Large Medical System Research Articles

Primary Care Behavioral Health Provider Training: Systematic Development and Implementation in a Large Medical System.

The expansion of integrated, collaborative, behavioral health services in primary care requires a trained behavioral health workforce with specific competencies to deliver effective, evidence-informed, team-based care. Most behavioral health providers do not have training or experience working as primary care behavioral health consultants (BHCs), and require structured training to function effectively in this role. This article discusses one such training program developed to meet the needs of a large healthcare system initiating widespread implementation of the primary care behavioral health model of service delivery. It details the Department of Defense's experience in developing its extensive BHC training program, including challenges of addressing personnel selection and hiring issues, selecting a model for training, developing and implementing a phased training curriculum, and improving the training over time to address identified gaps. Future directions for training improvements and lessons learned in a large healthcare system are discussed.

"The Spiral of Abuse? Reciprocal Relationships among Abusive Supervision, Performance, and Motives"

We propose a dynamic reciprocal relationship between abusive supervision and subordinate performance (i.e., task performance, citizenship behaviors, and deviance) in which subordinate performance promotes changes in abusive supervision and the altered abusive supervision, in turn, fuels further changes in subordinate performance. Drawing from theories of attribution and motivation, we further propose that this spiral of abuse is facilitated or mitigated by subordinate`s attributed motives behind abusive supervision (i.e., injury initiation motive vs. performance promotion motive) and supervisor`s own motives (i.e., self-serving motive vs. pro-social motive). In a five-wave longitudinal study based on a sample of 512 supervisor-subordinate dyads from a large medical system, results support the existence of the spiral of abuse, and the moderating effects of subordinate`s attributed motives and supervisor`s own motives on the corresponding loop of such spiral, respectively.

San Francisco children living in redeveloped public housing used acute services less than children in older public housing.

Understanding the links between housing and health is increasingly important. Poor housing quality is a predictor of poor health and developmental problems in low-income children. We examined associations between public housing type and recurrent pediatric emergency and urgent care hospital visits. Children ages 0-18 with public insurance who sought emergency care from any of three large medical systems in San Francisco were categorized by whether they lived in public housing redeveloped through the federal HOPE VI program, nonredeveloped public housing, or nonpublic housing in a census tract that also contained public housing. After we adjusted for potential confounding characteristics, we found that children living in nonredeveloped public housing were 39 percent more likely to have one or more repeat visits within one year for acute health care services unrelated to the initial visit, compared to children who lived in redeveloped HOPE VI housing. We observed no differences in repeat visits between children in redeveloped HOPE VI housing and those in nonpublic housing. These findings support the continued redevelopment of public housing as a means of both improving the health of vulnerable high-risk children from low-income neighborhoods and reducing health care costs.

Obesity Prevention and Treatment

Obesity Prevention and Treatment

Battlefield Acupuncture

Battlefield Acupuncture

Quality and customers: Type 2 change in mental health delivery within health care reform.

The traditional separation of mental health and medical programs is problematic because mental health issues are inseparable from the larger medical system. By contrast, a collaborative primary care model of mental health care, augmented and supported by secondary specialty mental health services, has the potential to optimize quality and cost goals while reinforcing health care reform principles. The flexibility of mental health treatment in this delivery structure provides opportunities to customize services according to patient and purchaser expectations.

Air Force, Army, Navy Physicians Face Unusual Variety of Challenges

THE PHYSICIAN who is surgeon general of the US Air Force, Army, or Navy today faces challenges that include: Providing medical care for the more than 2 million men and women of the US armed forces, for their nearly 3 million dependents, and for some 5 million military retirees, their surviving spouses, and their other dependents. Operating a network of medical facilities that spans much of the globe and that must be prepared for any medical emergency up to and including war. Recruiting and retaining physicians and other medical personnel who have numerous competing opportunities. Keeping pace with medical developments, encouraging research that may reduce the health hazards faced by military people, and adjusting to the changing environmental, technological, and cultural circumstances of military life. <h3>World's Largest System</h3> To meet these and other challenges, the Military Health Services System operates the world's largest medical system, with more than 500 facilities.