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Hundt NE, Plasencia M, Amspoker AB, Yusuf Z, Walder A, Nagamoto H, Kim B, Tsao CGJ, Smith TL. Evaluation of the Implementation of the FLOW Program for Increasing Access to Mental Health Care. J Behav Health Serv Res 2024; 51:325-337. [PMID: 38789862 DOI: 10.1007/s11414-024-09886-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2024] [Indexed: 05/26/2024]
Abstract
The FLOW program was designed to facilitate appropriate and safe transitions of patients from specialty mental health (SMH) to primary care (PC) as a method of improving access and reducing appointment burden on veterans who have improved or remitted. In this study, the team evaluated the implementation of FLOW across nine Veterans Affairs (VA) sites using a mixed-methods evaluation in a cluster-randomized stepped wedge trial design. Outcome assessments used data from VA databases, dashboards, and semi-structured interviews and were guided by the Reach, Adoption, Effectiveness, Implementation, and Maintenance (RE-AIM) framework. Across the sites, mean level reach was 1.36% of all specialty mental health patients transitioned to primary care (standard deviation [SD] = 1.05). Mean provider adoption was 10.2% (SD = 8.3%). Approximately 75% of veterans were fully satisfied with their transition and reported shared decision-making in the decision to transition. Rates of transitions did not decrease over the 6-month maintenance period following implementation. These data suggest that FLOW can be successfully implemented and maintained, although there was wide variation in implementation across sites. Future research should examine how to support sites that struggle with implementation.
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Affiliation(s)
- Natalie E Hundt
- Michael E. DeBakey VA Medical Center, VA HSR Center of Innovations in Quality, Effectiveness, and Safety, Houston, TX, USA.
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.
- South Central Mental Illness Research, Education, and Clinical Center, VA, Houston, TX, USA.
| | - Maribel Plasencia
- Michael E. DeBakey VA Medical Center, VA HSR Center of Innovations in Quality, Effectiveness, and Safety, Houston, TX, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- South Central Mental Illness Research, Education, and Clinical Center, VA, Houston, TX, USA
| | - Amber B Amspoker
- Michael E. DeBakey VA Medical Center, VA HSR Center of Innovations in Quality, Effectiveness, and Safety, Houston, TX, USA
- South Central Mental Illness Research, Education, and Clinical Center, VA, Houston, TX, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Zenab Yusuf
- Michael E. DeBakey VA Medical Center, VA HSR Center of Innovations in Quality, Effectiveness, and Safety, Houston, TX, USA
| | - Annette Walder
- Michael E. DeBakey VA Medical Center, VA HSR Center of Innovations in Quality, Effectiveness, and Safety, Houston, TX, USA
| | - Herbert Nagamoto
- VA Rocky Mountain Network, Denver, CO, USA
- University of Colorado School of Medicine, Denver, CO, USA
| | - Bo Kim
- VA HSR Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, 02130, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
| | - Christie Ga-Jing Tsao
- Michael E. DeBakey VA Medical Center, VA HSR Center of Innovations in Quality, Effectiveness, and Safety, Houston, TX, USA
| | - Tracey L Smith
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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Hundt NE, Yusuf ZI, Amspoker AB, Nagamoto HT, Kim B, Boykin DM, Smith TL. Improving the transition of patients with mental health disorders back to primary care: A protocol for a partnered, mixed-methods, stepped-wedge implementation trial. Contemp Clin Trials 2021; 105:106398. [PMID: 33848641 DOI: 10.1016/j.cct.2021.106398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/03/2021] [Accepted: 04/06/2021] [Indexed: 10/21/2022]
Abstract
The current study protocol regards a partnered, mixed-methods, cluster-randomized stepped wedge trial of the implementation and effectiveness of the FLOW program. FLOW (not an acronym) is a collection of resources and strategies to assist in determining which recovered or stabilized specialty mental health (SMH) patients should transition back to primary care (PC) and tools to make the transition seamless. Transitioning appropriate patients to PC can increase access and timeliness of mental health care for newly referred mental health patients. Nine sites in one US region will be randomized to one of three waves in which they will receive implementation-facilitation to implement the FLOW program. Primary outcomes will include the reach of FLOW, provider adoption of the program, effectiveness in increasing access in SMH, implementation fidelity, and maintenance over time. A mixed-methods analysis of implementation factors associated with implementation success will also be conducted, including the following as possible predictors: staffing ratios, site resources, leadership and provider support for the program, and local champion characteristics. This study's results will provide evidence for the effectiveness of FLOW in increasing access and may provide generalizable information about characteristics of sites that are likely to be successful with implementing similar programs.
