Skip to main content

Advertisement

Log in

Explication of a Behavioral Health-Primary Care Integration Learning Collaborative and Its Quality Improvement Implications

  • Brief Report
  • Published:
Community Mental Health Journal Aims and scope Submit manuscript

Abstract

In an effort to tackle fragmented care in the US healthcare delivery system, we explored the use of learning collaborative (LC) to advance integration of behavioral health and primary care as one of the potential solutions to a holistic approach to the delivery of quality healthcare to individuals with physical and mental illness. How a diverse group of primary care and behavioral health providers formed a Community of Practice (CoP) with a common purpose and shared vision to advance integrated care using a LC approach is described. An account of their learning experience, key components of their quality improvement, practice changes, clinical processes, and improved outcomes are explained. This paper aims at describing the history, creative design, processes, roles of the CoP and impact of the LC on the advancement of integrated care practice and quality improvements for further exploration and replications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

References

  • Antonini, V. P., Oeser, B. T., & Urada, D. (2012). The California integration learning collaborative: A forum to address challenges of SUD-primary care service integration. Journal of Psychoactive Drugs, 44(4), 285–291.

    Article  Google Scholar 

  • Archer, J., Bower, P., Gilbody, S., Lovell, K., Richards, D., Gask, L., & Coventry, P. (2012). Collaborative care for depression and anxiety problems. Cochrane database of systematic reviews (Online: Update Software), 10, CD006525. https://doi.org/10.1002/14651858.CD006525.

    Article  Google Scholar 

  • Aronson, E., Blaney, N., Stephan, C., Sikes, J., & Snapp, M. (1978). The jigsaw classroom. Beverley Hills, CA: Sage.

    Google Scholar 

  • Ayers, L. R., Beyea, S. C., Godfrey, M. M., Harper, D. C., Nelson, E. C., & Batalden, P. B. (2005). Quality improvement learning collaboratives. Quality Management in Health Care, 14(4), 234–247.

    Article  Google Scholar 

  • Burns, J. M. (1978). Leadership. New York: Harper & Row.

    Google Scholar 

  • Das, J., Das, R. K., & Das, V. (2012). The mental health gender-gap in urban India: Patterns and narratives. Social Science & Medicine, 75(9), 1660–1672.

    Article  Google Scholar 

  • Dillenbourg, P. (1999). Collaborative learning: Cognitive and computational approaches. Advances in learning and instruction series. New York, NY: Elsevier Science, Inc.

    Google Scholar 

  • Duffy, F. F., Chung, H., Trivedi, M., Rae, D. S., Regier, D. A., & Katzelnick, D. J. (2008). Systematic use of patient-rated depression severity monitoring: Is it helpful and feasible in clinical psychiatry? Psychiatric Services, 59(10), 1148–1154.

    Article  Google Scholar 

  • Ebert, L., Amaya-Jackson, L., Markiewicz, J. M., Kisiel, C., & Fairbank, J. A. (2011). Use of the breakthrough series collaborative to support broad and sustained use of evidence-based trauma treatment for children in community practice settings. Administration and Policy in Mental Health and Mental Health Services Research, 39(3), 187–199.

    Article  Google Scholar 

  • Ede, V., Okafor, M., Kinuthia, R., Belay, Z., Teclemichael, T., Alema-Mensah, E., et al. (2015). An examination of perceptions in integrated care practice. Community Mental Health.

  • Epstein, J. N., Langberg, J. M., Lichtenstein, P. K., Altaye, M., Brinkman, W. B., House, K., & Stark, L. J. (2010). Attention-deficit/hyperactivity disorder outcomes for children treated in community-based pediatric settings. Archives of Pediatrics & Adolescent Medicine, 164(2), 160–165.

    Article  Google Scholar 

  • Freeman, J. S. (2015). Providing whole-person care: Integrating behavioral health into primary care. North Carolina Medical Journal, 76(1), 24–28.

    Article  Google Scholar 

  • Haine-Schlagel, R., Brookman-Frazee, L., Janis, B., & Gordon, J. (2013). Evaluating a learning collaborative to implement evidence-informed engagement strategies in community-based services for young children. Child & Youth Care Forum, 42(5), 457–473.

    Article  Google Scholar 

  • Horbar, J. D., Plsek, P. E., & Leahy, K. (2003). NIC/Q 2000: Establishing habits for improvement in neonatal intensive care units. Pediatrics, 111(4 Pt 2), e397–e410.

