Integrated Healthcare Model Research Articles

Collaborative Healthcare in Incarcerated Settings.

A total of 2,162,400 adults were incarcerated in the United States in 2016. Sub-optimal health status, existing healthcare disparities, and fragmented healthcare delivery among incarcerated populations are concerning and warrant redress. This article highlights the need for and discusses the benefits of collaboration between healthcare professionals in incarcerated settings. The roles of primary care health professionals, pharmacists, and medical family therapists (MedFTs) in correctional facilities are outlined. Through integrated healthcare models, enhanced communication, improved continuity of care, and holistic treatment plans, existing gaps in healthcare delivery in correctional facilities can be filled. By working together and assuming nontraditional roles, medical professionals can help improve health outcomes of incarcerated individuals. Collaborative healthcare models in incarcerated settings can elevate public health in a cost-effective, yet positive manner.

Integrated Health and Social Care in the United States: A Decade of Policy Progress.

Introduction:Over the last decade in the United States (US), the burden of chronic disease, health care costs, and fragmented care delivery have increased at alarming rates. To address these challenges, policymakers have prioritized new payment and delivery models to incentivize better integrated health and social services.Policy practice:This paper outlines three major national and state policy initiatives to improve integrated health and social care over the last ten years in the US, with a focus on the Medicaid public insurance program for Americans with low incomes. Activities supported by these initiatives include screening patients for social risks in primary care clinics; building new cross-sector collaborations; financing social care with healthcare dollars; and sharing data across health, social and community services. Stakeholders from the private sector, including health systems and insurers, have partnered to advance and scale these initiatives. This paper describes the implementation and effectiveness of such efforts, and lessons learned from translating policy to practice.Discussion and Conclusion:National policies have catalyzed initiatives to test new integrated health and social care models, with the ultimate goal of improving population health and decreasing costs. Preliminary findings demonstrated the need for validated measures of social risk, engagement across levels of organizational leadership and frontline staff, and greater flexibility from national policymakers in order to align incentives across sectors.

Evolution of Palliative Care in the Department of Veterans Affairs: Lessons from an Integrated Health Care Model.

Palliative care (PC) is beneficial, however, in many settings it is under-resourced and unable to consistently meet the needs of patients and their families. A lack of national health policy support for PC contributes to underutilization and the low value care experienced by many patients with serious illness at the end of life. Through a series of transformative health care structure and process improvements including developing robust initiatives and promoting institutional culture change, the Department of Veterans Affairs (VA) has significantly improved the quality of PC among veterans. VA's strategic simultaneous top-down and bottom-up approach to develop programs, policies, and initiatives provides important perspectives and deserves attention toward advancing PC in the broader U.S. health care system. Although opportunities for improvement exist, the comprehensive framework within VA should help inform the future of program development and serve as a model for integrated and accountable care organizations to emulate.

Implementing a person centred collaborative health care model – A qualitative study on patient experiences

BackgroundCollaborative Health Care (CHC) is a unique model in which ambulance services, home health care, hospital care and the national telephone helpline for healthcare in Sweden – Swedish health care direct (SHD1177) collaborate to provide the fastest possible health care for inhabitants living in eleven municipalities in western region of Sweden. AimTo explore how patients experience and perceive health care received in the CHC. MethodQualitative descriptive study using open-ended individual telephone interviews with fifteen community dwelling persons with experiences of care throughthe model CHC were conducted. ResultsTwo main categories and six subcategories were identified. The category “Thoughts of time in regard to acute health care” include “CHC leads to shorter waiting time for health care”, “Knowledge about the staff working hours” and “To alert or not alert”. The category “Thoughts on unplanned health care from CHC” involved “Receiving health care in my home”, ”Coordination from SHD1177 surprises” and “Accessibility of health care values higher than continuity”. ConclusionIntegrated health care models such as CHC are time saving and highly appreciated by community dwelling persons. The benefits of provision of coherent health care like in CHC, addresses the need to implement innovative integrated healthcare models in today’s health care.

