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Working with Complexity in Integrated Behavioral Health Settings

  • Macaran A. BairdEmail author
  • C. J. Peek
  • William B. Gunn
  • Andrew Valeras
Chapter

Abstract

This chapter provides a practical approach for understanding and dealing with patient “complexity” in a health care context. Complexity is defined as the interaction of patient, provider, and care delivery variables, which intermingle to create situations where usual treatments are not working—or not working as well as patients and clinicians are expecting. These situations can only be understood by looking at the complex interaction of those variables and adopting new models of understanding and implementing new care-giving strategies. The chapter begins with a review of different approaches to dealing with complexity within the USA and in Europe. A particular method and clinical checklist is described in detail. A “real world” application, the Complex Continuity Clinic, using this and other methods of engaging patients in complex situations, is outlined, with clinical examples. Finally, the important implications of a complexity approach to emerging health care reform is described, shedding light on how effective approaches that embrace complex biopsychosocial health issues can result in greater quality and reduced costs.

Keywords

Care Plan Medical Complexity Care Coordination Primary Care Practice Health Care Team 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. Althoff, R. R., & Waterman, G. S. (2011). Commentary: Psychiatric training for physicians: A call to modernize. Academic Medicine, 86, 285–287.PubMedCrossRefGoogle Scholar
  2. Amundson, B. (2001). America’s rural communities as crucibles for clinical reform: Establishing collaborative care teams in rural communities. Families, Systems & Health, 19, 13–23.CrossRefGoogle Scholar
  3. Borrell-Carrio, F., Suchman, A. L., & Epstein, R. M. (2004). The biopsychosocial model 25 years later: Principles, practice, and scientific inquiry. Annals of Family Medicine, 2, 576–582.PubMedCrossRefGoogle Scholar
  4. Carlat, D. (2010a). The trouble with psychiatry: A doctor’s revelations about a profession in crisis. New York: Free Press.Google Scholar
  5. Carlat, D. (2010b). Mind over meds. The New York Times. Retrieved April 29, 2013, from http://www.nytimes.com/2010/04/25/magazine/25Memoir-t.html?pagewanted=all&_r=0
  6. de Jonge, P., Huyse, F. J., & Stiefel, F. C. (2006). Case and care complexity in the medically ill. Medical Clinics of North America, 90, 679–692.PubMedCrossRefGoogle Scholar
  7. Doherty, W. J., & Baird, M. A. (1983). Family therapy and family medicine: Toward the primary care of families. New York: Guilford Press.Google Scholar
  8. Engel, G. L. (1977). The need for a new medical model: A challenge for biomedicine. Science, 196, 129–136.PubMedCrossRefGoogle Scholar
  9. Engel, G. L. (1980). The clinical application of the biopsychosocial model. The American Journal of Psychiatry, 137, 535–544.PubMedGoogle Scholar
  10. Fournier, J. C., DeRubeis, R. J., Hollon, S. D., Dimidjian, S., Amsterdam, J. D., Shelton, R. C., et al. (2010). Antidepressant drug effects and depression severity: A patient-level meta-­analysis. Journal of the American Medical Association, 303, 47–53.PubMedCrossRefGoogle Scholar
  11. Gawande, A. (2011). The hot spotters: Can we lower medical costs by giving the neediest patients better care? The New Yorker. Retrieved April 29, 2013, from http://www.newyorker.com/reporting/2011/01/24/110124fa_fact_gawande
  12. Grant, R. W., Ashburner, J. M., Hong, C. C., Chang, Y., Barry, M. J., & Atlas, S. J. (2011). Defining patient complexity from the primary care physician’s perspective: A cohort study. Annals of Internal Medicine, 155, 797–804.PubMedCrossRefGoogle Scholar
