TY - JOUR
T1 - Integrating behavioral and physical health care in the real world
T2 - Early lessons from Advancing Care Together
AU - Davis, Melinda
AU - Balasubramanian, Bijal A.
AU - Waller, Elaine
AU - Miller, Benjamin F.
AU - Green, Larry A.
AU - Cohen, Deborah J.
PY - 2013/9
Y1 - 2013/9
N2 - Background: More than 20 years ago the Institute of Medicine advocated for integration of physical and behavioral health care. Today, practices are integrating care in response to recent policy initiatives. However, few studies describe how integration is accomplished in real-world practices without the financial or research support available for most randomized controlled trials. Methods: To study how practices integrate care, we are conducting a cross-case comparative, mixedmethods study of 11 practices participating in Advancing Care Together (ACT). Using a grounded theory approach, we analyzed multiple sources of data (eg, documents, practice surveys, field notes from observation visits, semistructured interviews, online diaries) collected from each ACT innovator. Results: Integration requires making changes in organization and interpersonal relationships. During early integration efforts, challenges related to workflow and access, leadership and culture change, and tracking and using data to evaluate patient- and practice-level improvement emerged for ACT innovators. We describe the strategies innovators are developing to address these challenges. Conclusion: Integrating care is a fundamental and difficult change for practices and health care professionals. Research identifying common challenges that manifest in early efforts can help others attempting integration and inform state, local, and federal policies aimed at achieving wide-spread implementation.
AB - Background: More than 20 years ago the Institute of Medicine advocated for integration of physical and behavioral health care. Today, practices are integrating care in response to recent policy initiatives. However, few studies describe how integration is accomplished in real-world practices without the financial or research support available for most randomized controlled trials. Methods: To study how practices integrate care, we are conducting a cross-case comparative, mixedmethods study of 11 practices participating in Advancing Care Together (ACT). Using a grounded theory approach, we analyzed multiple sources of data (eg, documents, practice surveys, field notes from observation visits, semistructured interviews, online diaries) collected from each ACT innovator. Results: Integration requires making changes in organization and interpersonal relationships. During early integration efforts, challenges related to workflow and access, leadership and culture change, and tracking and using data to evaluate patient- and practice-level improvement emerged for ACT innovators. We describe the strategies innovators are developing to address these challenges. Conclusion: Integrating care is a fundamental and difficult change for practices and health care professionals. Research identifying common challenges that manifest in early efforts can help others attempting integration and inform state, local, and federal policies aimed at achieving wide-spread implementation.
KW - Implementation research
KW - Integrated care
KW - Mental health
KW - Mixed methods
KW - Primary health care
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U2 - 10.3122/jabfm.2013.05.130028
DO - 10.3122/jabfm.2013.05.130028
M3 - Article
C2 - 24004711
AN - SCOPUS:84883715351
SN - 1557-2625
VL - 26
SP - 588
EP - 602
JO - Journal of the American Board of Family Medicine
JF - Journal of the American Board of Family Medicine
IS - 5
ER -