Gold SB, Green LA, Peek CJ. From our practices to yours: key messages for the journey to integrated behavioral health. JABFM Jan 2017;3025-34.
Clark KD, Miller BF, Green LA, deGruy FV, Davis M, Cohen DJ. Implementation of behavioral health interventions in real world scenarios: managing complex change. Family Systems and Health 2017;35:36-45.
Balasubramanian BA, Cohen DJ, Jetelina KK, Dickinson LM, Davis MM, Gunn R, Gowen K, deGruy FV, Miller BF, Green LA. Outcomes of integrated behavioral health with primary care. JABFM 2017;30:130-139.
Davis MM, Gunn R, Gowen LK, Miller BF, Green LA, Cohen DJ. A qualitative study of patient experience of integrated behavioral health and primary care settings: more similar than different. Translational Behavioral Medicine 2018;XX:XX-XX. doi:10.1093/tbm/ibx001.
Gold SB, Green LA, Editors. Integrated Behavioral Health in Primary Care: Your Patients Are Waiting. Springer Nature, 2018.
Green LA, Cifuentes M. Advancing Care Together by Integrating Primary Care and Behavioral Health. JABFM 2015; 28:S1-S6.
From Reform to the Norm?
2015 is the year when integrated care and payment overhaul begin in earnest.
Symposium Unplugged: Colorado’s Journey to Integrated Care
ACT Early Results
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 (e.g., 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.
Davis M, Balasubramanian BA, Waller E, Miller BF, Green LA, Cohen DJ. Integrating Behavioral and Physical Health Care in the Real World: Early Lessons from Advancing Care Together. The Journal of the American Board of Family Medicine. September 1, 2013 2013;26(5):588-602.
ACT Learning Evaluation
Background: In healthcare change interventions, on-the-ground learning about the implementation process is often lost because of a primary focus on outcome improvements. This paper describes the Learning Evaluation, a methodological approach that blends quality improvement and implementation research methods to study healthcare innovations.
Methods: Learning Evaluation is an approach to multi-organization assessment. Qualitative and quantitative data are collected to conduct real-time assessment of implementation processes while also assessing changes in context, facilitating quality improvement using run charts and audit and feedback, and generating transportable lessons. Five principles are the foundation of this approach: (1) gather data to describe changes made by healthcare organizations and how changes are implemented; (2) collect process and outcome data relevant to healthcare organizations and to the research team; (3) assess multi-level contextual factors that affect implementation, process, outcome, and transportability; (4) assist healthcare organizations in using data for continuous quality improvement; and (5) operationalize common measurement strategies to generate transportable results.
Results: Learning Evaluation principles are applied across organizations by the following: (1) establishing a detailed understanding of the baseline implementation plan; (2) identifying target populations and tracking relevant process measures; (3) collecting and analyzing real-time quantitative and qualitative data on important contextual factors; (4) synthesizing data and emerging findings and sharing with stakeholders on an ongoing basis; and (5) harmonizing and fostering learning from process and outcome data. Application to a multi-site program focused on primary care and behavioral health integration shows the feasibility and utility of Learning Evaluation for generating real-time insights into evolving implementation processes.
Conclusions: Learning Evaluation generates systematic and rigorous cross-organizational findings about implementing healthcare innovations while also enhancing organizational capacity and accelerating translation of findings by facilitating continuous learning within individual sites. Researchers evaluating change initiatives and healthcare organizations implementing improvement initiatives may benefit from a Learning Evaluation approach.
Balasubramanian BA, Cohen DJ, Davis MM, Gunn R, Dickinson LM, Miller WL, Crabtree BF, Stange KC. Learning Evaluation: blending quality improvement and implementation research methods to study healthcare innovations. Implement Sci. 2015 Mar 10;10(1):31