Narrative review of provider behavior in primary care behavioral health: How process data can inform quality improvement.

Provider- and staff-perceived levels of integration were measured during implementation of a primary care behavioral health clinic; these data were used to tailor and evaluate quality improvement strategies. Providers and staff at an urban, academic, adult primary care clinic completed the 32-item Level of Integration Measure (LIM) at baseline and 7 months. The LIM assesses 6 domains of integrated care. Overall and domain scores were calibrated from 0 to 100, with ≥80 representing a highly integrated clinic. Response rate was 79% (N = 46/58) at baseline and 83% (N = 52/63) at follow-up. Overall, LIM score increased from 64.5 to 70.1, P = .001. The lowest scoring domains at baseline were targeted for quality improvement and increased significantly: integrated clinical practice, 60.0 versus 68.4, P < .001; systems integration, 57.0 versus 63.8, P = .001; and training, 56.7 versus 65.3, P = .001. Ongoing quality improvement, including organizational and financial strategies, is needed to achieve higher levels of integration.

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Integrated primary care behavioral health for the rural older adult.

Practice Innovations ◽

10.1037/pri0000022 ◽

2016 ◽

Vol 1 (3) ◽

pp. 145-153

Author(s):

Stacy Ogbeide ◽

Gage Stermensky ◽

Summer Rolin

Keyword(s):

Primary Care ◽

Behavioral Health ◽

Older Adult ◽

Integrated Primary Care ◽

Primary Care Behavioral Health

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Improving Access to Integrated Behavioral Health in a Nurse-Led Federally Qualified Health Center

Journal of the American Psychiatric Nurses Association ◽

10.1177/1078390321994165 ◽

2021 ◽

pp. 107839032199416

Author(s):

Sarah Stalder ◽

Aimee Techau ◽

Jenny Hamilton ◽

Carlo Caballero ◽

Mary Weber ◽

...

Keyword(s):

Primary Care ◽

Quality Improvement ◽

Behavioral Health ◽

Behavioral Health Care ◽

Primary Care Providers ◽

Care Team ◽

Psychiatric Nurse ◽

Care Providers ◽

Team Members ◽

Task Forces

BACKGROUND: The specific aims of this project were to create a fully integrated, nurse-led model of a psychiatric nurse practitioner and behavioral health care team within primary care to facilitate (1) patients receiving an appropriate level of care and (2) care team members performing at the top of their scope of practice. METHOD: The guiding model for process implementation was Rapid Cycle Quality Improvement. Three task forces were established to develop interventions in the areas of Roles and Responsibilities, Training and Implementation, and the electronic health record. INTERVENTION: The four interventions that emerged from these task forces were (1) the establishment of patient tiers based on diagnosis, medications, and risk assessment; (2) the creation of process maps to engage care team members; (3) just-in-time education regarding psychiatric medication management for primary care providers; and (4) use of a registry to track patients. RESULTS: The process measures of referrals to the psychiatric care team and psychiatric assessment intakes performed as expected. Both measures were higher at the onset of the project and lower 1 year later. The outcome indicator, number of case reviews, increased dramatically over time. CONCLUSIONS: For psychiatric nurse practitioners, this quality improvement effort provides evidence that a consultative role can be effective in supporting primary care providers. Through providing education, establishing patient tiers, and establishing an effective workflow, more patients may have access to psychiatric services.

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