RT Journal Article
SR Electronic
T1 Designing Clinical Space for the Delivery of Integrated Behavioral Health and Primary Care
JF The Journal of the American Board of Family
                Medicine
JO J Am Board Fam Med
FD American Board of Family Medicine
SP S52
OP S62
DO 10.3122/jabfm.2015.S1.150053
VO 28
IS Supplement 1
A1 Gunn, Rose
A1 Davis, Melinda M.
A1 Hall, Jennifer
A1 Heintzman, John
A1 Muench, John
A1 Smeds, Brianna
A1 Miller, Benjamin F.
A1 Miller, William L.
A1 Gilchrist, Emma
A1 Brown Levey, Shandra
A1 Brown, Jacqueline
A1 Wise Romero, Pam
A1 Cohen, Deborah J.
YR 2015
UL http://www.jabfm.org/content/28/Supplement_1/S52.abstract
AB Purpose: This study sought to describe features of the physical space in which practices integrating primary care and behavioral health care work and to identify the arrangements that enable integration of care.Methods: We conducted an observational study of 19 diverse practices located across the United States. Practice-level data included field notes from 2–4-day site visits, transcripts from semistructured interviews with clinicians and clinical staff, online implementation diary posts, and facility photographs. A multidisciplinary team used a 4-stage, systematic approach to analyze data and identify how physical layout enabled the work of integrated care teams.Results: Two dominant spatial layouts emerged across practices: type-1 layouts were characterized by having primary care clinicians (PCCs) and behavioral health clinicians (BHCs) located in separate work areas, and type-2 layouts had BHCs and PCCs sharing work space. We describe these layouts and the influence they have on situational awareness, interprofessional “bumpability,” and opportunities for on-the-fly communication. We observed BHCs and PCCs engaging in more face-to-face methods for coordinating integrated care for patients in type 2 layouts (41.5% of observed encounters vs 11.7%; P < .05). We show that practices needed to strike a balance between professional proximity and private work areas to accomplish job tasks. Private workspace was needed for focused work, to see patients, and for consults between clinicians and clinical staff. We describe the ways practices modified and built new space and provide 2 recommended layouts for practices integrating care based on study findings.Conclusion: Physical layout and positioning of professionals' workspace is an important consideration in practices implementing integrated care. Clinicians, researchers, and health-care administrators are encouraged to consider the role of professional proximity and private working space when creating new facilities or redesigning existing space to foster delivery of integrated behavioral health and primary care.