Factors Influencing the Provision of Oral Health Care Practices by Antenatal Care Providers: A Systematic Review.

Background: Antenatal care (ANC) providers are recommended to promote oral health care during pregnancy through the provision of oral health care practices, but studies have indicated that providers remain unclear and inconstant in adopting these practices into routine care. Therefore, the objectives were to undertake a systematic review of the current oral health care practices of ANC providers and identify factors (barriers and facilitators) that influence the provision of ANC providers' oral health care practices. Methods: Qualitative and quantitative studies were systematically searched within four databases (database inception, October 2020). Studies were selected if they were published in English and conducted in developed countries. Thematic analysis was employed where reported barriers and facilitators from the included studies were grouped by themes and were inductively categorized within a multilevel framework. Reported current oral health care practices were deductively categorized according to a predetermined "assess," "advise," and "refer" framework. Summative frequencies of oral health care practices, if reported, were also extracted. Results: A total of 3519 ANC providers were included across 26 studies. Rates of reported current oral health care practices among ANC providers varied considerably. The most reported barriers related to providers' limited oral health care knowledge, concerns with dental costs, and absence of organizational referral processes. The most reported facilitators related to providers' level of oral health care knowledge, patient prompt, and access to informational and educational resources. Conclusions: Further efforts are needed to address the range of barriers identified in this review and support ANC providers' clinical practice behaviors. This includes improved interprofessional education, training opportunities, and integrated health care models.

An integrative healthcare model with heartfulness meditation and care coordination improves outcomes in cyclic vomiting syndrome.

Cyclic vomiting syndrome (CVS) is associated with psychosocial comorbidity and often triggered by stress. Since the current disease-centered care model doesnot address psychosocial factors, we hypothesized that holistic, patient-centered care integrating meditation and addressing psychosocial needs through a care coordinator will improve healthcare outcomes in CVS. We conducted a prospective randomized controlled trial: 49 patients with CVS (mean age: 34±14years; 81% female) were randomized to conventional health care (controls) or Integrative Health care (IHC) (27: controls, 22: IHC). The IHC group was assigned a care coordinator and received meditation with a certified instructor. Outcomes including psychological distress, coping strategies to manage chronic stress, cognitive symptom management, and Health-Related Quality of Life (HRQoL) were measured. In intention-to-treat analyses, patients receiving IHC showed significant improvement in multiple domains of coping including positive reframing, planning, and reduction in self-blame (p values ≤0.05), and physical HRQoL (p=0.03) at 6months. They also leaned toward spirituality/religion as a coping measure (p≤0.02 at 3 and 6months). Subgroup analysis of compliant patients showed additional benefit with significant reduction in psychological distress (p=0.04), improvement in sleep quality (p=0.03), reduction in stress levels (0.02), improvement in physical HRQoL (0.04), and further improvement in other domains of coping (p<0.05). An IHC model incorporating meditation and care coordination improves patient outcomes in CVS and is a useful adjunct to standard treatment. Studies to determine the independent effects of meditation and care coordination are warranted.

Addressing future work ability of employees in GP consultations: results of a cross-sectional study

ObjectivesIn this study we examined to what extent members of a best-practice integrated healthcare model in Germany discussed their subjective future work ability with their general practitioner (GP); furthermore, we examined independent variables which explain whether future work ability is discussed.MethodsIn a cross-sectional survey, 1168 (out of 3218 invited) integrated healthcare members responded to a standardized questionnaire. This study includes n = 475 employed respondents who were at most 65 years old. We determined the (relative) frequency of employed members up to 65 years who had already discussed their subjective future work ability with their GP. By means of logistic regression analysis, explanatory variables were identified which statistically explained the discussion of future work ability with their GP.ResultsN = 80 (16.8%) respondents stated they had discussed their future work ability with their GP. A multiple logistic regression analysis showed the following results: The odds ratio for discussing future work ability is increased the more satisfied respondents are with their general practitioner, the worse they assess their current work ability in relation to the physical demands of the job, and when respondents suffer from one or more chronic diseases (Nagelkerke’s pseudo-R2 = 0.13).ConclusionsEven in this healthcare setting, employees up to the age of 65 rarely discussed their subjective future work ability with their GP. This suggests that the issue ‘future work ability’ is even less commonly discussed in other community-based care settings in Germany. It seems that health care providers involved in acute care only sporadically take this issue into consideration - despite the great importance of maintaining work ability.

