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McConnell KJ, Edelstein S, Hall J, Levy A, Danna M, Cohen DJ, Unützer J, Zhu JM, Lindner S. Access, Utilization, and Quality of Behavioral Health Integration in Medicaid Managed Care. JAMA HEALTH FORUM 2023; 4:e234593. [PMID: 38153809 PMCID: PMC10755612 DOI: 10.1001/jamahealthforum.2023.4593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/25/2023] [Indexed: 12/30/2023] Open
Abstract
Importance Many states have moved from models that carve out to those that carve in or integrate behavioral health in their Medicaid managed care organizations (MCOs), but little evidence exists about the effect of this change. Objective To assess the association of the transition to integrated managed care (IMC) in Washington Medicaid with health services use, quality, health-related outcomes, and measures associated with social determinants of health. Design, Setting, and Participants This cohort study used difference-in-differences analyses of Washington State's 2014 to 2019 staggered rollout of IMC on claims-based measures for enrollees in Washington's Medicaid MCO. It was supplemented with interviews of 24 behavioral health agency leaders, managed care administrators, and individuals who were participating in the IMC transition. The data were analyzed between February 1, 2023, and September 30, 2023. Main Outcomes and Measures Claims-based measures of utilization (including specialty mental health visits and primary care visits); health-related outcomes (including self-harm events); rates of arrests, employment, and homelessness; and additional quality measures. Results This cohort study included 1 454 185 individuals ages 13 to 64 years (743 668 female [51.1%]; 14 306 American Indian and Alaska Native [1.0%], 132 804 Asian American and Pacific Islander [9.1%], 112 442 Black [7.7%], 258 389 Hispanic [17.8%], and 810 304 White [55.7%] individuals). Financial integration was not associated with changes in claims-based measures of utilization and quality. Most claims-based measures of outcomes were also unchanged, although enrollees with mild or moderate mental illness experienced a slight decrease in cardiac events (-0.8%; 95% CI, -1.4 to -0.2), while enrollees with serious mental illness experienced small decreases in employment (-1.2%; 95% CI -1.9 to -0.5) and small increases in arrests (0.5%; 95% CI, 0.1 to 1.0). Interviews with key informants suggested that financial integration was perceived as an administrative change and did not have substantial implications for how practices delivered care; behavioral health agencies lacked guidance on how to integrate care in behavioral health settings and struggled with new contracts and regulatory policies that may have inhibited the ability to provide integrated care. Conclusions and Relevance The results of this cohort study suggest that financial integration at the MCO level was not associated with significant changes in most measures of utilization, quality, outcomes, and social determinants of health. Additional support, including monitoring, training, and funding, may be necessary to drive delivery system changes to improve access, quality, and outcomes.
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Affiliation(s)
- K. John McConnell
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland
| | - Sara Edelstein
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland
| | - Jennifer Hall
- Department of Family Medicine, Oregon Health & Science University, Portland
| | - Anna Levy
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland
| | - Maria Danna
- Department of Family Medicine, Oregon Health & Science University, Portland
| | - Deborah J. Cohen
- Department of Family Medicine, Oregon Health & Science University, Portland
| | - Jürgen Unützer
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle
| | - Jane M. Zhu
- Division of General Internal Medicine, Oregon Health & Science University, Portland
| | - Stephan Lindner
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland
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Hodgkin D, Horgan CM, Jordan Brown S, Bart G, Stewart MT. Financial Sustainability of Novel Delivery Models in Behavioral Health Treatment. THE JOURNAL OF MENTAL HEALTH POLICY AND ECONOMICS 2023; 26:149-158. [PMID: 38113385 PMCID: PMC10752219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 09/26/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND In the US, much of the research into new intervention and delivery models for behavioral health care is funded by research institutes and foundations, typically through grants to develop and test the new interventions. The original grant funding is typically time-limited. This implies that eventually communities, clinicians, and others must find resources to replace the grant funding -otherwise the innovation will not be adopted. Diffusion is challenged by the continued dominance in the US of fee-for-service reimbursement, especially for behavioral health care. AIMS To understand the financial challenges to disseminating innovative behavioral health delivery models posed by fee-for-service reimbursement, and to explore alternative payment models that promise to accelerate adoption by better addressing need for flexibility and sustainability. METHODS We review US experience with three specific novel delivery models that emerged in recent years. The models are: collaborative care model for depression (CoCM), outpatient based opioid treatment (OBOT), and the certified community behavioral health clinic (CCBHC) model. These examples were selected as illustrating some common themes and some different issues affecting diffusion. For each model, we discuss its core components; evidence on its effectiveness and cost-effectiveness; how its dissemination was funded; how providers are paid; and what has been the uptake so far. RESULTS The collaborative care model has existed for longest, but has been slow to disseminate, due in part to a lack of billing codes for key components until recently. The OBOT model faced that problem, and also (until recently) a regulatory requirement requiring physicians to obtain federal waivers in order to prescribe buprenorphine. Similarly, the CCBHC model includes previously nonbillable services, but it appears to be diffusing more successfully than some other innovations, due in part to the approach taken by funders. DISCUSSION A common challenge for all three models has been their inclusion of services that were not (initially) reimbursable in a fee-for-service system. However, even establishing new procedure codes may not be enough to give providers the flexibility needed to implement these models, unless payers also implement alternative payment models. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE For providers who receive time-limited grant funding to implement these novel delivery models, one key lesson is the need to start early on planning how services will be sustained after the grant ends. IMPLICATIONS FOR HEALTH POLICY For research funders (e.g., federal agencies), it is clearly important to speed up the process of obtaining coverage for each novel delivery model, including the development of new billable service codes, and to plan for this as early as possible. Funders also need to collaborate with providers early in the grant period on sustainability planning for the post-grant environment. For payers, a key lesson is the need to fold novel models into stable existing funding streams such as Medicaid and commercial insurance coverage, rather than leaving them at the mercy of revolving time-limited grants, and to provide pathways for contracting for innovations under new payment models. IMPLICATIONS FOR FURTHER RESEARCH For researchers, a key recommendation would be to pay greater attention to the payment environment when designing new delivery models and interventions.
