Integrated Primary & Behavioral Healthcare: What is it and how will I know when I get there?
Integrated Primary & Behavioral HealthcareWhat is it and how will I know when I get there? Deb Hrouda Center for Evidence Based Practices Case Western Reserve University, Cleveland, Ohio www.centerforepb.case.edu
CEBP Customers • Policymakers; leaders of state and regional authorities; service organizations; hospitals; health clinics; and technical-assistance organizations • Ohio, 25 other states and five countries United States International• California (CA) • Maine (ME) • North Dakota (ND) • Australia• Colorado (CO) • Maryland (MD) • Ohio (OH) • Canada• Georgia (GA) • Michigan (MI) • Pennsylvania (PA) • England• Hawaii (HI) • Minnesota (MN) • South Dakota (SD) • The Netherlands• Illinois (IL) • Missouri (MO) • Vermont (VT) • Norway• Indiana (IN) • New Jersey (NJ) • Washington (WA)• Iowa (IA) • New Mexico (NM) • West Virginia (WV)• Kentucky (KY) • New York (NY) • Wisconsin (WI)• Louisiana (LA) • North Carolina (NC) www.centerforepb.case.edu 5
Goals for today• Discuss why integrated care is so important• Review models of integration and implementation• Convey importance of measuring implementation outcomes• Review Integrated Treatment Tool developed by CEBP• Meet your needs / answer your questions www.centerforepb.case.edu
Integrated Primary andBehavioral Health Care Why?
Recent data from several states have found thatpeople with severe and persistent mental illness (SMI) die, on average, 25 years earlier than the general population www.centerforepb.case.edu 8
Reasons for Morbidity and Mortality• Genetic link between BH and other d/os• Inadequate/non-existent health care (access?) – Fewer routine preventive services (Druss 2002) – Worse diabetes care (Desai 2002, Frayne 2006) – Lower rates of cardiovascular procedures (Druss 2000)• Side effects of medications• Smoking• Poor nutrition• Inadequate/non-existent physical activity www.centerforepb.case.edu 9
Morbidity and Mortality is largely due to• Preventable medical conditions – Cardiovascular disease, diabetes, metabolic syndrome• High prevalence of modifiable risk factors – Smoking, obesity, diet, exercise, substance use, infectious diseases, delayed/no well-care, medication and symptom management/monitoring• For people with SPMI, there is an epidemic within a National epidemic www.centerforepb.case.edu
SPMI alone may be a health risk factor• Patient factors, e.g.: amotivation, fearfulness, homelessness, victimization/trauma, resources, advocacy, unemployment, incarceration, social instability, and IV drug use• Provider factors: Comfort level and attitude of healthcare providers, coordination between mental health and general health care, stigma• System factors: Funding, fragmentation www.centerforepb.case.edu
Integrated Primary andBehavioral Health Care What does this mean?
Integrated Primary andBehavioral Health Care How will we know when we get there?
Implementation Approach (the CEBP Way)• Assess readiness – Identify Organization’s Stage of Change• Baseline status (fidelity where applicable)• Action plan• Consultation and training• Ongoing outcomes monitoring – Implementation/Process – program-level – Intervention – participant-level www.centerforepb.case.edu
Steps to Creating an Implementation Measure • See if a model exists (or can be adapted) • Literature review • Feedback from the field • Identify model principles/components • Define components and incremental steps • Expert consensus • Field testing • Refinement based on feedback www.centerforepb.case.edu
Existing models of integrating PC/BH• Few with direct focus on SMI• Direction is BH into PC• BH is seen as “specialty care”• PC physician “directs” care• Psychiatry is typically “consult” (sometimes without seeing the patient) www.centerforepb.case.edu
Integrated Treatment Tool “ITT”A Tool to Evaluate the Integration ofPrimary and Behavioral Health Care CENTER FOR EVIDENCE BASED PRACTICES AT
Integrated Treatment Tool “ITT”• Organizational• Treatment• Care Coordination/Management www.centerforepb.case.edu
Organizational CharacteristicsO1. Org. Philosophy O8. Org.-Wide TrainingO2. Org. Policies and O9. Clinical Supervision, Procedures Guidance & MonitoringO3. Integrated HIT O10. CQI O11. Pt-Centered ApproachO4. Multi-Disciplinary O12. Pt Access & Scheduling Health Care Approach O13. Executive LeadershipO5. Interdisciplinary Team Involvement Communication O14. Integrated ApproachO6. Care ManagerO7. Peer Supports www.centerforepb.case.edu
Treatment CharacteristicsT1. Comprehensive IdentificationT2. Holistic Integrated Care PlanT3. Integrated Stage-Appropriate TreatmentT4. OutreachT5. Stepped CareT6. Use of Motivational InterventionsT7. Self-Management Skill DevelopmentT8. Pharmacological ApproachesT9. Involvement of Social Support Network www.centerforepb.case.edu
Care Coordination/Management CharacteristicsC1. Activities, Elements, and DomainsC2. Laboratory and Test TrackingC3. Referral Facilitation and TrackingC4. Medication ReconciliationC5. RemindersC6. Transitions between settings/levels of careC7. Assessing effectiveness/quality of care rcvd www.centerforepb.case.edu
Deb Hrouda, MSSA,LISW-SDirector of Quality ImprovementCenter for Evidence-Based Practices (CEBP)Case Western Reserve University10900 Euclid AvenueCleveland, Ohio firstname.lastname@example.org www.centerforepb.case.edu