Integrating behavioral health into primary care addresses fragmentation and lack of coordination. Populations: Individuals with avoidable high health care utilization (excluding some populations such as transplant or sickle cell) Interventions: hotspotting, behavioral health support, nurse case management, social interventions, intensive primary care support, EDIE (ED alerts), opioid restrictions Comparisons: no interventions, usual care Out. For Question 3, descriptive and hypothetical studies will not be included. Authors: Deborah J. Cohen, Ph.D. . Possemato K, Johnson EM, Beehler GP, Shepardson RL, King P, Vair CL, Funderburk JS, Maisto SA, Wray LO. 62. 2006 Mar;36(3):353-63. https://doi.org/10.1017/s0033291705006896. Substance Abuse and Mental Health Services Administration. Translational Behavioral Medicine. practice/care delivery setting characteristics such as the policy environment, and geographic location. No. . Accessed September 23, 2022. Care as usual (e.g., non-integrated behavioral health and primary care services) in a different group or time period, Alternative care integration strategy or strategies, No comparator for KQ 2 (descriptive studies; such as case studies). resources and infrastructure required, such as staffing, payment models, financing, and technology. Accessed September 23, 2022. Accessed September 23, 2022. Centers for Disease Control and Prevention. Ogbeide SA, Landoll RR, Nielsen MK, Kanzler KE. 96. Countries with healthcare systems that do not provide information relevant to the U.S. Articles reporting simulation or speculation. 29. Because of their unique clinical or content expertise, individuals are invited to serve as Technical Experts and those who present with potential conflicts may be retained. This brief provides an overview of the state of the evidence for behavioral health apps and key considerations and concerns related to finding, evaluating, and selecting smartphone and Internet-based behavioral health apps to recommend or prescribe in primary care and integrated care settings. Accessed September 23, 2022. https://doi.org/10.1017/S1463423618000403. AHRQ seeks to build a centralized resource hub to provide the tools and materials to advance the field of integration, and to promote a collaborative environment for dialogue and discussion among leaders across behavioral health, and primary healthcare arenas. https://www.gao.gov/products/gao-19-274. Centers for Disease Control and Prevention. 10 exp residential facilities/ Examples of eligible programs/models for care integration include but are not limited to: The baseline requirement is that the practice design of the approach facilitates interaction among primary care and behavioral health providers in the provision of care. https://health.gov/healthypeople/priority-areas/social-determinants-health/literature-summaries/discrimination. Inertial sensor-based gait parameters reflect patient-reported fatigue Accessed September 23, 2022. About our work at AHRQ. 2021 Feb;40(2):297-306. https://doi.org/10.1377%2Fhlthaff.2020.01452. Assessment of Methodological Risk of Bias of Individual Studies. 67. We will consider how recent frameworks might be used to help standardize the description of integration strategies identified for this review. https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-related-conditions/co-occurring-disorders. https://www.kff.org/racial-equity-and-health-policy/issue-brief/disparities-in-health-and-health-care-5-key-question-and-answers/. This project and report adopt definitions from the AHRQ Lexicon for Behavioral Health and Primary Care Integration.7 These definitions are provided below to ensure consistency across . During topic refinement, Key Informants assisted with generating a list of integration modes and approaches that we will translate into our initial search strategy. Families, Systems, & Health. 11. Rather, most will be observational studies and these designs are likely to have limitations that must be considered in terms of the rigorous application of their results.34 Similar to other system-level interventions we have studied, the evidence on behavioral health and primary care integration strategies is more likely to consist of cluster and step wedge trials35-37 and different types of observational studies,19,29,30,38-42 including studies that report outcomes for different groups of patients before and after implementation. AHRQ has multiple initiatives to implement evidence-based practices in screening and management of unhealthy opioid and alcohol use. Investigators are unable to estimate an effect or have no confidence in the estimate of effect for this outcome. These needs are reflected in detailed questions in the next section of this protocol. 9, National Collaborating Centre for Determinants of Health. 2018 Jul 26;13(1):98. https://doi.org/10.1186/s13012-018-0784-z. Accessed September 23, 2022. 