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Affiliation(s)
- Dominic Hodgkin
- Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts 02453, United States
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Chang D, Morrison DJ, Bowen DJ, Harris HM, Dusic EJ, Velasquez MB, Ratzliff ADH. Making It to Sustainability: Evaluating Billing Strategies for Collaborative Care. Psychiatr Serv 2023; 74:1192-1195. [PMID: 36935624 DOI: 10.1176/appi.ps.20220596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
The collaborative care model (CoCM) is an effective strategy to manage common mental disorders in primary care. Despite the growing adoption of newer CoCM billing codes to support these programs, few studies have investigated the use of these codes. This column evaluated the implementation of CoCM billing codes by comparing clinics using different billing strategies and assessed the impact of CoCM code implementation on revenue and on clinical and process-of-care outcomes. Qualitative data were obtained to understand provider perspectives. The results indicate that CoCM billing code implementation is operationally feasible, does not adversely affect the delivery of patient care or revenue, and is acceptable to providers.
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Affiliation(s)
- Denise Chang
- Departments of Psychiatry and Behavioral Sciences (Chang, Morrison, Ratzliff), Bioethics and Humanities (Bowen, Harris, Dusic), and Family Medicine (Velasquez), University of Washington Medical Center, Seattle
| | - Debra J Morrison
- Departments of Psychiatry and Behavioral Sciences (Chang, Morrison, Ratzliff), Bioethics and Humanities (Bowen, Harris, Dusic), and Family Medicine (Velasquez), University of Washington Medical Center, Seattle
| | - Deborah J Bowen
- Departments of Psychiatry and Behavioral Sciences (Chang, Morrison, Ratzliff), Bioethics and Humanities (Bowen, Harris, Dusic), and Family Medicine (Velasquez), University of Washington Medical Center, Seattle
| | - Heather M Harris
- Departments of Psychiatry and Behavioral Sciences (Chang, Morrison, Ratzliff), Bioethics and Humanities (Bowen, Harris, Dusic), and Family Medicine (Velasquez), University of Washington Medical Center, Seattle
| | - Emerson J Dusic
- Departments of Psychiatry and Behavioral Sciences (Chang, Morrison, Ratzliff), Bioethics and Humanities (Bowen, Harris, Dusic), and Family Medicine (Velasquez), University of Washington Medical Center, Seattle
| | - Mariebeth B Velasquez
- Departments of Psychiatry and Behavioral Sciences (Chang, Morrison, Ratzliff), Bioethics and Humanities (Bowen, Harris, Dusic), and Family Medicine (Velasquez), University of Washington Medical Center, Seattle
| | - Anna D H Ratzliff
- Departments of Psychiatry and Behavioral Sciences (Chang, Morrison, Ratzliff), Bioethics and Humanities (Bowen, Harris, Dusic), and Family Medicine (Velasquez), University of Washington Medical Center, Seattle
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French R, Worley J, Lowenstein M, Bogner HR, Calderbank T, DePhilippis D, Forrest A, Gibbons MBC, Harris RA, Heywood S, Kampman K, Mandell DS, McKay JR, Newman ST, Oslin DW, Wadden S, Wolk CB. Adapting psychotherapy in collaborative care for treating opioid use disorder and co-occurring psychiatric conditions in primary care. FAMILIES, SYSTEMS & HEALTH : THE JOURNAL OF COLLABORATIVE FAMILY HEALTHCARE 2023; 41:377-388. [PMID: 37227828 PMCID: PMC10517081 DOI: 10.1037/fsh0000791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Opioid use disorder (OUD) and psychiatric conditions commonly co-occur yet are infrequently treated with evidence-based therapeutic approaches, resulting in poor outcomes. These conditions, separately, present challenges to treatment initiation, retention, and success. These challenges are compounded when individuals have OUD and psychiatric conditions. METHOD Recognizing the complex needs of these individuals, gaps in care, and the potential for primary care to bridge these gaps, we developed a psychotherapy program that integrates brief, evidence-based psychotherapies for substance use, depression, and anxiety, building on traditional elements of the Collaborative Care Model (CoCM). In this article, we describe this psychotherapy program in a primary care setting as part of a compendium of collaborative services. RESULTS Patients receive up to 12 sessions of evidence-based psychotherapy and case management based on a structured treatment manual that guides treatment via Motivational Enhancement; Cognitive Behavioral Therapies for depression, anxiety, and/or substance use disorder; and/or Behavioral Activation components. DISCUSSION Novel, integrated treatments are needed to advance service delivery for individuals with OUD and psychiatric conditions and these programs must be rigorously evaluated. We describe our team's efforts to test our psychotherapy program in a large primary care network as part of an ongoing three-arm randomized controlled trial. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Rachel French