Improving access to refugee-focused health services for people from refugee-like backgrounds in south-eastern Melbourne through the education sector.

People from refugee-like backgrounds living in Australia face substantial health challenges that benefit from access to health and social services. Many people from refugee-like backgrounds have frequent contact with education sector staff, who have the potential to act as conduits to health and social services. The aim of this project was to improve access to refugee-focused health services for people from refugee-like backgrounds in south-eastern Melbourne by codesigning and delivering a 1-day education forum to education sector staff. Evaluation of the forum used mixed-methods analysis of data from pre-post and follow-up surveys (n =11; administered before, immediately after and 1 month after the forum respectively), post-forum interviews (n =4) and one school's referral records. The forum improved attendees' refugee-focused health service referral knowledge, confidence and behaviour. This was supported by the qualitative findings of high staff motivation, high forum satisfaction and evidence of outcome sustainability. Education staff are an important complement to an integrated model of health care for recently resettled people from refugee-like backgrounds. These results show that a straightforward local intervention can improve the ability of education staff to act as conduits to health services, increasing access to health services for people from refugee-like backgrounds.

Assessment of integrating Environmental Factors into Healthcare Models for Enhancing Timely Epidemics Analysis: A Case study of Cholera in Dar es Salaam –Tanzania

The objective of this study is to assess the perspectives of users on the feasibility of using an integrated environmental factors-based healthcare model to enhance timely cholera epidemics analysis in Tanzania. The study used a mixed-design approach of quantitative and qualitative methods with focus group discussion and interviewer-administered questionnaires. Participants or users included; medical and epidemiological experts, environmental experts, Information and Communication Technology (ICT) experts, and cholera patients from Ilala, Ubungo, Kigamboni, Temeke, and Kinondoni districts in Dar es Salaam, Tanzania. In the process, a total of 500 interviews were conducted, consisting of 200 medical experts, 50 environmental experts, 50 ICT experts, and 200 cholera patients, with an average age of 28 years old, and at 3:2 female to male ratio. Overall, our findings showed that Health and Environmental Integrated Modelled Systems (HEIMs) interventions are acceptable, feasible, and capable in assisting timely analysis towards effective prediction and eradication of epidemics such as; cholera outbreaks at 79% acceptability, 90% aid-value and 69% awareness levels. Despite, the high acceptability level, participants also highlighted barriers of the model, such as; sustainability and operation costs, which need to be addressed. These findings confirm that the program of HEIMS is of high potential towards enhancing timely cholera analysis, clear public health significance, and relevant to policy-makers, government, society, and related stakeholders at large. Therefore, the study, recommends that there is a need for all these organs to work together towards clearing all obstacles in order to achieve the intended goal of the HEIMs program.

An Integrated Healthcare Model for Hospital Staff during the Pandemic

Surgeons and healthcare workers on the frontline have especially been hit hard during the COVID-19 pandemic, experiencing increased stress, anxiety, fatigue, grief, and job burnout. The rates of suicide are on the rise and in general, mental health has become an important issue for the medical workforce and innovative care solutions are particularly needed in order to address this growing psychological burden. Integrative collaborations can be utilized to benefit hospitals and their employees across the globe. The proposed model of integrated care will demonstrate how combining safe, non-invasive, research proven mind-body techniques, and collaboration with other disciplines and resources could potentially be used to improve the health benefits for both patients as well as their providers during extremely stressful situations. This integrative model is about changing the practical standard that currently exists for our healthcare workers in order to decrease their burnout and stress and is an excellent example for physician practices, hospitals, and health care facilities to follow globally. It provides a thriving system based on a healing environment focused on meeting the mental health needs of the staff, thus maximizing the value of the delivered care to their patients.

