Effects of different models of integrated collaborative care in a family medicine residency program.

Abstract

Integrated collaborative care (ICC) combines medical and behavioral health services in the primary care setting. Our family medicine residency program implemented care across three different models of integration over five years, allowing retrospective, cohort evaluation of the changes in behavioral health services and patient outcomes for depression. We identified three time periods representing increasing levels of services: Colocation of behavioral health services in 2004-05 (CL), primary care behavioral health model (behavioral health providers embedded in primary care) in 2009 (PCBH), and a blended model of PCBH and care management for depression in early 2010 (BM). All adult patient charts (n = 552) with PHQ9 scores ≥10 were analyzed for number of provider contacts (physician and behavioral health) and changes in scores during the 12-week follow-up. The percent of patients receiving adequate care (≥3 provider contacts in 12 weeks) improved from 43.5% (CL) to 55.1% (PCBH) to 60.6% (BM; Pearson chi-square, p = .02). Forty-two percent of patients in BM achieved remission (PHQ9 ≤ 4), 25.2% in PCBH and 12% in CL (Pearson chi-square, p = .02). The Blended Model resulted in better access to behavioral health care and outcomes for patients with depression symptoms.

Exploring anatomy and physiology using iPad applications

“…The cross tabulations were evaluated using chi‐square tests followed by Cramer's V in order to establish magnitudes of experimental effects (McHugh, ). The cross tabulations were also evaluated using Kendall's tau‐b and showed similar significance and values to Cramer's V. When the chi‐square tests were initially statistically significant, subsequent analyses used adjusted standardized residual values (Agresti, ; Landis et al, , Sharpe, ) to examine the contribution of each cell in the cross tabulation to the chi square value. Adjusted standard residuals (ASRs) have an approximate normal (Z) distribution so that a value > +2 would indicate that the relationship between a row category and a column category was significantly greater than chance at the 0.05 significance level or less.…”

Anxiety and diabetes: Innovative approaches to management in primary care

“…CMM uses a care manager, usually a member of the nursing staff who is employed by the primary care clinic, to follow a standard protocol of treatment to address the specific disease state. 69,71 The care manager may provide patient education regarding the specific disease state, engage the patient in SMG, or discuss coordination of care with the patient's multiple providers. They may engage in such interventions in-person, in the primary care setting, or via telephone between the patient's clinic visits.…”

“…In this model, the mental health services are not viewed as part of the patient's ''medical care''; rather as an adjunct service to which a patient is formally referred. 69 In the primary care behavioral health model (PCBH), mental health providers are embedded within the primary care setting. Ideally, the primary care provider introduces the mental health provider to the patient as part of the medial team during routine primary care visits.…”

“…The primary care provider and the mental health provider systematically share information via shared medical records. 69 The care management model (CMM) was developed for use in patients with a specific clinical problem, such as depression. CMM uses a care manager, usually a member of the nursing staff who is employed by the primary care clinic, to follow a standard protocol of treatment to address the specific disease state.…”

“…Common derivatives of collaborative care include ''Integrated Collaborative Care (ICC)'', ''Colocation'', ''Primary Care Behavioral Health (PCBH)'' and ''Care Management Model (CMM).'' [69][70][71][72] ICC is synonymous with the broad definition of ''collaborative care'' and is defined as a range of models in which BHPs and primary care physicians systematically communicate to co-manage the mental health and biomedical needs of patients through collaboration and coordination of care.…”