Literature Collection | Integration Academy

4941

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

Authors: R. Myers

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.

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4942

Functional concerns and treatment priorities among veterans receiving VHA Primary Care Behavioral Health services

Type: Journal Article

Authors: P. R. King, G. P. Beehler, L. J. Buchholz, E. M. Johnson, L. O. Wray

Year: 2019

Publication Place: United States

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4943

Functional evaluation of NK(1) antagonism on cue reactivity in opiate dependence; An fMRI study

Type: Journal Article

Authors: L. Fonville, L. Paterson, K. Herlinger, A. Hayes, R. Hill, D. Nutt, A. Lingford-Hughes

Year: 2021

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4944

Functional Limitations and Associated Factors among Older Low-Income U.S. Veterans: Results from the National Veteran Homeless and Other Poverty Experiences Study

Type: Journal Article

Authors: J. Liang, J. Tsai

Year: 2026

Abstract:

INTRODUCTION: Older low-income U.S. veterans experience elevated physical and social vulnerabilities, yet their functional limitations remain understudied. This study estimated the prevalence of activity of daily living (ADL) and instrumental activity of daily living (IADL) limitations and identified associated sociodemographic, health, and psychosocial factors. MATERIALS AND METHODS: We analyzed nationally representative data from the 2021 National Veteran Homeless and Other Poverty Experiences (NV-HOPE) Study of low-income veterans aged ≥ 55 years (N = 877; weighted ≈ 7.41 million). Survey-weighted logistic regression models identified factors associated with any ADL or IADL limitation across sociodemographic, health (chronic conditions, depression, anxiety, other mental diagnoses), and social/contextual domains (network size, perceived support, loneliness, housing). Exploratory margins analyses were used to descriptively examine potential differences across sex and race/ethnicity. RESULTS: Overall, 4.28% reported having at least 1 ADL limitation and 14.98% having at least 1 IADL limitation. ADL limitations were associated with higher anxiety (odds ratio [OR] = 1.32, 95% confidence interval [CI]: 1.04-1.67), "other" race/ethnicity (OR = 3.98, 95% CI: 1.27-12.51), and some college education (OR = 3.43, 95% CI: 1.13-10.46), whereas home ownership was protective (OR = 0.38, 95% CI: 0.16-0.91). IADL limitations were associated with Black (OR = 2.41, 95% CI: 1.12-5.16) and "other" race/ethnicity (OR = 2.61, 95% CI: 1.13-6.05), more chronic conditions (OR = 1.24 per condition, 95% CI: 1.10-1.40), higher anxiety (OR = 1.27, 95% CI: 1.04-1.54), and other mental diagnoses (OR = 2.15, 95% CI: 1.13-4.09); a moderate social network (3-5) was protective (OR = 0.37, 95% CI: 0.16-0.85). Descriptive subgroup analyses indicated that associations between mental health and ADL limitation appeared stronger among women, whereas relationships between depression, anxiety, or loneliness and IADL limitation varied across racial and ethnic groups. CONCLUSIONS: Functional limitations among older low-income veterans are multifactorial, reflecting intersecting demographic, clinical, and social determinants. Findings support integrated care models that combine mental-health screening and social-resource supports. Exploratory subgroup patterns highlight the importance of considering sex and race/ethnicity in identifying low-income veterans most at risk for functional decline and in tailoring prevention and intervention efforts.

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4945

Functional outcomes of multi-condition collaborative care and successful ageing: results of randomised trial

Type: Journal Article

Authors: M. Von Korff, W. J. Katon, E. H. Lin, P. Ciechanowski, D. Peterson, E. J. Ludman, B. Young, C. M. Rutter

