Integrated Care Environment Research Articles

Integrated care policy recommendations for complex multisystem long term conditions and long COVID

The importance of integrated care for complex, multiple long term conditions was acknowledged before the COVID pandemic but remained a challenge. The pandemic and consequent development of Long COVID required rapid adaptation of health services to address the population’s needs, requiring service redesigns including integrated care. This Delphi consensus study was conducted in the UK and found similar integrated care priorities for Long COVID and complex, multiple long term conditions, provided by 480 patients and health care providers, with an 80% consensus rate. The resultant recommendations were based on more than 1400 responses from survey participants and were supported by patients, health care professionals, and by patient charities. Participants identified the need to allocate resources to: support integrated care, provide access to care and treatments that work, provide diagnostic procedures that support the personalization of treatment in an integrated care environment, and enable structural consultation between primary and specialist care settings including physical and mental health care. Based on the findings we propose a model for delivering integrated care by a multidisciplinary team to people with complex multisystem conditions. These recommendations can inform improvements to integrated care for complex, multiple long term conditions and Long COVID at international level.

Palliative Care Psychiatry: Building Synergy Across the Spectrum.

Palliative care (PC) psychiatry is a growing subspecialty focusing on improving the mental health of those with serious medical conditions and their caregivers. This review elucidates the current practice and ongoing evolution of PC psychiatry. PC psychiatry leverages training and clinical practices from both PC and psychiatry, addressing a wide range of needs, including enhanced psychiatric care for patients with serious medical illness, PC access for patients with medical needs in psychiatric settings, and PC-informed psychiatric approaches for individuals with treatment-refractory serious mental illness. PC psychiatry is practiced by a diverse workforce comprising hospice and palliative medicine-trained psychiatrists, psycho-oncologists, geriatric psychiatrists, other mental health professionals, and non-psychiatrist PC clinicians. As a result, PC psychiatry faces challenges in defining its operational scope. The manuscript outlines the growth, current state, and prospects of PC psychiatry. It examines its roles across various healthcare settings, including medical, integrated care, and psychiatric environments, highlighting the unique challenges and opportunities in each. PC psychiatry is a vibrant and growing subspecialty of psychiatry that must be operationalized to continue its developmental trajectory. There is a need for a distinct professional identity for PC psychiatry, strategies to navigate administrative and regulatory hurdles, and greater support for novel clinical, educational, and research initiatives.

Interprofessional microteaching: An innovation to strengthen the behavioral health competencies of the primary care workforce.

There is significant variability in how residency programs prepare the primary care workforce in behavioral health competencies. One approach that warrants further exploration is to have integrated behavioral health consultants (BHCs) capitalize on in vivo clinical teaching opportunities in the context of team-based care. This article presents preliminary results from the implementation of a pilot program wherein BHCs use warm handoffs and other clinical interactions to provide brief, targeted education to medical residents. Twelve BHCs from five resident training clinics participated in a 1-hr training on "microteaching" skills that could be used in clinical teaching interactions. BHCs were asked to track instances of microteaching using an Excel spreadsheet. After 3 months, BHCs and residents responded to electronic surveys that assessed the acceptability and feasibility of this process. In 3 months, BHCs provided 269 instances of microteaching with 66 residents (66.7%) across five clinics. These microteachings occurred within the context of various interactions, including warm handoffs (n = 138, 51.3%), curbside consultations (n = 78, 29.0%), debriefs (n = 46, 17.1%), and team huddles (n = 7, 2.6%). Roughly half (n = 149, 55.4%) of these encounters involved Level 1 microteaching (i.e., lasting 2 min or less), while half (n = 120, 44.6%) involved Level 2 (i.e., lasting 3-10 min). BHCs and residents rated the microteaching interactions as acceptable and feasible. Leveraging embedded BHCs as clinical educators in integrated care environments may hold value for increasing behavioral health competencies among medical residents. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Perceptions of How Integrated Care Impacts Treatment in Rural Settings

Background: In light of the changing face of health care, it is important that practitioners and researchers begin to think strategically regarding comprehensive and accessible care. The purpose of this research study is to provide a deeper understanding of change among health care providers who work on multidisciplinary teams and the impact on patient outcomes. Methods: This research was designed as an exploratory phenomenological research study. The experience of interest was how providers described changes in care when working in an integrated care context. Eight semistructured in-depth interviews were conducted with physicians, nurse practitioners, social workers, and psychologists from locations in Southern Ohio, Central Maine, and Eastern Tennessee. Data were analyzed using qualitative coding to find patterns with and across participants associated with their perceptions of health integration. Results: Final developed themes described provider perceptions of working in an integrated care environment, and included access to care, interprofessional education, communication between providers. Conclusion: Through interviews and a review of the literature, we have found that as integrated care is employed throughout the country, patients have better health outcomes and providers experience efficient and effective work environments. Providers have adapted to the changing environment of integrative medicine; through this study we see that these changes have been for the benefit of the patients. Patients who disproportionately suffer from a lack of health care resources, such as those in rural areas, may benefit greatly from an integrated care model.