8. Adult Civilian Noninstitutionalized Population, 2017, AHRQ's Academy for Integrating Behavioral Health into Primary Care, Postpartum Mental Health Care for Rural Families, Tobacco Surcharges Associated with Reduced Marketplace Enrollment, Opioid and Non-opioid Analgesic Prescribing Before and After the CDC's 2016 Opioid Guideline, Users of Retail Medications for Opioid Use Disorders Faced High Out-of-Pocket Prescription Spending in 2011-2017, Patient Factors that Affect Opioid Use among Adults with and without Chronic Pain, The Complex Relationships among Race/Ethnicity, Social Determinants, and Opioid Utilization, Physician Networks and Potentially Inappropriate Opioid Prescriptions, The Impact of the Abuse-Deterrent Reformulation of Extended-Release OxyContin on Prescription Pain Reliever Misuse and Heroin Initiation, LETTER: Medicaid Expansion and Mental Health Care and Coverage, Healthcare Costs of Pediatric Autism Spectrum Disorder in the United States, 2003-2015. Efforts to integrate behavioral health and primary care are rooted in growing recognition that perpetuating separate systems is no longer tenable. Integrated behavioral health offers many benefits: Patients with chronic health conditions are more likely to have related behavioral health concerns and often find it easier to improve chronic conditions when these concerns are also addressed. The Center's team of experts in organizational readiness, integrated care models, workforce & clinical practice, health & wellness, and financing & sustainability are ready to partner with providers to create a customized approach to . Experimental and observational studies that describe and evaluate integration approach, For Scan Question 1 and Contextual Questions 3 and 5: Survey and Qualitative Studies, For Contextual Question 4: Psychometric Studies. York (UK): Centre for Reviews and Dissemination (UK); 1995. https://www.ncbi.nlm.nih.gov/books/NBK76532/. 3 exp General Practice/ 2006 Feb 1;29(2):265-70. https://doi.org/10.2337/diacare.29.02.06.dc05-1572. Pomerantz A, Cole BH, Watts BV, Weeks WB. 16 14 and 15 Melek SP, Norris DT, Paulus J, Matthews K, Weaver A, Davenport S. Potential economic impact of integrated medical-behavioral healthcare: Updated projections for 2017. Accessed September 23, 2022. AHRQ's research on behavioral health can be found on AHRQ's Academy for Integrating Behavioral Health into Primary Care and as part of its Evidence-based Practice Center Program. Key Question 2 and Question 5a. Search Strategy. We will review and highlight studies by using a hierarchy-of-evidence approach, where the best evidence is the focus of our synthesis for each question. PDF Key Principles for Making Integrated Care Successful Across Settings https://www.gao.gov/products/gao-22-104597. Accessed September 23, 2022. The Agency for Healthcare Research and Quality's (AHRQ) mission is to produce evidence to make health care safer, higher quality, more accessible, equitable, and affordable, and to work within the U.S. Department of Health and Human Services and with other partners to make sure that the evidence is understood and used. The Technical Expert Panel is selected to provide broad expertise and perspectives specific to the topic under development. Trauma and violence. Barriers to healthcare access among US adults with mental health challenges: A population-based study. If more studies are identified, we will select a limited number of criteria specific to the study designs (e.g., surveys, qualitative studies, descriptive studies). A new topic brief from AHRQ summarizes the evidence on finding, evaluating and selecting smartphone and Internet-based behavioral health apps to recommend or prescribe in primary care and integrated care settings. https://doi.org/10.1002/14651858.CD006525.pub2. American Journal of Psychiatry. 27 limit 26 to English language Accessed September 23, 2022. https://www.ahrq.gov/cpi/about/otherwebsites/integrationacademy.ahrq.gov/index.html. Sun M, Oliwa T, Peek ME, Tung EL. Tracking Healthy People 2020 internet, broadband, and mobile device access goals: An update using data from the health information national trends survey. Nonadherence With Guidelines Associated With Cardiac Surgery Infection Slomski A. Nong P, Raj M, Creary M, Kardia SLR, Platt JE. The studies for Question 5 will focus on care team member roles, integration, and training. 