Year: 2011

Publication Place: England

Abstract: OBJECTIVE: To evaluate the effectiveness of integrated care for chronic physical diseases and depression in reducing disability and improving quality of life. DESIGN: A randomised controlled trial of multi-condition collaborative care for depression and poorly controlled diabetes and/or risk factors for coronary heart disease compared with usual care among middle aged and elderly people SETTING: Fourteen primary care clinics in Seattle, Washington. PARTICIPANTS: Patients with diabetes or coronary heart disease, or both, and blood pressure above 140/90 mm Hg, low density lipoprotein concentration >3.37 mmol/L, or glycated haemoglobin 8.5% or higher, and PHQ-9 depression scores of >/= 10. INTERVENTION: A 12 month intervention to improve depression, glycaemic control, blood pressure, and lipid control by integrating a "treat to target" programme for diabetes and risk factors for coronary heart disease with collaborative care for depression. The intervention combined self management support, monitoring of disease control, and pharmacotherapy to control depression, hyperglycaemia, hypertension, and hyperlipidaemia. MAIN OUTCOME MEASURES: Social role disability (Sheehan disability scale), global quality of life rating, and World Health Organization disability assessment schedule (WHODAS-2) scales to measure disabilities in activities of daily living (mobility, self care, household maintenance). RESULTS: Of 214 patients enrolled (106 intervention and 108 usual care), disability and quality of life measures were obtained for 97 intervention patients at six months (92%) and 92 at 12 months (87%), and for 96 usual care patients at six months (89%) and 92 at 12 months (85%). Improvements from baseline on the Sheehan disability scale (-0.9, 95% confidence interval -1.5 to -0.2; P = 0.006) and global quality of life rating (0.7, 0.2 to 1.2; P = 0.005) were significantly greater at six and 12 months in patients in the intervention group. There was a trend toward greater improvement in disabilities in activities of daily living (-1.5, -3.3 to 0.4; P = 0.10). CONCLUSIONS: Integrated care that covers chronic physical disease and comorbid depression can reduce social role disability and enhance global quality of life. Trial registration Clinical Trials NCT00468676.

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4946

Functional roles and foundational characteristics of psychologists in integrated primary care

Type: Journal Article

Authors: J. M. Nash, K. M. McKay, M. E. Vogel, K. S. Masters

Year: 2012

Publication Place: United States

Abstract: Psychologists are presented with unprecedented opportunities to integrate their work in primary care settings. Although some roles of psychologists in primary care overlap with those in traditional psychology practice settings, a number are distinct reflecting the uniqueness of the primary care culture. In this paper, we first describe the integrated primary care setting, with a focus on those settings that have components of patient centered medical home. We then describe functional roles and foundational characteristics of psychologists in integrated primary care. The description of functional roles emphasizes the diversity of roles performed. The foundational characteristics identified are those that we consider the 'primary care ethic,' or core characteristics of psychologists that serve as the basis for the various functional roles in integrated primary care. The 'primary care ethic' includes attitudes, values, knowledge, and abilities that are essential to the psychologist being a valued, effective, and productive primary care team member.

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4947

Functioning and disability levels in primary care out-patients with one or more anxiety disorders

Type: Journal Article

Authors: Cathy D. Sherbourne, Greer Sullivan, Michelle G. Craske, Peter P. Roy-Byrne, Daniela Golinelli, Raphael D. Rose, Denise A. Chavira, Alexander Bystritsky, Murray B. Stein

Year: 2010

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4948

Fundamentals of primary care behavioral health integration

Type: Book Chapter

Authors: Anne C. Dobmeyer

Year: 2018

Publication Place: Washington, DC

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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4949

Funding Accountable Care in Oregon: Financial Models in Two Coordinated Care Organizations

Type: Journal Article

Authors: Lauren Broffman, Kristin Brown, K. B. Bayley, Lucy Savitz, Jill Rissi

Year: 2016

Publication Place: Chicago, Illinois

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4950

Funding and Billing for Integrated Behavioral Health Care

Type: Journal Article

Authors: K. Patel, R. W. Apple, J. Campbell

Year: 2021

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4951

Funding mechanisms for depression care management: Opportunities and challenges

Type: Journal Article

Authors: J. Bachman, H. A. Pincus, J. K. Houtsinger, J. Unutzer

Year: 2006

Publication Place: United States

Abstract: OBJECTIVE: Inconsistent third-party reimbursement for depression care management is a significant economic barrier to the utilization and sustainability of the chronic illness care model in primary care practice settings. We review common mechanisms used to procure payment for depression care management services, discuss obstacles encountered and suggest future directions. METHOD: We describe several extant models for funding depression care management services in use at the demonstration sites of the Robert Wood Johnson Foundation funded "Depression in Primary Care" project and similar programs. We derived this information from ongoing discussions with the sites' project directors and through an extensive electronic literature search on "care management, funding mechanisms and depression." RESULTS: Funding mechanisms include (a) practice-based care management on a fee-for-service basis, (b) practice-based care management under contract to health plans, (c) global capitation, (d) flexible infrastructure support for chronic care management, (e) health-plan-based care management, (f) third-party-based care management under contract to health plans and (g) hybrid models. CONCLUSIONS: While substantial obstacles remain in the way of fully implementing these depression care management funding mechanisms (e.g., variations in care managers' credentials and work locations and third-party payer concerns about overutilization and transaction costs), several recent policy advances provide some optimism for the potential adoption of financial mechanisms to support and disseminate these evidence-based practices.

