Literature Collection

501

The development of joint principles: integrating behavioral health care into the patient-centered medical home

Type: Journal Article

Authors: M. Baird, A. Blount, S. Brungardt, P. Dickinson, A. Dietrich, T. Epperly, L. Green, D. Henley, R. Kessler, N. Korsen, S. McDaniel, B. Miller, P. Pugno, R. Roberts, J. Schirmer, D. Seymour, F. DeGruy

Year: 2014

Publication Place: United States

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502

The effect of medical home on shared decision-making for caregivers of children with emotional, developmental, or behavioral health conditions

Type: Journal Article

Authors: Mckenzee Chiam, Erick Rojas, Meredith R. Bergey, Thomas I. Mackie

Year: 2021

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503

The effects of the Maryland Medicaid Health Home Waiver on Emergency Department and inpatient utilization among individuals with serious mental illness

Type: Journal Article

Authors: S. N. Bandara, A. Kennedy-Hendricks, E. A. Stuart, C. L. Barry, M. T. Abrams, G. L. Daumit, E. E. McGinty

Year: 2019

Publication Place: United States

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504

The empowerment paradox as a central challenge to patient centered medical home implementation in the veteran's health administration

Type: Journal Article

Authors: Samantha L. Solimeo, Sarah S. Ono, Michelle A. M. Lampman, Monica B. W. Paez, Gregory L. Stewart

Year: 2015

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505

The experience of Patient Aligned Care Team (PACT) members

Type: Journal Article

Authors: A. C. Ladebue, C. D. Helfrich, Z. T. Gerdes, S. D. Fihn, K. M. Nelson, G. G. Sayre

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.

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506

The future of pediatrics: Mental health competencies for pediatric primary care

Type: Journal Article

Authors: Committee on Psychosocial Aspects of Child and Family Health and Task Force on Mental Health

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.

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507

The group health medical home at year two: Cost savings, higher patient satisfaction, and less burnout for providers

Type: Journal Article

Authors: R. J. Reid, K. Coleman, E. A. Johnson, P. A. Fishman, C. Hsu, M. P. Soman, C. E. Trescott, M. Erikson, E. B. Larson

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.

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508

The health care home model: primary health care meeting public health goals

Type: Journal Article

Authors: R. Grant, D. Greene

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.

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509

The Heart Program: Integrated mental health care in an adolescent obstetric and teen-tot medical home

Type: Journal Article

Authors: Celeste St John-Larkin

Year: 2016

Publication Place: Baltimore

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510

The Hope Health and Wellness Clinic: Outcomes of Individuals with Serious Mental Illness in a Bidirectional Integrated Care Clinic

Type: Journal Article

Authors: A. Soberay, L. W. Tolle, E. Kienitz, A. Olson

Year: 2020

Publication Place: United States

Abstract:

The integrated health home, the Hope Health and Wellness Clinic, provides comprehensive primary and behavioral health services to adult clients of a Community Mental Health Center in Aurora, Colorado. A program evaluation of the effectiveness of this clinic was conducted over a 4 year period. Physical health data (Body Mass Index BMI, HbA1c, cholesterol, blood pressure, and waist circumference measurements) and self-report data (social connectedness, everyday functioning, psychological distress, perceived health, satisfaction with services) were tracked across time. Individuals enrolled (N = 534) experienced significant improvements over time in LDL and total cholesterol, as well as self-reported social connectedness, everyday functioning, perceived health, and psychological distress. At risk individuals demonstrated significant improvements in HDL cholesterol, triglycerides, blood pressure, tobacco and alcohol use. Individuals with serious mental illness show improvements in physical health and self-reported health after being involved in bidirectional integrated care.

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511

The impact of a complex care clinic in a children's hospital

Type: Journal Article

Authors: E. Cohen, J. N. Friedman, S. Mahant, S. Adams, V. Jovcevska, P. Rosenbaum

Year: 2010

Publication Place: England

Abstract: BACKGROUND: The number of medically complex and fragile children (MCFC) cared for in children's hospitals is growing, necessitating the need for optimal care co-ordination. The purpose of this study was to describe the impact of a nurse practitioner/paediatrician-run complex care clinic in a tertiary care hospital on healthcare utilization, parental and primary care provider (PCP) perceptions of care and parental quality of life. METHODS: MCFC and their parents were recruited for ambulatory follow-up by the hospital team to complement care provided by the PCP in this mixed methods single centre pre- or post-evaluative study. Parents participated in semi-structured interviews within 48 h of discharge; further data were collected at 6 and 12 months. Healthcare utilization was compared with equal time periods pre-enrolment. Parental health was assessed with the SF-36; parental perceptions of care were assessed using the Larsen's Client Satisfaction Questionnaire and the Measure of Processes of Care; PCPs completed a questionnaire at 12 months. Parental and PCP comments were elicited. Comparisons were made with baseline data. RESULTS: Twenty-six children and their parental caregivers attended the complex care clinic. The number of days that children were admitted to hospital decreased from a median of 43 to 15 days, and outpatient visits increased from 2 to 8. Mean standardized scores on the SF-36 increased (improved) for three domains related to mental health. A total of 24 PCPs responded to the questionnaire (92% response); most found the clinic helpful for MCFC and their families. Parents reported improvements in continuity of care, family-centredness of care, comprehensiveness and thoroughness of care, but still experienced frustrations with access to services and miscommunication with the team. CONCLUSION: A collaborative medical home focused on integrating community- and hospital-based services for MCFC is a promising service delivery model for future controlled evaluative studies.