School-based integrated healthcare model: how Our Mia Mia is improving health and education outcomes for children and young people.

Integrating healthcare into education settings represents a promising model to address complex health problems in disadvantaged communities through improving access to health and social services. One such example of an effective school-based health hub is the Our Mia Mia (OMM) Wellbeing Hub, located in a primary school in Nowra and servicing a community experiencing significant socioeconomic disadvantage. The efficacy of OMM rests on its success in facilitating access to services by removing the barriers of cost and transport and establishing connection to community. The OMM fosters collaborations between health professionals and educators to coordinate holistic treatment and implement appropriate student supports in a timely manner. The support of key individuals and groups, in addition to the flexibility of the model, has allowed the hub to pivot and adapt to meet the changing needs of its community, particularly as challenges pertaining to bureaucracy, financial sustainability and community mistrust have presented themselves. Future directions for the OMM hub, and the possibility of adapting and translating school-based healthcare delivery models in other disadvantaged communities, is discussed.

A New Integrated Healthcare Model: Radiotherapy and Palliative Care (RaP) Outpatient Clinic

A New Integrated Healthcare Model: Radiotherapy and Palliative Care (RaP) Outpatient Clinic

An Exploration of Pediatricians’ Personal Value on Mental Health: Experience with Integrated Healthcare and its Impact on Physicians’ Lives

An integrated healthcare model incorporates behavioral health services into a medical setting to address patients’ physical, emotional, and behavioral healthcare concerns. The integrated healthcare model has been associated with positive patient satisfaction and health outcomes, yet limited studies have examined, using qualitative methods, physicians’ experiences of working alongside behavioral health consultants (BHCs) in integrated healthcare settings. Data was gathered through semi-structured interviews with pediatricians (N=4) working in an integrated healthcare model. Participants shared that as pediatricians they received personal, educational, and organizational benefits from an integrated healthcare model. Pediatricians also reported increased knowledge in effectively addressing mental health concerns for their patients and decreased physician stress-levels. Results of pediatricians’ experiences working in an integrated healthcare setting are discussed with regard to their implications for clinical practice and research.

Development of new health provision models by advanced practice midwives - The Master of Science in Midwifery at the Bern University of Applied Sciences (BFH): an educational concept for the future

Background: The increase in chronic diseases, dealing with a diverse clientele, the rapidly developing digitalization in healthcare as well as the demand for interprofessionalism poses complex demands on the midwifery as profession. Within this context institutions of higher education are expected to train midwives as trendsetters in the development of new, integrated healthcare models which can meet the health needs of mothers and their families. Goal: The goal of the master course in midwifery is to increase awareness of the relevance of current challenges in maternity care. Midwives are prepared to competently deal with current health issues, using innovative healthcare models, by taking on advanced and specialized roles. Methods: The course imparts knowledge and know-how for midwives who wish to prepare to take on duties in modern obstetric and maternity care. Midwifery master students complete interprofessional course modules, such as Ethics, Advanced Practice or Health Policy and Health Economics, conjointly with fellow students of nursing, physiotherapy as well as nutrition and dietetics degrees. Three profession-specific course modules focus on the challenges imposed by complex processes in perinatal care. Results: The case study of a 5th semester student shows how the course supports the development of the new role of an Advanced Practice Midwife (APM) in the field of perinatal mental health. As an assignment within the profession-specific course module Perinatal Mental Health the student developed a concept draft for an APM role. She presented the concept in her own field of work, where she was charged with further developing and advancing the project. Furthermore, the student focused her Transfer Course modules on the project and deepened her skills in mental health and research skills through work shadowing in a research department and mental health ward, also called ,,Crisis lntervention Centre", in a university psychiatric clinic. Based on the APN model she finally developed how to establish the APM role in her master thesis. To conduct the needs assessment for mentally ill pregnant women and mothers she is conducting a secondary data analysis of a research project of the Division of Midwifery of BFH. Relevance: The establishment of integrated and intersectoral healthcare models is currently being discussed in Switzerland. The models require specific skills in healthcare professionals. The interprofessionally oriented master studies at BFH teach midwives to meet the requirements of needs-based, family-centred perinatal healthcare and strengthen its quality. Recommendations/Conclusions: The interlocking of master studies and practice offers the unique opportunity to further develop innovative healthcare models which are aimed at addressing present and future challenges in healthcare delivery and which are based on research.

