“Implementation and evaluation of an integrated care program in a VA medical center": Correction to Barber et al. (2011).

Objective: To examine the effectiveness of integrating generalist and specialist care for veterans with depression. Method: We conducted a randomized trial of patients screening positive for depression at two Veterans Affairs Medical Center general medicine clinic firms. Control firm physicians were notified prior to the encounter when eligible patients had PRIME-MD depression diagnoses. In the intervention firm, a mental health clinical nurse specialist (CNS) was to: design a treatment plan; implement that plan with the primary care physician; and monitor patients via telephone or visits at two weeks, one month and two months. Primary outcomes (depressive symptoms, patient satisfaction with health care) were collected at 3 and 12 months. Results: Of 268 randomized patients, 246 (92%) and 222 (83%) completed 3- and 12-month follow-up interviews. There were no between-group differences in depressive symptoms or satisfaction at 3 or 12 months. The intervention group had greater chart documentation of depression at baseline (63% versus 33%, p = 0.003) and a higher referral rate to mental health services at 3 months (27% versus 9%, p = 0.019). There was no difference in the rate of new prescriptions for, or adequate dosing of, anti-depressant medications. In 40% of patients, CNSs disagreed with the PRIME-MD depression diagnosis, and their rates of watchful waiting were correspondingly high. Conclusions: Implementing an integrated care model did not occur as intended. Experienced CNSs often did not see the need for treatment in many primary care patients identified by the PRIME-MD. Integrating integrated care models in actual practice may prove challenging.

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The COMPASS initiative: implementing a complex integrated care program

General Hospital Psychiatry ◽

10.1016/j.genhosppsych.2016.06.007 ◽

2017 ◽

Vol 44 ◽

pp. 67-68 ◽

Cited By ~ 1

Author(s):

James R. Rundell ◽

Jeff C. Huffman

Keyword(s):

Integrated Care ◽

Care Program

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The Effect of a Methadone Treatment Program Upon Pregnant Heroin Addicts and Their Newborn Infants

PEDIATRICS ◽

10.1542/peds.54.3.300 ◽

1974 ◽

Vol 54 (3) ◽

pp. 300-305

Author(s):

Rita G. Harper ◽

George I. Solish ◽

Henry M. Purow ◽

Edward Sang ◽

William C. Panepinto

Keyword(s):

New York ◽

Psychosocial Support ◽

Past History ◽

Medical Center ◽

Methadone Treatment ◽

Newborn Infants ◽

Care Program ◽

State University ◽

Downstate Medical ◽

History Of

A Family and Maternity Care Program (FMCP) for pregnant addicts, their spouses and the newborn infants was organized at the State University of New York Downstate Medical Center. Twenty-five percent of the women were treated for syphilis; 18% had a recurrent or recent past history of hepatitis. Obstetrical complications were reduced or eliminated by careful obstetrical surveillance. None of the mothers signed out against medical advice postpartum. Of the 51 living infants delivered within the study period, there were 17 infants weighing less than 2,500 gm. The Apgar score at one minute was 7 or higher in 84% of the infants. An excessive incidence of congenital malformation was not seen. Ninety-four percent of the infants developed withdrawal symptoms, 6% of whom convulsed repetitively. Infant withdrawal, however, was unassociated with an increase in mortality or known prolonged morbidity. This low-dose methadone program coupled with intense psychosocial support appeared to alleviate many of the common problems associated with addiction in pregnancy, but failed to prevent withdrawal in the newborn.

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Impact of family physician integrated care program on decreasing utilization of emergency department visit and hospital admission: a population-based retrospective cohort study

BMC Health Services Research ◽

10.1186/s12913-020-05347-7 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Po-Tsung Huang ◽

Pei-Tseng Kung ◽

Wen-Yin Kuo ◽

Wen-Chen Tsai

Keyword(s):

Emergency Department ◽

Cohort Study ◽

Hospital Admission ◽

Integrated Care ◽

Emergency Department Visit ◽

Family Physician ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Care Program ◽

Population Based

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Meeting Resident Scholarly Activity Requirements Through a Longitudinal Quality Improvement Curriculum

Journal of Graduate Medical Education ◽

10.4300/jgme-d-14-00360.1 ◽

2015 ◽

Vol 7 (1) ◽

pp. 86-90 ◽

Cited By ~ 17

Author(s):

Madeline Simasek ◽

Stephanie L. Ballard ◽

Phillip Phelps ◽

Rowena Pingul-Ravano ◽

N. Randall Kolb ◽

...

Keyword(s):

Quality Improvement ◽

Family Medicine ◽

Literature Review ◽

Work Group ◽

Medical Center ◽

Care Program ◽

Scholarly Activity ◽

University Of Pittsburgh ◽

Outpatient Practice ◽

The University

Abstract Background Quality improvement (QI) skills are learned during residency, yet there are few reports of the scholarly activity outcomes of a QI curriculum in a primary care program. Intervention We examined whether scholarly activity can result from a longitudinal, experiential QI curriculum that involves residents, clinic staff, and faculty. Methods The University of Pittsburgh Medical Center Shadyside Family Medicine Residency implemented a required longitudinal outpatient practice improvement rotation (LOPIR) curriculum in 2005. The rotation format includes weekly multidisciplinary work group meetings alternating with resident presentations delivered to the entire program. Residents present the results of a literature review and provide 2 interim project updates to the residency. A completed individual project is required for residency graduation, with project results presented at Residency Research Day. Scholarly activity outcomes of the curriculum were analyzed using descriptive statistics. Results As of 2014, 60 residents completed 3 years of the LOPIR curriculum. All residents satisfied the 2014 Accreditation Council for Graduate Medical Education (ACGME) scholarly activity and QI requirements with a literature review presentation in postgraduate year 2, and the presentation of a completed QI project at Residency Research Day. Residents have delivered 83 local presentations, 13 state/regional presentations, and 2 national presentations. Residents received 7 awards for QI posters, as well as 3 grants totaling $21,639. The educational program required no additional curriculum time, few resources, and was acceptable to residents, faculty, and staff. Conclusions LOPIR is an effective way to meet and exceed the 2014 ACGME scholarly activity requirements for family medicine residents.

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