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512

The Impact of Alternative Payment in Chronically Ill and Older Patients in the Patient-centered Medical Home

Type: Journal Article

Authors: C. A Salzberg, A. Bitton, S. R. Lipsitz, C. Franz, S. Shaykevich, L. P. Newmark, J. Kwatra, D. W. Bates

Year: 2017

Publication Place: United States

Abstract: BACKGROUND: Patient-centered medical home (PCMH) has gained prominence as a promising model to encourage improved primary care delivery. There is a paucity of studies that evaluate the impact of payment models in the PCMH. OBJECTIVES: We sought to examine whether coupling coordinated, team-based care transformation plan with a novel reimbursement model affects outcomes related to expenditures and utilization. RESEARCH DESIGN: Interrupted time-series model with a difference-in-differences approach to assess differences between intervention and control groups, across time periods attributable to PCMH transformation and/or payment change. RESULTS: Although results were modest and mixed overall, PCMH with payment reform is associated with a reduction of $1.04 (P=0.0347) per member per month (PMPM) in pharmacy expenditures. Patients with hypertension, hyperlipidemia, diabetes, and coronary atherosclerosis enrolled in PCMH without payment reform experienced reductions in emergency department visits of 2.16 (P<0.0001), 2.42 (P<0.0001), 3.98 (P<0.0001), and 3.61 (P<0.0001) per 1000 per month. Modest increases in inpatient admission were seen among these patients in PCMH either with or without payment reform. Patients 65 and older enrolled in PMCH without payment reform experienced reductions in pharmacy expenditures $2.35 (P=0.0077) PMPM with a parallel reduction in pharmacy standardized cost of $2.81 (P=0.0174) PMPM indicative of a reduction in the intensity of drug utilization. CONCLUSIONS: We conclude that PCMH implementation coupled with an innovative payment arrangement generated mixed results with modest improvements with respect to pharmacy expenditures, but no overall financial improvement. However, we did see improvement within specific groups, especially older patients and those with chronic conditions.

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513

The impact of Medical Home on selected children's health outcome

Type: Journal Article

Authors: Michael M. O. Seipel

Year: 2011

Publication Place: United Kingdom: Taylor & Francis

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514

The Impact of the Patient-Centered Medical Home on Health Care Disparities: Exploring Stakeholder Perspectives on Current Standards and Future Directions

Type: Journal Article

Authors: Emilia H. De Marchis, Rachel Willard-Grace, J. N. Olayiwola, Kirti Doekhie

Year: 2019

Publication Place: New Rochelle, New York

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515

The importance of time in treating mental health in primary care

Type: Journal Article

Authors: B. F. Miller, B. Teevan, R. L. Phillips, S. M. Petterson, A. W. Bazemore

Year: 2011

Publication Place: United States

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516

The Integrated Care Team Approach of the Department of Veterans Affairs (VA): Geriatric Primary Care

Type: Journal Article

Authors: D. Rasin-Waters, V. Abel, L. K. Kearney, A. Zeiss

Year: 2018

Publication Place: United States

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517

The Integration of Care for Mental Health, Substance Abuse, and Other Behavioral Health Conditions Into Primary Care

Type: Journal Article

Authors: R. Saitz, S. E. Wakeman, J. F. Kelly

Year: 2016

Publication Place: United States

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518

The Integration of Care for Mental Health, Substance Abuse, and Other Behavioral Health Conditions Into Primary Care

Type: Journal Article

Authors: R. A. Crowley, N. Kirschner, D. V. Moyer

Year: 2016

Publication Place: United States

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519

The medical home and integrated behavioral health

Type: Journal Article

Authors: J. M. Foy

Year: 2015

Publication Place: United States

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520

The medical home and integrated behavioral health: Advancing the policy agenda

Type: Journal Article

Authors: J. Ader, C. J. Stille, D. Keller, B. F. Miller, M. S. Barr, J. M. Perrin

Year: 2015

Publication Place: United States

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