18. Manatt, Phelps & Phillips, LLP. Because of their role as end-users, individuals are invited to serve as Key Informants and those who present with potential conflicts may be retained. Questions 2 and 5a. Gain a practical definition of behavioral health integration as implemented in actual practice settings and develop shared language that helps communication and collaboration across sites, disciplines, and time. Telephone: (301) 427-1364, Powered by the Evidence-based Practice Centers, Strategies for Integrating Behavioral Health and Primary Care, https://effectivehealthcare.ahrq.gov/products/strategies-integrating-behavioral-health/protocol, Comment on Key Questions and Draft Reports, 25 Years of the AHRQ Evidence-based Practice Center Program, II. The goal is to provide healthcare systems and clinical practices seeking to implement behavioral health and primary care integration with a foundation for practical guidance on selection, implementation, sustainability, and ongoing assessment of approaches to integrate behavioral health in primary care. Engaging patients to improve quality of care: A systematic review. Accessed September 23, 2022. www.ahrq.gov Contract No. People with multiple chronic conditions have poorer health outcomes, use more health services, and spend more on healthcare.16,17Integrating behavioral health into primary care can provide the collaborative, patient-centered, and whole-person care needed to address biopsychosocial factors that affect health, well-being, and quality of life and reduce disparities in health and healthcare.17,18,19. Telephone: (301) 427-1364, The Academy for Integrating Behavioral Health and Primary Care, https://www.ahrq.gov/cpi/about/otherwebsites/integrationacademy.ahrq.gov/index.html, AHRQ Publishing and Communications Guidelines, Evidence-based Practice Center (EPC) Reports, National Healthcare Quality and Disparities Reports, National Healthcare Quality and Disparities Report, Healthcare Cost and Utilization Project (HCUP), AHRQ Quality Indicator Tools for Data Analytics, United States Health Information Knowledgebase (USHIK), AHRQ Informed Consent & Authorization Toolkit for Minimal Risk Research, Grant Application, Review & Award Process, Study Sections for Scientific Peer Review, Getting Recognition for Your AHRQ-Funded Study, AHRQ Research Summit on Diagnostic Safety, AHRQ Research Summit on Learning Health Systems, National Action Alliance To Advance Patient Safety, National Advisory Council for Healthcare Research and Quality, U.S. Department of Health & Human Services. Katon W, Russo J, Sherbourne C, Stein MB, Craske M, Fan MY, Roy-Byrne P. Incremental cost-effectiveness of a collaborative care intervention for panic disorder. Crapanzano KA, Hammarlund R, Ahmad B, Hunsinger N, Kullar R. The association between perceived stigma and substance use disorder treatment outcomes: a review. Accessed September 23, 2022. 63. Washington, DC: American Hospital Association; 2019 May. After studies are deemed to meet inclusion criteria, data will be abstracted, including elements such as: study design, year, setting, country, sample size, patient and provider types and characteristics (e.g., age, sex, race, diagnosis/condition, provider training/background/scope of practice), integration approach characteristics, and results relevant to each Question as outlined in the previous PICOS section. 17 11 and 16 Integrating Behavioral Health and Primary Care Playbook Accessed September 23, 2022. Upstream has community impact. A record of studies excluded at the full-text level with reasons for exclusion will be maintained and made available as an appendix to the final report. Seattle, WA: Milliman; 2018 Jan. Accessed September 23, 2022. Below are MEPS statistical briefs on national behavioral healthcare use and costs. American Psychological Association. Nondiscrimination Notice, U.S. Department of Health & Human Services, Background - Foundational Information on Disparities in Health and healthcare, What We Know - The Role of Behavioral Health Integration in Reducing Disparities, Assemble a planning and implementation team for this initiative and provide appropriate training, such as, Assess the organizations readiness to make changes - you can use a tool such as, Implement changes - you can use an implementation tool such as, Assess current workplace culture - you can, Develop and implement strategies, activities, and tactics to recruit, support, affirm, and recognize staff and stakeholders from groups that are underrepresented, such as. Accessed September 23, 2022. 79. Scan Question. https://www.apa.org/workforce/data-tools/demographics. Effective Health Care Program, Agency for Healthcare Research and Quality, Rockville, MD. The specifics of how we synthesize the data will be driven by the types and quantity of data available. 53. Cully JA, Stanley MA, Petersen NJ, Hundt NE, Kauth MR, Naik AD, Sorocco K, Sansgiry S, Zeno D, Kunik ME. 89. United States Government Accountability Office. If meta-analysis is performed, randomized controlled trials will be analyzed separately from observational studies. Accessed September 23, 2022. 