Care Coordination and Population Health Management Strategies and Challenges in a Behavioral Health Home Model.
Care Coordination and Population Health Management Strategies and Challenges in a Behavioral Health Home Model.
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DOI：
10.1097/mlr.0000000000001023
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发表时间：
2019-01
期刊：
影响因子：
3
通讯作者：
McGinty EE
中科院分区：
文献类型：
--
作者：
Daumit GL;Stone EM;Kennedy-Hendricks A;Choksy S;Marsteller JA;McGinty EE
行为健康之家（BHH）模式已被开发，以整合身体和精神保健，并解决患有严重精神疾病（SMIs）的个人的医疗合并症。先前的研究发现，人口健康管理能力和与初级保健提供者（pcp）的协调是实施BHH的主要障碍。本研究考察了在马里兰州实施BHH的社区心理健康项目中，BHH领导人对这些职能的看法和组织能力。对马里兰州48个BHH项目中的46个项目的72名实施负责人和627名一线员工进行了访谈和调查。人口健康管理和初级保健协调主题的深入编码确定了与这些主题相关的分主题。BHH工作人员描述了支持循证实践的文化，但有效执行人口健康管理或初级保健协调的能力有限。人口健康管理与直接临床护理之间的紧张关系、缺乏经验以及国家对服务提供的规定被确定为人口健康管理的主要挑战。参与pcp是护理协调的主要障碍。卫生信息技术（HIT）和人员配备是这两项职能的障碍。BHHs在有效实施核心规划要素方面面临许多障碍。为了提高项目进行有效的人口健康管理和护理协调的能力，并对重度精神障碍患者的健康结果产生有意义的影响，需要采取多种战略，包括正式的协议、对工作人员的培训、改变融资机制和改善卫生保健系统。
Behavioral health home (BHH) models have been developed to integrate physical and mental health care and address medical comorbidities for individuals with serious mental illnesses (SMIs). Previous studies identified population health management capacity and coordination with primary care providers (PCPs) as key barriers to BHH implementation. This study examines the BHH leaders’ perceptions of and organizational capacity to conduct these functions within the community mental health programs implementing BHHs in Maryland. Interviews and surveys were conducted with 72 implementation leaders and 627 front-line staff from 46 of the 48 Maryland BHH programs. In-depth coding of the population health management and primary care coordination themes identified sub-themes related to these topics. BHH staff described cultures supportive of evidence-based practices, but limited ability to effectively perform population health management or primary care coordination. Tension between population health management and direct, clinical care, lack of experience, and state regulations for service delivery were identified as key challenges for population health management. Engaging PCPs was the primary barrier to care coordination. Health information technology (HIT) and staffing were barriers to both functions. BHHs face a number of barriers to effective implementation of core program elements. To improve programs’ ability to conduct effective population health management and care coordination and meaningfully impact health outcomes for individuals with SMI, multiple strategies are needed, including formalized protocols, training for staff, changes to financing mechanisms, and HIT improvements.