  13. Huyse, F., Stiefel, F., & deJonge, P. (2006). Identifiers or “red flags” of complexity and need for integrated care. Medical Clinics of North America 90 (2006) 703–712.PubMedCrossRefGoogle Scholar
  14. Institute of Medicine. (2002). Confronting racial and ethnic disparities in health care. National Academy of Sciences. Retrieved April 29, 2013, from http://www.iom.edu/Reports/2002/Unequal-Treatment-Confronting-Racial-and-Ethnic-Disparities-in-Health-Care.aspx
  15. Katerndahl, D. A., Wood, R., & Jaen, C. R. (2010). A method for estimating relative complexity of ambulatory care. Annals of Family Medicine, 8, 341–347.PubMedCrossRefGoogle Scholar
  16. Kathol, R., Perez, R., Cohen, J., & Huyse, F. (2010). The integrated case management manual: Assisting complex patients regain physical and mental health. New York: Springer.Google Scholar
  17. Kirsch, I. (2010). The emperor’s new drugs: Exploding the antidepressant myth. New York: Basic Books.Google Scholar
  18. Kottke, T. E., & Pronk, N. P. (2009). Taking on the social determinants of health: A framework for action. Minnesota Medicine, 92, 36–39.PubMedGoogle Scholar
  19. Kupersmith, J. (2007). Managing patient and system complexities to improve the quality and outcomes of chronic care: papers from VA’s state-of-the-art conference: Managing complexity in chronic care. Journal of General Internal Medicine, 22, 373–444.PubMedCrossRefGoogle Scholar
  20. Lane, C. (2007). How normal behavior became a sickness. Binghamton, NY: Vail-Ballou Press.Google Scholar
  21. Lebensohn-Chialvo, P., Crago, M., & Shisslak, C. M. (2000). The reflecting team: An innovative approach for teaching clinical skills to family practice residents. Family Medicine, 32, 556–560.PubMedGoogle Scholar
  22. Lyons, J. S. (2006). Communimetrics: A communication theory of measurement in human service settings. New York: Springer.Google Scholar
  23. Martin, C. M., & Sturmberg, J. P. (2009). Perturbing ongoing conversations about systems and complexity in health services and systems. Journal of Evaluation in Clinical Practice, 15, 549–552.PubMedCrossRefGoogle Scholar
  24. Maxwell, M., Hibberd, C., Pratt, R., Cameron, I., & Mercer, S. (2011). Development and initial validation of the Minnesota Edinburgh complexity assessment method (MECAM) for use within the Keep Well Health Check. 2011, Healthier Scotland: Edinburgh.Google Scholar
  25. McDonald, K. M., Schultz, E., Pineda, N., Lonhart, J., Chapman, T., & Davies, S. (2012). Care coordination accountability measures for primary care practice Prepared by Stanford University under subcontract to Battelle on Contract No. 290-04-0020 (AHRQ Publication No. 12-0019-EF). Agency for Healthcare Research and Quality. Retrieved April 29, 2013, from http://www.ahrq.gov/research/findings/final-reports/pcpaccountability/index.html
  26. National Committee for Quality Assurance. (2011). 2011 PCMH standards and guidelines. National Committee for Quality Assurance. Retrieved April 29, 2013, from http://www.iafp.com/pcmh/ncqa2011.pdf
  27. Peek, C. J. (2009). Integrating care for persons, not only diseases. Journal of Clinical Psychology in Medical Settings, 16, 13–20.PubMedCrossRefGoogle Scholar
  28. Peek, C. J. (2010). Building a medical home around the patient: What it means for behavior. Families, Systems & Health, 28, 322–333.CrossRefGoogle Scholar
  29. Peek, C. J., Baird, M. A., & Coleman, E. (2009). Primary care for patient complexity, not only disease. Families, Systems & Health, 27, 287–302.CrossRefGoogle Scholar
  30. Peek, C. J., & Oftedahl, G. (2010). A concensus operational definition of Patient-Centered Medical Home (PCMH) also known as health care home. Minneapolis, MN: University of Minnesota and Institute for Clinical Systems Improvement.Google Scholar
  31. Peek, C. J., & Van Riper, K. (2011). Level of care coordination needed. Unpublished instructional draft, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN.Google Scholar