93. According to the Agency for Healthcare Research and Quality (AHRQ) Academy (a part of the US Department of Health & Human Services attempting to universalize the language and conception of IBH), the definition of IBH includes a team of primary and mental health clinicians working together with patients and their families. Eliason MJ, Streed Jr C, Henne M. Coping with stress as an LGBTQ+ health care professional. A randomized trial to improve the quality of treatment for panic and generalized anxiety disorders in primary care. Background and Objectives II. Data abstraction forms will be developed after full text review and the data to be included in evidence tables will be discussed with the AHRQ TOO, the TEP, and the partners. They do not review the report, except as given the opportunity to do so through the peer or public review mechanism. Grading the Strength of Evidence (SOE) for Major Comparisons and Outcomes. 18 (BHI or IBH or ((behav* adj3 (health* or care or cares or caring or cared) adj5 (integrat* or collaborat* or comprehensiv* or coordinat* or implement* or initiat* or launch* or establish* or introduc* or strateg* or philosoph* or approach*)) or (integrat* adj5 (team* adj2 (base or based or focus* or align*) adj2 (health* or care or cares or caring or cared))) or (integrat* adj (healthcare* or (health* adj (care or cares or caring or cared)))) or (whole person* adj2 (care or cares or caring or cared))) or (patient* adj2 (centered or focused or aligned) adj7 ((care or cares or caring or cared or healthcar*) adj3 (team* or provider* or approach* or philosoph*)))).mp. Question 4 (Contextual). What is Integrated Behavioral Health? | The Academy Accessed September 23, 2022. Upstream tactics include laws, policies, and regulation that create community conditions supporting health for all people. 5600 Fishers Lane Key Question (2) and Sub-question 5a. Advancing patient-centered care for people living with multiple chronic conditions. Nursing homes, group homes and other long-term residential settings. If sufficient data are available, meta-analyses will be conducted to summarize data and obtain more precise estimates of outcomes across any subgroups of studies homogeneous enough to provide a meaningful combined estimate. Accessed September 23, 2022. Agency for Healthcare . These surveys can be used for all patients receiving care for mental, emotional, or behavioral health issues, regardless of setting. Updating an organizations mission and goals requires a clear, shared vision with aligned incentives, resources, and buy-in. American Journal of Psychiatry. American Journal of Preventive Medicine. https://doi.org/10.2196%2F13300. Int J Nurs Stud Adv. 57. American Hospital Association. Accessed September 23, 2022. J Nurse Pract. Telephone: (301) 427-1364, AHRQ Publishing and Communications Guidelines, Evidence-based Practice Center (EPC) Reports, National Healthcare Quality and Disparities Reports, National Healthcare Quality and Disparities Report, Healthcare Cost and Utilization Project (HCUP), AHRQ Quality Indicator Tools for Data Analytics, United States Health Information Knowledgebase (USHIK), AHRQ Informed Consent & Authorization Toolkit for Minimal Risk Research, Grant Application, Review & Award Process, Study Sections for Scientific Peer Review, Getting Recognition for Your AHRQ-Funded Study, AHRQ Research Summit on Diagnostic Safety, AHRQ Research Summit on Learning Health Systems, National Action Alliance To Advance Patient Safety, Academy for Integrating Behavioral Health and Primary Care (the Academy), Medication-Assisted Treatment (MAT) for OUD Playbook, Integrating Behavioral Health and Primary Care Playbook, Collection of Unhealthy Alcohol Use Tools and Resources, Collection of MAT for OUD Tools and Resources, Resources for Nursing Home Staff and Resident Well-Being, AHRQ's Nursing Home COVID-19 Action Network, Consumer Assessment of Healthcare Provider and Systems (CAHPS) Mental Healthcare Surveys, The Healthcare Cost and Utilization Project (HCUP), HCUP Data Visualization on Inpatient Trends in COVID-19 and Other Conditions, HCUP Fast Stats: Opioid-Related Hospital Use, HCUP Fast Stats: Neonatal Abstinence Syndrome (NAS) Among Newborn Hospitalizations, Geographic Variation in Inpatient Stays for Five Leading Substance Use Disorders, 2016-2018, Geographic Variation in Inpatient Stays for Five Leading Mental Disorders, 2016-2018, Opioid-Related and Stimulant-Related Adult Inpatient Stays, 2012-2018, Emergency Department Visits Related to Suicidal Ideation or Suicide Attempt, 2008-2017, Hospital Burden of Opioid-Related Inpatient Stays: Metropolitan and Rural Hospitals, 2016, Costs of Emergency Department Visits for Mental and Substance Use Disorders in the United States, 2017, County-Level Determinants of High Opioid-Related Hospitalization Rates, Distribution and Correlates of Neonatal Abstinence Syndrome Across US Counties, 2016, Any Use and Frequent Use of Opioids among Non-Elderly Adults in 2018-2019, by Socioeconomic Characteristics, Any Use and Frequent Use of Opioids among Elderly Adults in 2018-2019, by Socioeconomic Characteristics, Healthcare Expenditures for Treatment of Mental Disorders: Estimates for Adults Ages 18 and Older, U.S.

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