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- National Clinician Scholars Program, University of Pennsylvania, Philadelphia, PA 19104, USA
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Julie Worley
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Margaret Lowenstein
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA 19104, USA
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Hillary R. Bogner
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Tara Calderbank
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Dominick DePhilippis
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- VA Office of Mental Health and Suicide Prevention, Veterans Health Administration, Washington DC, 20420, USA
| | - Andrew Forrest
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Mary Beth Connolly Gibbons
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Rebecca Arden Harris
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Saida Heywood
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Kyle Kampman
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - David S. Mandell
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - James R. McKay
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA 19104, USA
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA 19104, USA
| | - Schyler Tristen Newman
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - David W. Oslin
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA 19104, USA
| | - Steven Wadden
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Courtney Benjamin Wolk
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA 19104, USA
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Turi E, McMenamin A, Kueakomoldej S, Kurtzman E, Poghosyan L. The effectiveness of nurse practitioner care for patients with mental health conditions in primary care settings: A systematic review. Nurs Outlook 2023; 71:101995. [PMID: 37343483 PMCID: PMC10592550 DOI: 10.1016/j.outlook.2023.101995] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 05/19/2023] [Accepted: 05/23/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND The nurse practitioner (NP) workforce is key to meeting the demand for mental health services in primary care settings. PURPOSE The purpose of this study is to synthesize the evidence focused on the effectiveness of NP care for patients with mental health conditions in primary care settings, particularly focused on primary care NPs and psychiatric mental health NPs and patients with anxiety, depression, and substance use disorders. METHODS Studies published since 2014 in the United States studying NP care of patients with anxiety, depression, or substance use disorders in primary care settings were included. FINDINGS Seventeen studies were included. Four high-quality studies showed that NP evidence-based care and prescribing were comparable to that of physicians. Seven low-quality studies suggest that NP-led collaborative care is associated with reduced symptoms. DISCUSSION More high-quality evidence is needed to determine the effectiveness of NP care for patients with mental health conditions in primary care settings.
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Affiliation(s)
- Eleanor Turi
- School of Nursing, Columbia University, New York, NY.
| | - Amy McMenamin
- School of Nursing, Columbia University, New York, NY.
| | | | - Ellen Kurtzman
- Edward J. Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, NJ.
| | - Lusine Poghosyan
- School of Nursing, Columbia University, New York, NY; Mailman School of Public Health, Columbia University, New York, NY.
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Copeland JN, Jones K, Maslow GR, French A, Davis N, Greiner MA, Heilbron N, Pullen SJ. Use of North Carolina Medicaid Collaborative Care Billing Codes After Statewide Approval for Reimbursement. Psychiatr Serv 2022; 73:1420-1423. [PMID: 35734864 DOI: 10.1176/appi.ps.202200027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Effective October 2018, North Carolina Medicaid approved reimbursement for collaborative care model (CoCM) billing codes. From October 2018 through December 2019, only 915 of the estimated two million eligible Medicaid beneficiaries had at least one CoCM claim, and the median number of claims per patient was two. Availability of reimbursement for CoCM Medicaid billing codes in North Carolina did not immediately result in robust utilization of CoCM. Furthermore, the low median number of claims per patient suggests lack of fidelity to CoCM. A better understanding of barriers to CoCM implementation is necessary to expand utilization of this evidence-based model.