Physician Attitudes and Perceptions of Complementary and Alternative Medicine (CAM): A Multicentre Italian Study.

Purpose: Complementary and Alternative Medicine (CAM) interventions are widely used by patients with chronic disorders, including cancer, and may interact with cancer treatment. Physicians are often unaware of this, probably due to poor patient-physician communication on CAM. The purpose of this study was to evaluate physicians' knowledge, attitudes and practice patterns regarding CAM in a survey conducted in Italy.Methods: A questionnaire was administered to 438 physicians (11 Italian hospitals) who predominantly treat patients with chronic disease, to collect personal and professional data and information on attitudes toward CAM and its possible role in Conventional Medicine (CM).Results: Of the 438 participants, most were specialists in oncology (18%), internal medicine (17%), surgery (15%), and radiotherapy (11%). Most worked at university (44%) or research hospitals (31%). Forty-two percent of participants believed that CAM could have an integrative role within CM. Oncologists were the physicians who were best informed on CAM (58%). Physicians working at research institutes or university hospitals had a greater knowledge of CAM than those employed at general hospitals (p < 0.0001), and those who were also involved in research activity had a greater knowledge of CAM than those who were not (p < 0.003). Length of work experience was significantly related to CAM knowledge. Moreover, 55% of participants suggest CAM interventions to their patients and 44% discuss CAM with them. The best-known interventions were acupuncture, Aloe vera and high-dose vitamin C.Conclusion: CAM use by patients with chronic disease and/or cancer has become a topical issue for the scientific community and for physicians. Knowing the reasons that prompt these patients to use CAM and guiding them in their decisions would improve treatment and outcomes and also benefit healthcare systems. Our findings contribute to a greater understanding of CAM knowledge, attitudes, and practice among Italian physicians. Further research is needed to identify the more effective CAM treatments and to work toward an integrated healthcare model.

Entwicklung eines Indikatorensets zur Evaluation der Integrierten Versorgung Gesundes Kinzigtal