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Affiliation(s)
- Natalie E Hundt
- VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States; VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX, United States.
| | - Zenab I Yusuf
- VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States
| | - Amber B Amspoker
- VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States; VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX, United States
| | - Herbert T Nagamoto
- VA Rocky Mountain Network, Denver, CO, United States; University of Colorado School of Medicine, Denver, CO, United States
| | - Bo Kim
- HSR&D Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA 02130, United States; Department of Psychiatry, Harvard Medical School, Boston, MA 02115, United States
| | - Derrecka M Boykin
- VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States; VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX, United States
| | - Tracey L Smith
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
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Raczkiewicz D, Owoc J, Krakowiak J, Rzemek C, Owoc A, Bojar I. Patient safety culture in Polish Primary Healthcare Centers. Int J Qual Health Care 2020; 31:G60-G66. [PMID: 30753667 DOI: 10.1093/intqhc/mzz004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 11/08/2018] [Accepted: 01/17/2019] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To examine patient safety culture in primary healthcare centers in Poland. DESIGN A cross-sectional survey conducted in 2017 using the questionnaire based on the 'Medical Office Survey on Patient Safety Culture' from Agency for Healthcare Research and Quality (AHRQ). SETTING Three hundred thirty-seventy primary healthcare centers in Poland. PARTICIPANTS Family physician practices in Poland selected from the population of 5400 using systematic random sampling. The response rate was 62%. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) The survey includes 38 items that measured 10 dimensions of patient safety culture and questions referring to information exchange with other settings, quality issues and overall ratings on quality and safety. Mean percent positive scores on all items in each composite were calculated according to user's guide. RESULTS Individual domains of patient safety culture had better scores among younger respondents and respondents with job seniority at their clinic under 10 years. Patient safety culture scores correlated with size and location (urban or rural) of studied centers, as well as with respondents' gender. The most highly ranked domains were: organizational learning (87.05% of positive scores), teamwork (84.91%), overall perception of patient safety and quality (84.77%) and leadership support for patient safety (84.30%) while the lowest ranked ones were: patient care tracking and follow-up (65.11%), work pressure and pace (57.77%). Other domains such as communication openness (80.96%), staff training (78.90%), office processes and standardization (71.92%) and communication about error (69.80%) ranked between. CONCLUSIONS Patient safety culture in primary healthcare centers in Poland was evaluated positively.
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Affiliation(s)
- Dorota Raczkiewicz
- Department of Demography, Institute of Statistics and Demography, Collegium of Economic Analysis, SGH Warsaw School of Economics, Warsaw, Poland
| | - Jakub Owoc
- Department of Gerontology, Public Health and Education, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Jan Krakowiak
- Department of Social Medicine, Chair of Social and Preventive Medicine, Medical University of Lodz, Lodz, Poland
| | - Cezary Rzemek
- University Children's Clinical Hospital, L. Zamenhof in Bialystok, Bialystok, Poland
| | - Alfred Owoc
- The College of Business and Entrepreneurship in Ostrowiec Świętokrzyski, Ostrowiec Swietokrzyski, Poland
| | - Iwona Bojar
- Department for Women's Health, Institute of Rural Health in Lublin, Lublin, Poland
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Crocker RL, Grizzle AJ, Hurwitz JT, Rehfeld RA, Abraham I, Horwitz R, Weil A, Maizes V. Integrative medicine primary care: assessing the practice model through patients' experiences. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 17:490. [PMID: 29141643 PMCID: PMC5688715 DOI: 10.1186/s12906-017-1996-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 11/07/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND The University of Arizona Integrative Health Center (UAIHC) was an innovative integrative medicine (IM) adult primary care clinic in Phoenix, Arizona. UAIHC used a hybrid payment model to deliver comprehensive healthcare that includes conventional and complementary medical treatments. METHODS Fidelity measures were collected to evaluate how well the IM care delivery process matched ideals for IM. Patient experiences are presented here. Patients visiting UAIHC on 1 of 10 randomly selected days between September 2013 and February 2015 were surveyed. Patients were asked about their experience with: holistic care; promotion of health, self-care, and well-being; relationship and communication with practitioners; and overall satisfaction. RESULTS Eighty-three patients completed surveys. Based on patient-reported experiences, UAIHC delivered IM care as defined by the practice model. CONCLUSIONS Patients received holistic care, established positive caring relationships with providers who promoted their self-care and well-being, and reported high overall satisfaction with UAIHC.
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Affiliation(s)
- Robert L Crocker
- University of Arizona Center for Integrative Medicine, College of Medicine, University of Arizona, Tucson, AZ, USA.
| | - Amy J Grizzle
- Center for Health Outcomes & PharmacoEconomic Research (HOPE), College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - Jason T Hurwitz
- Center for Health Outcomes & PharmacoEconomic Research (HOPE), College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - Rick A Rehfeld
- Center for Health Outcomes & PharmacoEconomic Research (HOPE), College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - Ivo Abraham
- Center for Health Outcomes & PharmacoEconomic Research (HOPE), College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - Randy Horwitz
- University of Arizona Center for Integrative Medicine, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Andrew Weil
- University of Arizona Center for Integrative Medicine, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Victoria Maizes
- University of Arizona Center for Integrative Medicine, College of Medicine, University of Arizona, Tucson, AZ, USA
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