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Affiliation(s)
- J Nathan Copeland
- Department of Psychiatry and Behavioral Sciences (Copeland, Maslow, French, Davis, Heilbron, Pullen) and Department of Population Health Sciences (Jones, Greiner), Duke University School of Medicine, Durham, North Carolina
| | - Kelley Jones
- Department of Psychiatry and Behavioral Sciences (Copeland, Maslow, French, Davis, Heilbron, Pullen) and Department of Population Health Sciences (Jones, Greiner), Duke University School of Medicine, Durham, North Carolina
| | - Gary R Maslow
- Department of Psychiatry and Behavioral Sciences (Copeland, Maslow, French, Davis, Heilbron, Pullen) and Department of Population Health Sciences (Jones, Greiner), Duke University School of Medicine, Durham, North Carolina
| | - Alexis French
- Department of Psychiatry and Behavioral Sciences (Copeland, Maslow, French, Davis, Heilbron, Pullen) and Department of Population Health Sciences (Jones, Greiner), Duke University School of Medicine, Durham, North Carolina
| | - Naomi Davis
- Department of Psychiatry and Behavioral Sciences (Copeland, Maslow, French, Davis, Heilbron, Pullen) and Department of Population Health Sciences (Jones, Greiner), Duke University School of Medicine, Durham, North Carolina
| | - Melissa A Greiner
- Department of Psychiatry and Behavioral Sciences (Copeland, Maslow, French, Davis, Heilbron, Pullen) and Department of Population Health Sciences (Jones, Greiner), Duke University School of Medicine, Durham, North Carolina
| | - Nicole Heilbron
- Department of Psychiatry and Behavioral Sciences (Copeland, Maslow, French, Davis, Heilbron, Pullen) and Department of Population Health Sciences (Jones, Greiner), Duke University School of Medicine, Durham, North Carolina
| | - Samuel J Pullen
- Department of Psychiatry and Behavioral Sciences (Copeland, Maslow, French, Davis, Heilbron, Pullen) and Department of Population Health Sciences (Jones, Greiner), Duke University School of Medicine, Durham, North Carolina
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Goldman ML, Swartz MS, Norquist GS, Horvitz-Lennon M, Balasuriya L, Jorgensen S, Greiner M, Brinkley A, Hayes H, Isom J, Dixon LB, Druss BG. Building Bridges Between Evidence and Policy in Mental Health Services Research: Introducing the Policy Review Article Type. Psychiatr Serv 2022; 73:1165-1168. [PMID: 35378994 DOI: 10.1176/appi.ps.202100428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Although it is widely accepted that patients do better when evidence-based health care practices are used, there is less acknowledgment of the positive outcomes associated with evidence-based policy making. To address the need for high-quality evidence to inform mental health policies, Psychiatric Services has recently launched a new article format: the Policy Review. This review type defines a specific policy-relevant issue affecting behavioral health systems, describes current knowledge and limitations, and discusses policy implications. Reviews can focus on mental health policies or examine how other health or social policies affect people with mental illness or substance use disorders. This brief overview of the need for a policy review article type describes differences between evidence-based policy making and practices and looks at research approaches focused on evidence-based policy making, as well as legislative and other efforts to support it. Broad guidelines for potential submissions are also provided.
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Affiliation(s)
- Matthew L Goldman
- San Francisco Department of Public Health and Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry and Behavioral Sciences (Norquist) and Rollins School of Public Health (Druss), Emory University, Atlanta; RAND Corporation, Pittsburgh (Horvitz-Lennon); Yale National Clinical Scholars Program (Balasuriya) and Department of Psychiatry (Isom), Yale University School of Medicine, New Haven, Connecticut; Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry, Weill Cornell Medical Center, New York City (Greiner); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Dixon)
| | - Marvin S Swartz
- San Francisco Department of Public Health and Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry and Behavioral Sciences (Norquist) and Rollins School of Public Health (Druss), Emory University, Atlanta; RAND Corporation, Pittsburgh (Horvitz-Lennon); Yale National Clinical Scholars Program (Balasuriya) and Department of Psychiatry (Isom), Yale University School of Medicine, New Haven, Connecticut; Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry, Weill Cornell Medical Center, New York City (Greiner); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Dixon)
| | - Grayson S Norquist
- San Francisco Department of Public Health and Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry and Behavioral Sciences (Norquist) and Rollins School of Public Health (Druss), Emory University, Atlanta; RAND Corporation, Pittsburgh (Horvitz-Lennon); Yale National Clinical Scholars Program (Balasuriya) and Department of Psychiatry (Isom), Yale University School of Medicine, New Haven, Connecticut; Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry, Weill Cornell Medical Center, New York City (Greiner); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Dixon)
| | - Marcela Horvitz-Lennon
- San Francisco Department of Public Health and Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry and Behavioral Sciences (Norquist) and Rollins School of Public Health (Druss), Emory University, Atlanta; RAND Corporation, Pittsburgh (Horvitz-Lennon); Yale National Clinical Scholars Program (Balasuriya) and Department of Psychiatry (Isom), Yale University School of Medicine, New Haven, Connecticut; Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry, Weill Cornell Medical Center, New York City (Greiner); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Dixon)
| | - Lilanthi Balasuriya