IntroductionThe project “INTEGRAL−10-year evaluation of the population-based integrated health care model ‘Gesundes Kinzigtal’ (Healthy Kinzigtal)” (ICM-GK) is funded by the Innovation Committee of the Federal Joint Committee (G-BA) (grant no. 01VSF16002). The evaluation is to be based on a set of indicators that can be captured in routine data. On the one hand, they can be used to assess ICM-GK programs that are program-specific and geared towards prevention and disease management. On the other hand, possible negative side effects of the ICM-GK, which is designed as a “shared savings contract”, are to be examined by also observing care needs not covered by the ICM-GK contract. Since an indicator set for the evaluation of regional integrated care (IC) programs in Germany is not yet available, a suitable indicator set should be developed. Methods1.Defining a methodological framework for the development of indicators based on concepts from the literature2.Searching for potential quality indicators (QIs) a) in the literature (PubMed, Web of Science, Cochrane, Embase) and b) in indicator databases3.Conducting document analysis of the ICM-GK programs4.Conducting focus groups with patients, doctors and ICM-GK stakeholders5.Merging QIs from the various sources, removing duplicates, comparing the indicators with the data basis of routine statutory health insurance data6.Allocating indicators to disease categories, care needs and quality dimensions according to OECD and Donabedian7.Evaluating and consenting the indicators by a multidisciplinary group of experts using the modified RAND-UCLA Appropriateness Method (RAM) based on the relevance and feasibility of the indicators ResultsThe methodological framework links the OECD concept for quality assessment of health systems with Kessner's tracer methodology. Disease groups with a high prevalence (“common diseases”), prevention potential and potential for improvement through IC were selected as tracers. The literature search resulted in 239 QIs and the QI database search in 293 QIs, which were supplemented by 21 QIs from the focus groups. Out of a total of 553 QIs, 251 QIs remained after removal of duplicates and comparison with the data basis. This preliminary QI set was reduced to 101 QIs by consensus. In addition, 48 health reporting indicators were supplemented which serve to classify regional quality results. The final QI set maps the following 19 disease categories/tracers: heart failure (16 QIs), myocardial infarction (4 QIs), CHD (10 QIs), stroke (6 QIs), metabolic syndrome (7 QIs of which 5 were diabetes-related), COPD (6 QIs), asthma (3 QIs), chronic pain (5 QIs), back pain (3 QIs), geriatrics (7 QIs), dementia (8 QIs), osteoporosis (3 QIs), rheumatism (3 QIs), multiple sclerosis (2 QIs), depression (4 QIs), antibiotic therapy (3 QIs), drug safety (1 QI), child care (5 QIs), early detection/prevention (5 QIs). 33 of these QIs are dedicated to five tracers that are not explicitly ICM-GK programs. Most QIs assess aspects of the effectiveness of care for the chronically ill and measure process quality. DiscussionThe set of indicators initially enables the quality assessment of regional, cross-indication care quality in the population-based integrated health care model ‘Gesundes Kinzigtal’ on the basis of routine data. Although the QI set focuses on effectiveness and process quality, it also includes QIs for preventive and acute care, coordination of care, patient orientation and safety, and outcomes. In contrast to other QI sets, both primary care and specialist health care and integrated, cross-sectoral and cross-professional care aspects have been considered. The benefits of the QI set for comparisons of regional quality and the evaluation of different IC programs remain to be tested. ConclusionOn the basis of a broadly based research and participatory development process, a set of indicators has been developed that enables comprehensive evaluation of the regional quality of care of cross-indication, integrated care models focusing on common diseases. In order to be able to increasingly evaluate aspects of care coordination and patient orientation, health promotion as well as nursing, palliative and emergency care in the future, it would be helpful if routine data were collected or made accessible in these areas as well.

