Integrating behavioral and physical health care in the real world: Early lessons from Advancing Care Together

Melinda Davis, Bijal A. Balasubramanian, Elaine Waller, Benjamin F. Miller, Larry A. Green, Deborah Cohen

Research output: Contribution to journalArticle

42 Citations (Scopus)

Abstract

Background: More than 20 years ago the Institute of Medicine advocated for integration of physical and behavioral health care. Today, practices are integrating care in response to recent policy initiatives. However, few studies describe how integration is accomplished in real-world practices without the financial or research support available for most randomized controlled trials. Methods: To study how practices integrate care, we are conducting a cross-case comparative, mixedmethods study of 11 practices participating in Advancing Care Together (ACT). Using a grounded theory approach, we analyzed multiple sources of data (eg, documents, practice surveys, field notes from observation visits, semistructured interviews, online diaries) collected from each ACT innovator. Results: Integration requires making changes in organization and interpersonal relationships. During early integration efforts, challenges related to workflow and access, leadership and culture change, and tracking and using data to evaluate patient- and practice-level improvement emerged for ACT innovators. We describe the strategies innovators are developing to address these challenges. Conclusion: Integrating care is a fundamental and difficult change for practices and health care professionals. Research identifying common challenges that manifest in early efforts can help others attempting integration and inform state, local, and federal policies aimed at achieving wide-spread implementation.

Original languageEnglish (US)
Pages (from-to)588-602
Number of pages15
JournalJournal of the American Board of Family Medicine
Volume26
Issue number5
DOIs
StatePublished - Sep 2013

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Delivery of Health Care
National Academies of Science, Engineering, and Medicine (U.S.) Health and Medicine Division
Workflow
Information Storage and Retrieval
Randomized Controlled Trials
Observation
Organizations
Interviews
Research
Surveys and Questionnaires
Grounded Theory

Keywords

  • Implementation research
  • Integrated care
  • Mental health
  • Mixed methods
  • Primary health care

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Family Practice

Cite this

Integrating behavioral and physical health care in the real world : Early lessons from Advancing Care Together. / Davis, Melinda; Balasubramanian, Bijal A.; Waller, Elaine; Miller, Benjamin F.; Green, Larry A.; Cohen, Deborah.

In: Journal of the American Board of Family Medicine, Vol. 26, No. 5, 09.2013, p. 588-602.

Research output: Contribution to journalArticle

Davis, Melinda ; Balasubramanian, Bijal A. ; Waller, Elaine ; Miller, Benjamin F. ; Green, Larry A. ; Cohen, Deborah. / Integrating behavioral and physical health care in the real world : Early lessons from Advancing Care Together. In: Journal of the American Board of Family Medicine. 2013 ; Vol. 26, No. 5. pp. 588-602.
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