- San Francisco Department of Public Health and Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry and Behavioral Sciences (Norquist) and Rollins School of Public Health (Druss), Emory University, Atlanta; RAND Corporation, Pittsburgh (Horvitz-Lennon); Yale National Clinical Scholars Program (Balasuriya) and Department of Psychiatry (Isom), Yale University School of Medicine, New Haven, Connecticut; Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry, Weill Cornell Medical Center, New York City (Greiner); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Dixon)
| | - Shea Jorgensen
- San Francisco Department of Public Health and Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry and Behavioral Sciences (Norquist) and Rollins School of Public Health (Druss), Emory University, Atlanta; RAND Corporation, Pittsburgh (Horvitz-Lennon); Yale National Clinical Scholars Program (Balasuriya) and Department of Psychiatry (Isom), Yale University School of Medicine, New Haven, Connecticut; Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry, Weill Cornell Medical Center, New York City (Greiner); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Dixon)
| | - Miranda Greiner
- San Francisco Department of Public Health and Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry and Behavioral Sciences (Norquist) and Rollins School of Public Health (Druss), Emory University, Atlanta; RAND Corporation, Pittsburgh (Horvitz-Lennon); Yale National Clinical Scholars Program (Balasuriya) and Department of Psychiatry (Isom), Yale University School of Medicine, New Haven, Connecticut; Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry, Weill Cornell Medical Center, New York City (Greiner); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Dixon)
| | - Amy Brinkley
- San Francisco Department of Public Health and Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry and Behavioral Sciences (Norquist) and Rollins School of Public Health (Druss), Emory University, Atlanta; RAND Corporation, Pittsburgh (Horvitz-Lennon); Yale National Clinical Scholars Program (Balasuriya) and Department of Psychiatry (Isom), Yale University School of Medicine, New Haven, Connecticut; Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry, Weill Cornell Medical Center, New York City (Greiner); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Dixon)
| | - Heath Hayes
- San Francisco Department of Public Health and Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry and Behavioral Sciences (Norquist) and Rollins School of Public Health (Druss), Emory University, Atlanta; RAND Corporation, Pittsburgh (Horvitz-Lennon); Yale National Clinical Scholars Program (Balasuriya) and Department of Psychiatry (Isom), Yale University School of Medicine, New Haven, Connecticut; Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry, Weill Cornell Medical Center, New York City (Greiner); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Dixon)
| | - Jessica Isom
- San Francisco Department of Public Health and Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry and Behavioral Sciences (Norquist) and Rollins School of Public Health (Druss), Emory University, Atlanta; RAND Corporation, Pittsburgh (Horvitz-Lennon); Yale National Clinical Scholars Program (Balasuriya) and Department of Psychiatry (Isom), Yale University School of Medicine, New Haven, Connecticut; Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry, Weill Cornell Medical Center, New York City (Greiner); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Dixon)
| | - Lisa B Dixon
- San Francisco Department of Public Health and Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry and Behavioral Sciences (Norquist) and Rollins School of Public Health (Druss), Emory University, Atlanta; RAND Corporation, Pittsburgh (Horvitz-Lennon); Yale National Clinical Scholars Program (Balasuriya) and Department of Psychiatry (Isom), Yale University School of Medicine, New Haven, Connecticut; Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry, Weill Cornell Medical Center, New York City (Greiner); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Dixon)
| | - Benjamin G Druss
- San Francisco Department of Public Health and Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry and Behavioral Sciences (Norquist) and Rollins School of Public Health (Druss), Emory University, Atlanta; RAND Corporation, Pittsburgh (Horvitz-Lennon); Yale National Clinical Scholars Program (Balasuriya) and Department of Psychiatry (Isom), Yale University School of Medicine, New Haven, Connecticut; Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry, Weill Cornell Medical Center, New York City (Greiner); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Dixon)
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8
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Callahan CM, Unutzer J. Robotic-assisted collaborative care. J Am Geriatr Soc 2022; 70:2484-2486. [PMID: 35781250 DOI: 10.1111/jgs.17934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Christopher M Callahan
- Department of Medicine, Indiana University Center for Aging Research, Indianapolis, Indiana, USA.,Sandra Eskenazi Center for Brain Care Innovation, Eskenazi Health, Indianapolis, Indiana, USA.,Regenstrief Institute, Inc., Indianapolis, Indiana, USA
| | - Jurgen Unutzer
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA.,Garvey Institute for Brain Health Solutions, University of Washington, Seattle, Washington, USA
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Collaboration Leading to Addiction Treatment and Recovery from Other Stresses (CLARO): process of adapting collaborative care for co-occurring opioid use and mental disorders. Addict Sci Clin Pract 2022; 17:25. [PMID: 35395811 PMCID: PMC8991671 DOI: 10.1186/s13722-022-00302-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 03/16/2022] [Indexed: 12/15/2022] Open
Abstract
