primary care
Type: Journal Article
Year: 2009
Publication Place: United States
Abstract: Pediatric primary care clinicians have unique opportunities and a growing sense of responsibility to prevent and address mental health and substance abuse problems in the medical home. In this report, the American Academy of Pediatrics proposes competencies requisite for providing mental health and substance abuse services in pediatric primary care settings and recommends steps toward achieving them. Achievement of the competencies proposed in this statement is a goal, not a current expectation. It will require innovations in residency training and continuing medical education, as well as a commitment by the individual clinician to pursue, over time, educational strategies suited to his or her learning style and skill level. System enhancements, such as collaborative relationships with mental health specialists and changes in the financing of mental health care, must precede enhancements in clinical practice. For this reason, the proposed competencies begin with knowledge and skills for systems-based practice. The proposed competencies overlap those of mental health specialists in some areas; for example, they include the knowledge and skills to care for children with attention-deficit/hyperactivity disorder, anxiety, depression, and substance abuse and to recognize psychiatric and social emergencies. In other areas, the competencies reflect the uniqueness of the primary care clinician's role: building resilience in all children; promoting healthy lifestyles; preventing or mitigating mental health and substance abuse problems; identifying risk factors and emerging mental health problems in children and their families; and partnering with families, schools, agencies, and mental health specialists to plan assessment and care. Proposed interpersonal and communication skills reflect the primary care clinician's critical role in overcoming barriers (perceived and/or experienced by children and families) to seeking help for mental health and substance abuse concerns.
Topic(s):
Education & Workforce
See topic collection
, Financing & Sustainability
See topic collection
, Healthcare Disparities
See topic collection
, Healthcare Policy
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, Medical Home
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Reference Links:
View the DOI record for The future of pediatrics: Mental health competencies for pediatric primary care
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View the PubMed citation for The future of pediatrics: Mental health competencies for pediatric primary care498
The group health medical home at year two: Cost savings, higher patient satisfaction, and less burnout for providers
Type: Journal Article
Year: 2010
Publication Place: United States
Abstract: As the patient-centered medical home model emerges as a key vehicle to improve the quality of health care and to control costs, the experience of Seattle-based Group Health Cooperative with its medical home pilot takes on added importance. This paper examines the effects of the medical home prototype on patients' experiences, quality, burnout of clinicians, and total costs at twenty-one to twenty-four months after implementation. The results show improvements in patients' experiences, quality, and clinician burnout through two years. Compared to other Group Health clinics, patients in the medical home experienced 29 percent fewer emergency visits and 6 percent fewer hospitalizations. We estimate total savings of $10.3 per patient per month twenty-one months into the pilot. We offer an operational blueprint and policy recommendations for adoption in other health care settings.
Topic(s):
Financing & Sustainability
See topic collection
, Medical Home
See topic collection
, Healthcare Policy
See topic collection
Reference Links:
View the DOI record for The group health medical home at year two: Cost savings, higher patient satisfaction, and less burnout for providers
View DOI Record
View the PubMed citation for The group health medical home at year two: Cost savings, higher patient satisfaction, and less burnout for providers499
The health care home model: primary health care meeting public health goals
Type: Journal Article
Year: 2012
Publication Place: United States
Abstract: In November 2010, the American Public Health Association endorsed the health care home model as an important way that primary care may contribute to meeting the public health goals of increasing access to care, reducing health disparities, and better integrating health care with public health systems. Here we summarize the elements of the health care home (also called the medical home) model, evidence for its clinical and public health efficacy, and its place within the context of health care reform legislation. The model also has limitations, especially with regard to its degree of involvement with the communities in which care is delivered. Several actions could be undertaken to further develop, implement, and sustain the health care home.
Topic(s):
Medical Home
See topic collection
Reference Links:
View the DOI record for The health care home model: primary health care meeting public health goals
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View the PubMed citation for The health care home model: primary health care meeting public health goals