Integrating primary care and behavioral health is an important focus of health system transformation. Cross-case comparative analysis of 19 practices in the United States describing integrated care clinical workflows. Surveys, observation visits, and key informant interviews analyzed using immersion-crystallization. Staff performed tasks and behaviors-guided by protocols or scripts-to support 4 workflow phases: (1) identifying; (2) engaging/transitioning; (3) providing treatment; and (4) monitoring/adjusting care. Shared electronic health records and accessible staffing/scheduling facilitated workflows. Stakeholders should consider these workflow phases, address structural features, and utilize a developmental approach as they operationalize integrated care delivery.
Bibliographical noteFunding Information:
Portions of this work were presented during the 2014 Practice-based Research Network (PBRN) Annual Meeting in Bethesda, Maryland. The authors are thankful to the 19 participating practices. Larry A. Green, MD and Frank deGruy III, MD, provided helpful comments preparing this manuscript. This research was supported by grants from the Colorado Health Foundation (CHF-3848), Agency for Healthcare Research and Quality—8846.01-S01. Tides Foundation/CalMHSA Integrated Behavioral Health Project-AWD-131237. Maine Health Access Foundation—2012FI-0009. Dr Davis is supported in part by a Cancer Prevention, Control, Behavioral Sciences, and Populations Sciences Career Development Award from the National Cancer Institute (K07CA211971).
© 2019 Wolters Kluwer Health, Inc.
- behavioral medicine
- case study
- medical home/patient-centered medical home
- mental health
- practice management
- primary care
- qualitative research/study