  32. Pigott, H. E., Leventhal, H. M., Alter, G. S., & Boren, J. J. (2010). Efficacy and effectiveness of antidepressants: Current status of research. Psychotherapy and Psychosomatics, 79, 267–279.PubMedCrossRefGoogle Scholar
  33. Pronk, N. P., Peek, C. J., & Goldstein, M. G. (2004). Addressing multiple behavioral risk factors in primary care. A synthesis of current knowledge and stakeholder dialogue sessions. American Journal of Preventive Medicine, 27, 4–17.PubMedCrossRefGoogle Scholar
  34. Rasmussen, N. H., Furst, J. W., Swenson-Dravis, D. M., Agerter, D. C., Smith, A. J., Baird, M. A., et al. (2006). Innovative reflecting interview: Effect on high-utilizing patients with medically unexplained symptoms. Disease Management, 9, 349–359.PubMedCrossRefGoogle Scholar
  35. Safford, M. M., Allison, J. J., & Kiefe, C. I. (2007). Patient complexity: More than comorbidity. The vector model of complexity. Journal of General Internal Medicine, 22(Suppl 3), 382–390.PubMedCrossRefGoogle Scholar
  36. Salazar-Fraile, J., Sempere-Verdu, E., Mossakowski, K., & Bryan, J. (2010). “Doctor, I just can’t go on.” Cultural constructions of depression and the prescription of antidepressants to users who are not clinically depressed. International Journal of Mental Health, 39, 29–67.CrossRefGoogle Scholar
  37. Sargut, G., & McGrath, R. G. (2011). Learning to live with complexity. Harvard Business Review, 89(68–76), 136.Google Scholar
  38. Starfield, B., Weiner, J., Mumford, L., & Steinwachs, D. (1991). Ambulatory care groups: A categorization of diagnoses for research and management. Health Services Research, 26, 53–74.PubMedGoogle Scholar
  39. Stiefel, F. C., Huyse, F. J., Sollner, W., Slaets, J. P. J., Lyons, J. S., Latour, C. H. M., et al. (2006). Operationalizing integrated care on a clinical level: The INTERMED project. Medical Clinics of North America, 90, 713–758.PubMedCrossRefGoogle Scholar
  40. Trangle, M., Dieperink, B., Gabert, T., Haight, B., Lindvall, B., Mitchell, J. et al. (2012). Institute for Clinical Systems Improvement. Major depression in adults in primary care. http://bit.ly/Depr0512. Updated May 2012.Google Scholar
  41. Waters, E. (2010a). Crazy like us: The globalization of the American psyche. New York: Free Press.Google Scholar
  42. Waters, E. (2010b). The Americanization of mental illness. The New York Times. Retrieved April 29, 2013, from http://www.nytimes.com/2010/01/10/magazine/10psyche-t.html?_r=1&pagewanted=all
  43. Weiner, J. P., Starfield, B. H., Steinwachs, D. M., & Mumford, L. M. (1991). Development and application of a population-oriented measure of ambulatory care case-mix. Medical Care, 29, 452–472.PubMedCrossRefGoogle Scholar
  44. Weiss, K. B. (2007). Managing complexity in chronic care: An overview of the VA state-of-the-art (SOTA) conference. Journal of General Internal Medicine, 22(Suppl 3), 374–378.PubMedCrossRefGoogle Scholar
  45. Weydt, A. P. (2009). Defining, analyzing, and quantifying work complexity. Creative Nursing, 15, 7–13.PubMedCrossRefGoogle Scholar
  46. Zimmerman, B., Lindberg, C., & Plsek, P. (2008). Edgeware: Lessons from complexity science for health care leaders. Irving, TX: Plexus Institute.Google Scholar
  47. Zwarenstein, M., Treweek, S., Gagnier, J. J., Altman, D. G., Tunis, S., Haynes, B. et al. (2008). Improving the reporting of pragmatic trials: An extension of the CONSORT statement. British Medical Journal, 337, a2390. doi: http://10.1136/bmj.a2390.Google Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Macaran A. Baird
    • 1
    Email author
  • C. J. Peek
    • 1
  • William B. Gunn
    • 2
  • Andrew Valeras
    • 3
  1. 1.Department of Family Medicine and Community HealthUniversity of Minnesota Medical SchoolMinneapolisUSA
  2. 2.NH/Dartmouth FPR ProgramConcordUSA
  3. 3.New Hampshire Dartmouth Family Medicine ResidencyConcordUSA

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