Literature Collection

BACKGROUND: With new payment systems to prompt more sophisticated data activities, primary care practices are developing technological capabilities to manage patient care and information. One burgeoning capability is the collection of social determinants of health (SDOH) data and using that information to provide social care. This study describes the information infrastructure and technological capabilities developed by community health centers (CHCs) and examines the factors influencing SDOH data integration and management in primary care practice. It offers health care leaders insights and strategies to build capacity for managing social care and quality. METHODS: An observational design was used to examine the technological capabilities of CHCs in Michigan via a practice survey, and factors related to developing information infrastructure were qualitatively explored. The practice survey, semi-structured interviews, and national health center data were analyzed. Sociotechnical systems and organizational theories were used to develop the survey and interview guide. A sample of Michigan CHCs (n = 15) was recruited for the study. The practice survey was administered to CHC leaders, clinicians, and staff (n = 27). Semi-structured interviews (n = 25) were then conducted to explore infrastructural, organizational, and technological factors associated with managing social care and information. RESULTS: Michigan CHCs developed capabilities to exchange patient information with state and local partners. Data were typically shared with maternal and infant health (n = 5, 33.3%), mental health (n = 5, 33.3%), substance use (n = 6, 40%), domestic violence (n = 6, 40%), and food assistance (n = 6, 40%) providers, but CHCs did not develop the same capabilities with all social services examined. The interviews revealed that CHCs leveraged health care and government investments in information technology (IT) as a strategy to share data and address quality. The survey results revealed that CHCs developed the ability to use SDOH data to manage population health and provide value-based care. CONCLUSIONS: IT used to manage social care and address quality is necessary but insufficient in primary care settings. The technological capabilities developed to integrate SDOH data into practice and exchange health information support critical infrastructure and learning opportunities to improve care, quality, and outcomes.

Screening for psychosis spectrum disorders in primary care could improve early identification and reduce the duration of untreated psychosis. However, the accuracy of psychosis screening in this setting is unknown. To address this, we conducted a diagnostic accuracy study of screening for psychosis spectrum disorders in eight behavioral health services integrated into primary care clinics. Patients attending an integrated behavioral health appointment at their primary care clinic completed the Prodromal Questionnaire - Brief (PQ-B) immediately prior to their intake assessment. This was compared to a diagnostic phone interview based on the Structured Interview for Psychosis Risk Syndromes (SIPS). In total, 145 participants completed all study procedures, of which 100 screened positive and 45 negative at a provisional PQ-B threshold of ≥20. The PQ-B was moderately accurate at differentiating psychosis spectrum from no psychosis spectrum disorders; a PQ-B distress score of ≥27 had a sensitivity and specificity of 71.2 % and 57.0 % respectively. In total, 66 individuals (45.5 %) met criteria for a psychosis spectrum disorder and 24 (16.7 %) were diagnosed with full psychosis, indicating a high prevalence of psychosis in the sample. Overall, screening for psychosis spectrum disorders in an IBH primary care setting identified a relatively high number of individuals and may identify people that would otherwise be missed. The PQ-B performed slightly less well than in population-based screening in community mental health settings. However, the findings suggest this may represent an effective way to streamline the pathway between specialty early psychosis programs and primary care clinics for those in need.

Diabetes self-management is critical for improving health outcomes, but people with severe mental illness (SMI) face additional barriers that complicate effective engagement with self-management behaviours and with existing diabetes services. This feasibility study assessed the acceptability and feasibility of the DIAMONDS intervention, a tailored type 2 diabetes (T2D) self-management programme designed for people with SMI and delivered by trained coaches over 16 weekly sessions, in preparation for a future randomised controlled trial (RCT). Thirty participants with both T2D and SMI were recruited, and 29 were included in the study. The thresholds for participant recruitment and retention for progression to the RCT were met. Twenty-three participants (66%) attended at least one intervention session. Consistent weekly participation proved challenging, with only 15 participants (52%) attending eight or more (50%+) sessions. However, the intervention was acceptable to both participants and coaches, as indicated by coach session logs. High completion rates were observed for self-reported measures, while physical health data and data from primary care records had some omissions, prompting refinements in data collection for the RCT. This study highlights the feasibility and acceptability of delivering an evaluation of a structured diabetes self-management intervention in people with SMI. Some modifications to study processes will be required before moving to the main RCT, including adjustments to intervention delivery (including more flexibility in the timing of intervention sessions and coach training to improve confidence in supporting the use of a mobile app), data collection processes, and intervention fidelity assessment for the RCT, to enhance adherence and accommodating the complex needs of this population. This study represents an important step towards the development and robust evaluation of a self-management intervention to improve diabetes outcomes for people with SMI, addressing a significant gap in health equity. CLINICAL TRIAL REGISTRATION: https://www.isrctn.com/ISRCTN15328700, ISRCTN 15328700.