Input From Practice: Reshaping Dental Education for Integrated Patient Care.

Among the primary challenges in advancing the practice of integrated primary dental and medical health care is the appropriate educational and clinical preparation of a dental workforce that can function and flourish within integrated care environments. Most dental schools teach to traditional concepts and standards of dental care delivery which may be inconsistent with those of integrated care and could deter the entry and retention of graduates in contemporary, non-traditional practice models. To better understand how the dental school curriculum should be modified to accommodate integrative care models, a number of patient care organizations actively engaged in dental-medical integration were site visited to gain insight into the readiness of newer graduates, with emphasis on the US DMD/DDS graduate, to function in integrated practice. Leaders, practicing clinicians and staff were interviewed and common observations and themes were documented. This manuscript will focus on those educational components that integrated care organizations identify as absent or inadequate in current dentist education which must be addressed to meet the unique expectations and requirements of integrated patient care. These changes appear pivotal in the preparation of a dental clinician workforce that is respectful and receptive to new practice concepts, adaptative to new practice models, and competent in new care delivery systems.

Aims, development, and early results of an interdisciplinary primary care initiative to address patient vulnerabilities

ABSTRACT Addressing substance use disorders and social determinants of poor health at a population level is a major national healthcare priority. One promising model to improve healthcare outcomes for patients with these conditions is the Vulnerable Veteran Innovative Patient-Aligned Care Team (PACT) Initiative, or VIP – an interdisciplinary, team-based primary care delivery model designed to address the needs of vulnerable patients in the Veterans Health Administration. VIP establishes a single, integrated primary care environment for the management of substance use disorders, mental illness, social determinants of poor health, and complexities in care resulting from the co-occurrence of these conditions. We describe the origination, goals, and evolution of VIP to provide an example of how clinics and health systems can address vulnerable patient populations within a primary care clinic framework. While ongoing evaluation will be essential to understand its impact on patient outcomes and its sustainability and scalability in the future, VIP holds promise as a novel model to improve care for patients with addiction and other vulnerabilities.

Towards Value in an Integrated Care Environment: Early Lessons from an Ontario Health Team.

Integrated healthcare models are being experimented with in many jurisdictions as a way to improve patient care and lower system costs. This commentary presents early lessons from one Ontario Health Team as it works towards new models of care. The authors recount early discussions on developing an integrated health services network, how funding for "winter surge initiatives" became an opportunity to test ideas and how these experiences are informing current planning. Some of the early lessons learned include the value of trusted relationships, moving care upstream and framing problems as collective challenges.

An Ontology-Based Personalized Decision Support System for Use in the Complex Chronically Ill Patient.

Management of the complex chronically ill patient is highly problematic. This is due to the need to complement recommendations in clinical guidelines with recommendations based on treatments performed on a representative set of patients. It is necessary to identify conflicts between the recommendations of different guidelines designed for handling specific chronic diseases. The PITeS-TIiSS project (code PI15/01213) aims to overcome this problem by designing and deploying an ontology-based personalized clinical decision support tool. This helps to improve personalized decisions and reduces variability in clinical practice in an integrated care environment. This paper describes the methodology followed in developing the ontology used to infer clinical knowledge and to develop and implement the support tool. The tool will access the information provided by the Electronic Health Record of Andalusian Health Public Service, the main healthcare provider in a region in Spain with more than eight million inhabitants.

Impact of integrated care and co-location of care on mental help-seeking perceptions

Background Integrated care may offer a solution to subpar mental health referral adherence, but people’s openness to receiving psychological treatment in this setting is understudied. Aims The present study examined the influence of the integrated care context and co-location of care on people’s help-seeking perceptions. Method This study (N = 397) used an experimental vignette design to compare the impact of treatment type (integrated care vs. traditional psychotherapy) and distance (close vs. far) on help-seeking perceptions. Results The integrated care environment (significant effect on perceived behavioral control) and closer proximity of the psychologist (significant effect on intention, attitudes, perceived effectiveness of treatment, self-stigma) only improved help-seeking perceptions among those with prior experience with mental health treatment. In the overall sample, treatment type and distance only demonstrated an effect among women, but not men. Conclusions Pending replication with samples from diverse populations, these findings provide a cautionary tale about lay perceptions of integrated care’s anticipated utility. However, co-location and, to a lesser degree, the common attributes of the integrated care format (e.g. team approach, flexible scheduling) may represent a potential pathway for reducing resistance to help seeking that can accompany traditional psychotherapy referrals among those with past exposure to behavioral healthcare.

