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Research ArticleFamily Medicine and the Health Care System

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 and Deborah J. Cohen
The Journal of the American Board of Family Medicine September 2013, 26 (5) 588-602; DOI: https://doi.org/10.3122/jabfm.2013.05.130028
Melinda Davis
the Department of Family Medicine, Oregon Health & Science University, Portland (MD, EW, DJC); University of Texas Health Science Center, Houston, School of Medicine, Dallas (BAB); the Office of Integrated Healthcare Research and Policy (BFM) and the Department of Family Medicine (BFM, LAG), University of Colorado, Aurora.
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Bijal A. Balasubramanian
the Department of Family Medicine, Oregon Health & Science University, Portland (MD, EW, DJC); University of Texas Health Science Center, Houston, School of Medicine, Dallas (BAB); the Office of Integrated Healthcare Research and Policy (BFM) and the Department of Family Medicine (BFM, LAG), University of Colorado, Aurora.
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Elaine Waller
the Department of Family Medicine, Oregon Health & Science University, Portland (MD, EW, DJC); University of Texas Health Science Center, Houston, School of Medicine, Dallas (BAB); the Office of Integrated Healthcare Research and Policy (BFM) and the Department of Family Medicine (BFM, LAG), University of Colorado, Aurora.
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Benjamin F. Miller
the Department of Family Medicine, Oregon Health & Science University, Portland (MD, EW, DJC); University of Texas Health Science Center, Houston, School of Medicine, Dallas (BAB); the Office of Integrated Healthcare Research and Policy (BFM) and the Department of Family Medicine (BFM, LAG), University of Colorado, Aurora.
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Larry A. Green
the Department of Family Medicine, Oregon Health & Science University, Portland (MD, EW, DJC); University of Texas Health Science Center, Houston, School of Medicine, Dallas (BAB); the Office of Integrated Healthcare Research and Policy (BFM) and the Department of Family Medicine (BFM, LAG), University of Colorado, Aurora.
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Deborah J. Cohen
the Department of Family Medicine, Oregon Health & Science University, Portland (MD, EW, DJC); University of Texas Health Science Center, Houston, School of Medicine, Dallas (BAB); the Office of Integrated Healthcare Research and Policy (BFM) and the Department of Family Medicine (BFM, LAG), University of Colorado, Aurora.
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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, mixed-methods 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.

  • Implementation Research
  • Integrated Care
  • Mental Health
  • Mixed Methods
  • Primary Health Care
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The Journal of the American Board of Family     Medicine: 26 (5)
The Journal of the American Board of Family Medicine
Vol. 26, Issue 5
September-October 2013
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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 J. Cohen
The Journal of the American Board of Family Medicine Sep 2013, 26 (5) 588-602; DOI: 10.3122/jabfm.2013.05.130028

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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 J. Cohen
The Journal of the American Board of Family Medicine Sep 2013, 26 (5) 588-602; DOI: 10.3122/jabfm.2013.05.130028
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Keywords

  • Implementation Research
  • Integrated Care
  • Mental Health
  • Mixed Methods
  • Primary Health Care

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