MORTALITY AND MEDICAL COMORBIDITY IN OLDER ADULTS WITH SCHIZOPHRENIA: A LITERATURE REVIEW

Introduction By 2025, the population of adults with schizophrenia over the age of 55 will reach 1.1?million. By 2050, this population may reach 10?million. Few studies have examined the physical comorbidities and mortality of Adults with (OAS). Recent national register studies have begun to yield compelling data on the medical issues facing this emerging demographic. These studies as well as other population based studies provide an opportunity to broadly assess whether this population's risk for specific medical disorders is increased compared to healthy peers and younger adults with schizophrenia. Methods Recent prominent register studies in the Netherlands, Denmark, Finland, United Kingdom, Sweden, Manitoba, Canada and Indiana, United States were reviewed in detail. The search term Older Adults with Schizophrenia was searched on PsycInfo, Google Scholar, Psychiatry Online with the following terms added: mortality, disease diabetes, utilization. antipsychotics. Approximately 112 journal articles, book chapters were selected for this review, prioritizing register studies, large population studies and journal articles focused on schizophrenic patients above the age of 55. . After removing redundant selections, approximately 93 articles were determined to be appropriate for this review. Results Recent register studies across nations and health care systems have demonstrated an approximate 2.0 to 2.5 increase in all-cause mortality in OAS compared to age peers. The all-cause mortality risk broadly appears to be improved compared to middle-aged and younger schizophrenics. The risk of suicide trends downward in OAS patients after the age of 60, further decreasing past the age of 70. Female OAS patients appear to have a higher suicide risk than males. OAS patients are still at significant risk of suicide compared to age peers without schizophrenia. Among OAS there is increased mortality for respiratory disease compared to the general population, but reduced compared to younger persons with schizophrenia. Increased prevalence of respiratory diseases in OAS has not been demonstrated consistently. There has been no demonstrated increase in mortality or prevalence of diabetes in the OAS population. OAS patients have a declining mortality from cardiovascular disease as they age compared to their younger counterparts, but still elevated compared to their age peers. Survival bias cannot be ruled out. Antipsychotic medication may play a role in increased cardiovascular mortality in OAS patients,(e.g., a U-shaped mortality curve pattern at no, low, and high doses) and suggests more research is needed to optimize dosing in this population. Population studies suggest a paradox where cancer incidence among persons with schizophrenia appears to be the same or lower than their age peers, but their mortality rate is higher; indeed, a screening and treatment gap exists in OAS patients with respect to cancer, which may account for lower incidence rates and higher mortality rates. A health care utilization gap for outpatient care exists for OAS patients across nations and health care systems. Integrated health care models show promise in bridging primary and psychiatric care. Conclusions Adults with is an emerging demographic in the schizophrenic population. Their healthcare outcomes appear to be unique when compared to younger individuals with schizophrenia and compared to their age peers without schizophrenia. This review evidences an increase in all-cause mortality for OAS patients compared to healthy age peers and this increase in mortality may extend to respiratory and cardiovascular diseases. OAS patients appear to have improved mortality rates for all-cause, respiratory disease, cardiovascular disease and suicide risk when compared to younger peers with schizophrenia; however, further study to understand what modifiable risk factors are influencing the mortality data is needed. This review also argues for a healthcare utilization gap in this population which may explain some of the modifiable risk affecting this population. This research was funded by: None

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 Integrated Healthcare Model for our County's Most Vulnerable Patients: Making an Impact with PACT (Post-Acute Care Transition)

An Integrated Healthcare Model for our County's Most Vulnerable Patients: Making an Impact with PACT (Post-Acute Care Transition)

A Public Health Perspective on Screening for Psychosis Within General Practice Clinics.

Screening for major mental illness in adolescents and young adults has lagged behind screening for physical illness for a myriad of reasons. Existing pediatric behavioral health screening tools screen primarily for disorders of attention, disruptive behaviors, depression, and anxiety. A few also screen for substance use and suicide risk. Although it is now possible to reliably identify young people at imminent risk for a psychotic disorder, arguably the most severe of mental illnesses, general practitioners (GP) rarely screen for psychotic symptoms or recognize when to refer patients for a specialized risk assessment. Research suggests that barriers such as inadequate knowledge or insufficient access to mental health resources can be overcome with intensive GP education and the integration of physical and mental health services. Under the lens of two public health models outlining the conditions under which disease screening is warranted, we examine additional evidence for and against population-based screening for psychosis in adolescents and young adults. We argue that systematic screening within general health settings awaits a developmentally well-normed screening tool that includes probes for psychosis, is written at a sufficiently low reading level, and has acceptable sensitivity and, in particular, specificity for detecting psychosis and psychosis risk in both adolescents and young adults. As integrated healthcare models expand around the globe and psychosis-risk assessments and treatments improve, a stratified screening and careful risk management protocol for GP settings could facilitate timely early intervention that effectively balances the benefit/risk ratio of employing such a screening tool at the population level.