A Capacity Allocation Planning Model for Integrated Care and Access Management.

The prevailing first-come-first-served approach to outpatient appointment scheduling ignores differing urgency levels, leading to unnecessarily long waits for urgent patients. In data from a partner healthcare organization, we found in some departments that urgent patients were inadvertently waiting longer for an appointment than non-urgent patients. This paper develops a capacity allocation optimization methodology that reserves appointment slots based on urgency in a complicated, integrated care environment where multiple specialties serve multiple types of patients. This optimization reallocates network capacity to limit access delays (indirect waiting times) for initial and downstream appointments differentiated by urgency. We formulate this problem as a queueing network optimization and approximate it via deterministic linear optimization to simultaneously smooth workloads and guarantee access delay targets. In a case study of our industry partner we demonstrate the ability to (1) reduce urgent patient mean access delay by 27% with only a 7% increase in mean access delay for non-urgent patients, and (2) increase throughput by 31% with the same service levels and overtime.

Social Worker Integrated Care Competencies Scale (SWICCS): Assessing social worker clinical competencies for health care settings

ABSTRACTIntegrating physical and behavioral health services has the potential to reduce health disparities and service inequities among persons most at risk. However, clinical social workers in integrated health settings must possess relevant knowledge and skills to provide quality care to diverse populations. The Social Worker Integrated Care Competency Scale (SWICCS), developed to complement the Integrated and Culturally Relevant Care (ICRC) field education curriculum, measures students’ self-perceptions of knowledge and skills associated with providing behavioral health care. Three student cohorts (n = 38) completed the SWICCS three times during an integrated care field practicum. Results indicated a statistically significant increase in student knowledge and skills at each time point, with a large effect size (r = −.87). The SWICCS demonstrated utility in measuring and tracking social work student acquisition of knowledge and skills required for practice in integrated care environments.

Health and social electronic records integratation in catalonia

Introduction: The Healthcare System in Catalonia is a public integrated network with >30 information systems IS. In 2008, Catalonia Shared Electronic Health Record HC31was launched up to allow interoperability among different healthcare providers. The Social care System is organised on two levels: the basic social service, under responsibility of the local authorities, and the specialised social, mostly under regional responsibility. Although Social Service Act of 2017 foresaw the creation of a single Social Record, this has not yet been developed. There are therefore different coexisting IS: Nursing Homes, residential care, daily care facilities for elderly etc. Regarding Catalan Integrated health and social care Plan, interoperability between social services care records and HC3 was prioritized . Short description of practice change implemented: In 2017, a pilot project has started with the basic social services area of Barcelona Council with HC3. Data exchange between Social Services of Barcelona Council and Health Services in Catalonia is now a reality. A professionals’ committee health and social defined the minimum data set to which health and social professionals could have access which will be progressively widened to other territories. Aim and theory of change: The main aims2 to integrate both care systems: To disseminate information among both care systems in an Integrated care environment3. Interoperability with the main local government IS. Connection to central repositories of DW with information on dependent and disabled people that has been formally assessed and recognized by the DW to HC3. Integrate the public owned residential care and nursing homes to HC3. To facilitate HC3 access to teams assessing condition of dependency and disability. Targeted population and stakeholders People in the Region. Timeline: Systems piloted and operational in Barcelona. 80% of Catalan territories will be exchanging data by the end of 2018. Highlights: It will allow exchange of health and social information of citizens in Catalonia who require the use of the system in an Integrated Care environment Comments on sustainability: Each municipality will bear the integration and maintenance cost of the platform and will be supported by HC3. Comments on transferability: Experiences and lessons learnt in terms of legal, technical and functional issues will be made available to other areas of social care records in Catalonia and other EU regions. Conclusions: The completed first phase Barcelona project gave us a lot of knowledge and experience, which will aid in the quick deployment of the project in the Catalonian Region. It will also help increase the cross-platform information exchange and the number of municipal social care services. Discussions: First phase had great impact to establish solid base and make the model sustainable. A common Identification Number has been established by the Catalan government this year facilitating current and future interoperability scenarios related to information sharing and required in implementation of an Integrated Health and Social care Plan4. Lessons learned: Interdepartmental project means that we have to work collaboratively and highly coordinated, emphasizing being respectful in the state of each department, even when there are differences in technological and structural capacity.

