Focus On Research September 2013

Focus on Research:

Primary Care & Behavioral Care Intervention

Cohen, Debbie web researcg profile
Debbie Cohen, PhD
 Sara Keller, MPH, MSW
Sara Keller, MPH, MSW
 Jennifer Hall
Jennifer Hall, MPH
 Rose Gunn, MA
Rose Gunn, MA

By Debbie Cohen, PhD; Sara Keller, MPH, MSW; Jennifer Hall, MPH; & Rose Gunn, MA

Integrated care means integrating behavioral health (mental health, substance use and health behavior) and physical health care in a single setting. The aim is to close the mind/body divide in health care. Integration requires comprehensive practice transformation to enable patient-centered care and collaboration among physical and behavioral providers to provide high-quality, unified care. Deborah Cohen, PhD and her OHSU team work on two studies related to integration.

Advancing Care Together (ACT) is a program designed to evaluate methods to integrate primary care and behavioral health care for patients. Integration of primary care, behavior change, mental health services and substance use is at the core of ACT’s fundamental objectives. With the support of the Colorado Health Foundation, ACT aims to transform the delivery of health care by learning from a set of 11 demonstration projects about what it takes to create models of integrated care that succeed in real-world settings. Implementation of the innovation, evaluation and real-time learning comprise the four-year program.  

The OHSU team, led by Cohen, is working with researchers at the University of Texas and University of Colorado, Denver to evaluate ACT. The ACT evaluation is using a mixed method, comparative case study design to learn how integration is achieved on the ground and to identify successful approaches to integrating care for patients. Entering the third year of study, Cohen and her team are collecting and analyzing qualitative and quantitative data for dissemination. They have an early findings paper due out in the Journal of the American Board of Family Medicine soon. For an advanced copy, email Melinda Davis.  

Additionally, Cohen and her team are taking the lead on an Agency for Healthcare Research and Quality contract, in collaboration with Westat and the University of Colorado, Denver to study the workforce competencies that are critical to supporting integrated primary and behavioral health care. The team has visited some of the top integrated sites in the US, including Cherokee Health System in Tennessee and South Central Foundation in Alaska. For this study, the team spends several weeks gathering information and planning the site visit, then they spend three days on an intensive site visit, observing team meetings, operations, clinical care delivery and conducting in-depth interviews with a range of staff. In total, they will be visiting 10 sites: three in California, two in Maine and one practice each in Tennessee, Minnesota, Alaska, New York and Illinois. This project is a part of the AHRQ Academy for Integrating Behavioral Health and Primary Care. 

There is a tremendous amount of learning that is done by watching how some of the most advanced integrated clinics organize and deliver care. Cohen and her team are about halfway through data collection and anticipate having a preliminary set of competencies identified by March and a great deal more analysis and writing to do in 2014. 

Visit the following sites for more information