Background Opioid use disorders (OUD), co-occurring with either depression and/or PTSD, are prevalent, burdensome, and often receive little or low-quality care. Collaborative care is a service delivery intervention that uses a team-based model to improve treatment access, quality, and outcomes in primary care patients, but has not been evaluated for co-occurring OUD and mental health disorders. To address this treatment and quality gap, we adapted collaborative care for co-occurring OUD and mental health disorders. Methods Our adapted model is called Collaboration Leading to Addiction Treatment and Recovery from Other Stresses (CLARO). We used the five-step Map of Adaptation Process (McKleroy in AIDS Educ Prev 18:59–73, 2006) to develop the model. For each step, our stakeholder team of research and clinical experts, primary care partners, and patients provided input into adaptation processes (e.g., adaptation team meetings, clinic partner feedback, patient interviews and beta-testing). To document each adaptation and our decision-making process, we used the Framework for Reporting Adaptations and Modifications-Enhanced (Wiltsey Stirman in Implement Sci 14:1–10, 2019). Results We documented 12 planned fidelity-consistent adaptations to collaborative care, including a mix of content, context, and training/evaluation modifications intended to improve fit with the patient population (co-occurring disorders) or the New Mexico setting (low-resource clinics in health professional shortage areas). Examples of documented adaptations include use of community health workers as care coordinators; an expanded consultant team to support task-shifting to community health workers; modified training protocols for Problem-Solving Therapy and Written Exposure Therapy to incorporate examples of treating patients for depression or PTSD with co-occurring OUD; and having care coordinators screen for patients’ social needs. Conclusions We completed the first three steps of the Map of Adaptation Process, resulting in a variety of adaptations that we believe will make collaborative care more acceptable and feasible in treating co-occurring OUD and mental health disorders. Future steps include evaluating the effectiveness of CLARO and documenting reactive and/or planned adaptations to the model that occur during its implementation and delivery. Trial registration NCT04559893, NCT04634279. Registered 08 September 2020, https://clinicaltrials.gov/ct2/show/NCT04559893
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10
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Duncan MH, Erickson JM, Chang D, Toor R, Ratzliff ADH. Psychiatry's Expanded Integration into Primary Care. Psychiatr Clin North Am 2022; 45:71-80. [PMID: 35219443 DOI: 10.1016/j.psc.2021.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Integrated behavioral care, and in particular, the collaborative care model, has been working to improve access and treatment for people with mental health disorders. Integrated care allows for adaptable, scalable, and sustainable practice that addresses the mental health needs of the public. During the pandemic several challenges emerged to delivering integrated care. This disruption happened at a systems level, team-based care level, scope of care level, and patient access level. This article looks through the lens of those various levels to identify and some of the lessons learned to help build a more resilient and flexible integrated care program.
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Affiliation(s)
- Mark H Duncan
- Department of Psychiatry and Behavioral Sciences, University of Washington, 4225 Roosevelt Way Northeast, Street 306, Seattle, WA 98105, USA.
| | - Jennifer M Erickson
- Department of Psychiatry and Behavioral Sciences, University of Washington, 4225 Roosevelt Way Northeast, Street 306, Seattle, WA 98105, USA
| | - Denise Chang
- Department of Psychiatry and Behavioral Sciences, University of Washington, 4225 Roosevelt Way Northeast, Street 306, Seattle, WA 98105, USA
| | - Ramanpreet Toor
- Department of Psychiatry and Behavioral Sciences, University of Washington, 4225 Roosevelt Way Northeast, Street 306, Seattle, WA 98105, USA
| | - Anna D H Ratzliff
- Department of Psychiatry and Behavioral Sciences, University of Washington, 4225 Roosevelt Way Northeast, Street 306, Seattle, WA 98105, USA
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11
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Ratzliff ADH, Toor R, Erickson JM, Bauer A, Duncan M, Chang D, Chwastiak L, Raue PJ, Unutzer J. Development and Implementation of an Integrated Care Fellowship. J Acad Consult Liaison Psychiatry 2022; 63:280-289. [PMID: 35123126 DOI: 10.1016/j.jaclp.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 01/17/2022] [Accepted: 01/25/2022] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Integrated care is a common approach to leverage scarce psychiatric resources to deliver mental health care in primary care settings. To date, a formal clinical fellowship devoted to professional development for this role has not been described. METHODS The development of a formal year-long clinical fellowship in integrated care is described. The curriculum consists of an Integrated Care Didactic Series, Integrated Care Clinical Skill Experiences, and Integrated Care System-Based Leadership Experiences. Evaluation of impact was assessed with descriptive statistics. RESULTS We successfully recruited three classes of fellows to the Integrated Care Fellowship, with 5 program graduates in the first 3 years. All five graduated fellows were hired into integrated care and/or telepsychiatry positions. Integrated Care fellows had a high participation rate in didactics (mean attendance = 80.6%; n=5). We received a total of 582 didactic evaluations for the 151 didactic sessions. On a scale of 1 (poor) to 6 (fantastic), the mean quality of the interactive learning experience was rated as 5.33 (n=581), and the mean quality of the talk was 5.35 (n=582). Rotations were rated with the mean overall teaching quality of 4.98/5 (n = 76 evaluations from 5 fellows). CONCLUSIONS The Integrated Care clinical fellowship serves as a model for training programs seeking to provide training in clinical and systems-based skills needed for practicing integrated care. Whether such training is undertaken as a standalone fellowship or incorporated into existing Consultation-Liaison Psychiatry programs, such skills are increasingly valuable as integrated care becomes commonplace in practice.