A Capacity Allocation Planning Model for Integrated Care and Access Management

The prevailing first-come-first-served approach to outpatient appointment scheduling ignores differing urgency levels, leading to unnecessarily long waits for urgent patients. In data from a partner healthcare organization, we found in some departments that urgent patients were inadvertently waiting longer for an appointment than non-urgent patients. This paper develops a capacity allocation optimization methodology that reserves appointment slots based on urgency in a complicated, integrated care environment where multiple specialties serve multiple types of patients. This optimization reallocates network capacity to limit access delays (indirect waiting times) for initial and downstream appointments differentiated by urgency. We formulate this problem as a queueing network optimization and approximate it via deterministic linear optimization to simultaneously smooth workloads and guarantee access delay targets. In a case study of our industry partner we demonstrate the ability to (1) reduce urgent patient mean access delay by 27% with only a 7% increase in mean access delay for non-urgent patients, and (2) increase throughput by 31% with the same service levels and over.

Meeting the Challenge of Preparing Social Workers for Integrated Health Practice: Evidence From Two MSW Cohorts

ABSTRACTChanges in health care policy have led to an expansion of integrated care models that rely on collaboration among interprofessional health teams. Recent federal funding has encouraged the development of innovative training models to prepare social workers for integrated health practice. This article presents evidence from the first two MSW cohorts of the Integrated Mental and Behavioral Health Training Program funded by the Health Resources and Services Administration. Twelve students completing the program in 2014 (n = 5) and 2015 (n = 7) participated in evaluation activities at the time of program completion and at 1-year postgraduation. Findings highlight key components of the training program instrumental in student attainment of program goals and competencies. Implications for MSW education and training for practice in integrated care environments are discussed.

Integrating Behavioral Health and Primary Care: Consulting, Coordinating and Collaborating Among Professionals

This paper sought to describe how clinicians from different backgrounds interact to deliver integrated behavioral and primary health care, and the contextual factors that shape such interactions. This was a comparative case study in which a multidisciplinary team used an immersion-crystallization approach to analyze data from observations of practice operations, interviews with practice members, and implementation diaries. The observed practices were drawn from 2 studies: Advancing Care Together, a demonstration project of 11 practices located in Colorado; and the Integration Workforce Study, consisting of 8 practices located across the United States. Primary care and behavioral health clinicians used 3 interpersonal strategies to work together in integrated settings: consulting, coordinating, and collaborating (3Cs). Consulting occurred when clinicians sought advice, validated care plans, or corroborated perceptions of a patient's needs with another professional. Coordinating involved 2 professionals working in a parallel or in a back-and-forth fashion to achieve a common patient care goal, while delivering care separately. Collaborating involved 2 or more professionals interacting in real time to discuss a patient's presenting symptoms, describe their views on treatment, and jointly develop a care plan. Collaborative behavior emerged when a patient's care or situation was complex or novel. We identified contextual factors shaping use of the 3Cs, including: time to plan patient care, staffing, employing brief therapeutic approaches, proximity of clinical team members, and electronic health record documenting behavior. Primary care and behavioral health clinicians, through their interactions, consult, coordinate, and collaborate with each other to solve patients' problems. Organizations can create integrated care environments that support these collaborations and health professions training programs should equip clinicians to execute all 3Cs routinely in practice.

Cost Minimization Analysis of Low Back Pain Claims Data for Chiropractic Vs Medicine in a Managed Care Organization

Objective A managed care organization (MCO) examined differences in allowed cost for managing low back pain by medical providers vs chiropractors in an integrated care environment. The purpose of this study is to provide a retrospective cost analysis of administrative data of chiropractic vs medical management of low back pain in a managed care setting. Methods All patients with a low back pain–related diagnosis presenting for health care from January 2004 to June 2004 who were insured by an MCO in northeast Wisconsin were tracked. The cumulative health care costs incurred by this MCO during the 2-year period from January 2004 to December 2005 related to these back pain diagnoses were collected. Results Allowed costs of chiropractic treatment were 12% greater than medical primary care and 60% less per case than other types of medical care combined, on a per-case basis: median cost of medical primary care was $365.00, chiropractic care was $417.00, and medical nonprimary care was $669.00. Conclusion This study of an MCO's low back pain allowed costs may be better redirected to primary care or chiropractic, given equivalent levels of case complexity. This study suggests chiropractic management as less expensive compared with medical management of back pain when care extends beyond primary care. Primary care management alone is virtually indistinguishable from chiropractic management in terms of costs.

Call for integrated care environment

Call for integrated care environment