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4952

Funding, financing, and investing in integrated early childhood mental health services in primary care settings

Type: Book Chapter

Authors: Ayelet Talmi, Melissa Buchholz, Emily F. Muther

Year: 2016

Publication Place: Switzerland

Topic(s):

,

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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4953

Funding, financing, and investing in integrated early childhood mental health services in primary care settings

Type: Book

Authors: Ayelet Talmi, Melissa Buchholz, Emily F. Muther

Year: 2016

Publication Place: Cham

Topic(s):

, ,

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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4954

Further Experience with the Practice Integration Profile: A Measure of Behavioral Health and Primary Care Integration

Type: Journal Article

Authors: J. R. Hitt, S. A. Brennhofer, M. P. Martin, C. R. Macchi, D. Mullin, C. van Eeghen, B. Littenberg, R. S. Kessler

Year: 2022

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4955

Further policy changes are needed to improve depression care

Type: Journal Article

Authors: K. Zivin, W. Katon

Year: 2015

Publication Place: United States

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4956

Furthering the reliable and valid measurement of mental health screening, diagnoses, treatment and outcomes through health information technology

Type: Journal Article

Year: 2013

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4957

Future complexity of care tier affected by depression outcomes

Type: Journal Article

Authors: K. B. Angstman, M. R. Meunier, J. E. Rohrer, S. S. Oberhelman, J. A. Maxson, P. A. Rahman

Year: 2014

Publication Place: United States

Abstract: BACKGROUND: The inclusion of mental health issues in the evaluation of multimorbidity generally has been as the presence or absence of the condition rather than severity, complexity, or stage. The hypothesis for this study was that clinical outcome of the depression 6 months after enrollment into collaborative care management would have a role in predicting future complexity of care tier. METHODS: This study was a retrospective chart review of 1894 primary care patients who were diagnosed with major depressive disorder or dysthymia as of December 2012. Multiple logistic regression analysis was used to test the independent associations between each variable and the odds of being included in the higher tiers (HT) group. RESULTS: Age (odds ratio [OR] = 1.022, confidence interval [CI] = 1.013-1.030, P /= 2, OR = 4.678, CI = 3.242-6.750, P /= 10) at 6 months conferred 2.280 (CI = 1.673-3.107, P < .001) times likely odds of HT level compared with clinical remission at 6 months. CONCLUSION: Patients with the diagnosis of major depression or dysthymia had greater odds of complex tier levels in the future, if depression was not treated to remission by 6 months. This study demonstrated the importance of the goal of significant improvement (ie, remission) of depression symptoms by 6 months (especially those older patients with more comorbidity) from entering into the higher complexity tiers.

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4958

Future directions for medication assisted treatment for opioid use disorder with American Indian/Alaska Natives

Type: Journal Article

Authors: Kamilla L. Venner, Dennis M. Donovan, Aimee N. C. Campbell, Dennis C. Wendt, Traci Rieckmann, Sandra M. Radin, Sandra L. Momper, Carmen L. Rosa

Year: 2018

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4959

Future directions in training, funding, and research

Type: Book Chapter

Authors: Anne C. Dobmeyer

Year: 2018

Publication Place: Washington, DC

Topic(s):

, ,

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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4960

Future research needs for evaluating the integration of mental health and substance abuse treatment with primary care

Type: Journal Article

Authors: T. S. Carey, K. A. Crotty, J. P. Morrissey, D. E. Jonas, S. Thaker, A. R. Ellis, C. Woodell, R. C. Wines, M. Viswanathan

Year: 2013

Publication Place: United States

Abstract: Research needs are many in the current health care environment. In this article, we describe a novel method developed by the Agency for Healthcare Research and Quality (AHRQ) Evidence-based Practice Center Program for prioritizing areas for future research. Using a recent- ly published systematic review as a foundation, investigators worked with a diverse group of 10 stakeholders to identify and prioritize research needs. We enumerate 13 high-priority research needs, as determined by stakeholders who represented researchers, funders, health care providers, and patients and families, and discuss considerations for specific study designs. Our findings suggest that future research on integrating mental health and primary care should focus first on a) identifying methods of integrating primary care into specialty mental health settings, b) identifying cross-cutting strategies for integration across multiple mental health diagnostic categories as opposed to a separate strategy for each diagnostic category, and c) examining the use of information technology for integrating mental and general medical health care. Other priorities for consideration include examining the economic and organizational sus- tainability of successful integration models, identifying dissemination methods for various settings, examining the business case for integration as well as methods of payment, assessing the cost-effectiveness of integration, and identifying key components of successful strategies. The importance of sustainability and economic justification for integrated care strategies was a recurring theme in discussions with the stake- holders. The ability to sustain integrated care in everyday practice remains to be proved and will depend in part on the level of incentives and sup- port provided through payment system reform, as well as the ability of practices to provide care efficiently.

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