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Affiliation(s)
- Anna D H Ratzliff
- University of Washington, Department of Psychiatry and Behavioral Sciences, 1959 NE Pacific St, Box 306560, Seattle, WA 98125.
| | - Ramanpreet Toor
- University of Washington, Department of Psychiatry and Behavioral Sciences, 1959 NE Pacific St, Box 306560, Seattle, WA 98125
| | - Jennifer M Erickson
- University of Washington, Department of Psychiatry and Behavioral Sciences, 1959 NE Pacific St, Box 306560, Seattle, WA 98125
| | - Amy Bauer
- University of Washington, Department of Psychiatry and Behavioral Sciences, 1959 NE Pacific St, Box 306560, Seattle, WA 98125
| | - Mark Duncan
- University of Washington, Department of Psychiatry and Behavioral Sciences, 1959 NE Pacific St, Box 306560, Seattle, WA 98125
| | - Denise Chang
- University of Washington, Department of Psychiatry and Behavioral Sciences, 1959 NE Pacific St, Box 306560, Seattle, WA 98125
| | - Lydia Chwastiak
- University of Washington, Department of Psychiatry and Behavioral Sciences, 325 Ninth Ave; Box 359911: Seattle WA 98104
| | - Patrick J Raue
- University of Washington, Department of Psychiatry and Behavioral Sciences, 1959 NE Pacific St, Box 306560, Seattle, WA 98125
| | - Jurgen Unutzer
- University of Washington, Department of Psychiatry and Behavioral Sciences, 1959 NE Pacific St, Box 306560, Seattle, WA 98125
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12
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Fortney JC, Bauer AM, Cerimele JM, Pyne JM, Pfeiffer P, Heagerty PJ, Hawrilenko M, Zielinski MJ, Kaysen D, Bowen DJ, Moore DL, Ferro L, Metzger K, Shushan S, Hafer E, Nolan JP, Dalack GW, Unützer J. Comparison of Teleintegrated Care and Telereferral Care for Treating Complex Psychiatric Disorders in Primary Care: A Pragmatic Randomized Comparative Effectiveness Trial. JAMA Psychiatry 2021; 78:1189-1199. [PMID: 34431972 PMCID: PMC8387948 DOI: 10.1001/jamapsychiatry.2021.2318] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/29/2021] [Indexed: 11/14/2022]
Abstract
Importance Only one-third of patients with complex psychiatric disorders engage in specialty mental health care, and only one-tenth receive adequate treatment in primary care. Scalable approaches are critically needed to improve access to effective mental health treatments in underserved primary care settings. Objective To compare 2 clinic-to-clinic interactive video approaches to delivering evidence-based mental health treatments to patients in primary care clinics. Design, Setting, and Participants This pragmatic comparative effectiveness trial used a sequential, multiple-assignment, randomized trial (SMART) design with patient-level randomization. Adult patients treated at 24 primary care clinics without on-site psychiatrists or psychologists from 12 federally qualified health centers in 3 states who screened positive for posttraumatic stress disorder and/or bipolar disorder and who were not already receiving pharmacotherapy from a mental health specialist were recruited from November 16, 2016, to June 30, 2019, and observed for 12 months. Interventions Two approaches were compared: (1) telepsychiatry/telepsychology-enhanced referral (TER), where telepsychiatrists and telepsychologists assumed responsibility for treatment, and (2) telepsychiatry collaborative care (TCC), where telepsychiatrists provided consultation to the primary care team. TER included an adaptive intervention (phone-enhanced referral [PER]) for patients not engaging in treatment, which involved telephone outreach and motivational interviewing. Main Outcomes and Measures Survey questions assessed patient-reported outcomes. The Veterans RAND 12-item Health Survey Mental Component Summary (MCS) score was the primary outcome (range, 0-100). Secondary outcomes included posttraumatic stress disorder symptoms, manic symptoms, depressive symptoms, anxiety symptoms, recovery, and adverse effects. Results Of 1004 included participants, 701 of 1000 (70.1%) were female, 660 of 994 (66.4%) were White, and the mean (SD) age was 39.4 (12.9) years. Baseline MCS scores were 2 SDs below the US mean; the mean (SD) MCS scores were 39.7 (14.1) and 41.2 (14.2) in the TCC and TER groups, respectively. There was no significant difference in 12-month MCS score between those receiving TCC and TER (β = 1.0; 95% CI, -0.8 to 2.8; P = .28). Patients in both groups experienced large and clinically meaningful improvements from baseline to 12 months (TCC: Cohen d = 0.81; 95% CI, 0.67 to 0.95; TER: Cohen d = 0.90; 95% CI, 0.76 to 1.04). For patients not engaging in TER at 6 months, there was no significant difference in 12-month MCS score between those receiving PER and TER (β = 2.0; 95% CI, -1.7 to 5.7; P = .29). Conclusions and Relevance In this comparative effectiveness trial of patients with complex psychiatric disorders randomized to receive TCC or TER, significantly and substantially improved outcomes were observed in both groups. From a health care system perspective, clinical leadership should implement whichever approach is most sustainable. Trial Registration ClinicalTrials.gov Identifier: NCT02738944.
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Affiliation(s)
- John C. Fortney
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle
- Department of Veterans Affairs, Health Services Research and Development, Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington
| | - Amy M. Bauer
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle
| | - Joseph M. Cerimele
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle
| | - Jeffrey M. Pyne
- Department of Psychiatry and Behavioral Sciences, College of Medicine, University of Arkansas for Medical Sciences, Little Rock
- Department of Veterans Affairs, Health Services Research and Development, Center for Mental Healthcare and Outcomes Research, Little Rock, Arkansas
| | - Paul Pfeiffer
- University of Michigan Medical School, Ann Arbor
- Department of Veterans Affairs, Health Services Research and Development, Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Patrick J. Heagerty
- Department of Biostatistics, School of Public Health, University of Washington, Seattle
| | - Matt Hawrilenko
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle
| | - Melissa J. Zielinski
- Department of Psychiatry and Behavioral Sciences, College of Medicine, University of Arkansas for Medical Sciences, Little Rock
| | - Debra Kaysen
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California
| | - Deborah J. Bowen
- Department of Bioethics and Humanities, University of Washington, Seattle
| | - Danna L. Moore
- School of Economic Sciences, Washington State University, Pullman
| | - Lori Ferro
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle
| | | | | | - Erin Hafer
- Community Health Plan of Washington, Seattle
| | | | | | - Jürgen Unützer
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle
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Boustani M, Unützer J, Leykum LK. Design, implement, and diffuse scalable and sustainable solutions for dementia care. J Am Geriatr Soc 2021; 69:1755-1762. [PMID: 34245584 DOI: 10.1111/jgs.17342] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/14/2021] [Accepted: 05/16/2021] [Indexed: 12/20/2022]
Abstract
Most innovations developed to reduce the burden of Alzheimer disease and other related dementias (ADRD) are difficult to implement, diffuse, and scale. The consequences of such challenges in design, implementation, and diffusion are suboptimal care and resulting harm for people living with ADRD and their caregivers. National experts identified four factors that contribute to our limited ability to implement and diffuse of evidence-based services and interventions for people living with ADRD: (1) limited market demand for the implementation and diffusion of effective ADRD interventions; (2) insufficient engagement of persons living with ADRD and those caring for them in the development of potential ADRD services and interventions; (3) limited evidence and experience regarding scalability and sustainability of evidence-based ADRD care services; and (4) difficulties in taking innovations that work in one context and successfully implementing them in other contexts. New investments in the science of human-centered design, implementation, and diffusion are crucial for meeting the goals of the National Plan to Address Alzheimer's Disease under the auspices of the National Alzheimer's Project Act.
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Affiliation(s)
- Malaz Boustani
- Department of Medicine, Indiana University, Center for Health Innovation and Implementation Science, Indianapolis, Indiana, USA.,Sandra Eskenazi Center for Brain Care Innovation, Eskenazi Health, Indianapolis, Indiana, USA.,Regenstrief Institute, Inc, Indianapolis, Indiana, USA
| | - Jürgen Unützer
- Department of Psychiatry, University of Washington, Seattle, Washington, USA
| | - Luci K Leykum
- Department of Internal Medicine, South Texas Veterans Healthcare System, Austin, Texas, USA.,Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
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Ketel C, Hedges JP, Smith JP, Hopkins LW, Pfieffer ML, Kyle E, Raman R, Pilon B. Suicide detection and treatment in a nurse-led, interprofessional primary care practice: A 2-year report of quality data. Nurse Pract 2021; 46:33-40. [PMID: 33739326 DOI: 10.1097/01.npr.0000737208.68560.b8] [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] [Indexed: 06/12/2023]
Abstract
ABSTRACT Analysis of 2 years of quality improvement data after the implementation of a suicidality screening and treatment protocol in a primary care setting found that among 1,733 patients, 149 had suicidal ideation. Among the 112 of those patients who remained in care, more than half presented with only nonpsychiatric complaints. Primary care practices may be viable tools to combat the nation's suicide epidemic.
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