    PubMed  Google Scholar 

  • Huang, H., Meller, W., Kishi, Y., & Kathol, R. G. (2014). What is integrated care? International Review of Psychiatry, 26(6), 620–628.

    Article  Google Scholar 

  • Huang, Y., Wei, X., Wu, T., Chen, R., & Guo, A. (2013). Collaborative care for patients with depression and diabetes mellitus: A systematic review and meta-analysis. BMC Psychiatry, 13(1), 260.

    Article  CAS  Google Scholar 

  • Ivbijaro, G. O., Enum, Y., Khan, A. A., Lam, S. S., & Gabzdyl, A. (2014). Collaborative care: Models for treatment of patients with complex medical-psychiatric conditions. Current Psychiatry Reports, 16(11), 506.

    Article  Google Scholar 

  • Katon, W., Russo, J., Lin, E. H., Schmittdiel, J., Ciechanowski, P., Ludman, E., et al. (2012). Cost-effectiveness of a multicondition collaborative care intervention: A randomized controlled trial. Archives of General Psychiatry, 69(5), 506–514.

    Article  Google Scholar 

  • Katzelnick, D. J., Von Korff, M., Chung, H., Provost, L. P., & Wagner, E. H. (2005). Applying depression-specific change concepts in a collaborative breakthrough series. The Joint Commision Journal on Quality and Patient Safety, 31(7), 386–397.

    Article  Google Scholar 

  • Kilo, C. M. (1998). A framework for collaborative improvement. Quality Management in Health Care, 6(4), 1–14.

    Article  CAS  Google Scholar 

  • Klein, S., & Hostetter, M. (2014). In focus: Integrating behavioral health and primary care. The Commonwealth Fund, Retrieved from http://www.commonwealthfund.org/publications/newsletters/quality-matters/2014/august-september/in-focus.

  • Kohn, R. (2014). Trends, gaps, and disparities in mental health. In S. O. Okpaku (Ed.) Essentials of global mental health (pp. 27–38). Cambridge: Cambridge University Press.

  • Lipshutz, A. K., Fee, C., Schell, H., Campbell, L., Taylor, J., Sharpe, B. A., et al. (2008). Strategies for success: A PDSA analysis of three QI initiatives in critical care. The Joint Commision Journal on Quality and Patient Safety, 34(8), 435–444.

    Article  Google Scholar 

  • Minkman, M., Schouten, L., Huijsman, R., & Splunteren, P. V. (2005). Integrated care for patients with a stroke in the Netherlands: Results and experiences from a National breakthrough collaborative improvement project. International Journal of Integrated Care. https://doi.org/10.5334/ijic.118

  • Morehouse School of Medicine. The Satcher Health Leadership Institute. (2015). Division of Behavioral Health, Behavioral Health Integration Demonstration Project Report. Retrieved Aug 11, 2015 from http://www.msm.edu/Research/research_centersandinstitutes/SHLI/aboutUs/behavioralhealth/abo utus.php.

  • Morrissey, J. P., Domino, M., Wicher, C., Kilany, M., Gaynes, B. (2009). Integrating primary care and mental health services: Final evaluation report on the ICARE integration pilot sites. Chapel Hill: University of North Carolina at Chapel Hill.

    Google Scholar 

  • Nadeem, E., Olin, S. S., Hill, L. C., Hoagwood, K. E., & Horwitz, S. M. (2014). A literature review of learning collaboratives in mental health care: Used but untested. Psychiatric Services, 65(9), 1088–1099.

    Article  Google Scholar 

  • Nembhard, I. M. (2012). All teach, all learn, all improve?: The role of interorganizational learning in quality improvement collaboratives. Health Care Management Review, 37(2), 154–164.

    Article  Google Scholar 

  • Okafor, M., Ede, V., Kinuthia, R., Strotz, D., Marchman, C., Weeks, S., et al. (2014). Impact of relaxation and group psycho-education on health outcomes using integrated care models and quality improvement. Open Journal of Preventative Medicine, 4(12), 887–896.

    Article  Google Scholar 

  • OVretveit, J., Bate, P., Cleary, P., Cretin, S., Gustafson, D., McInnes, K., et al. (2002). Quality collaboratives: Lessons from research. Quality and Safety in Health Care, 11(4), 345–351.

    Article  CAS  Google Scholar 

  • Paula, C. S., Bordin, I. A., Mari, J. J., Velasque, L., Rohde, L. A., & Coutinho, E. S. (2014). The mental health care gap among children and adolescents: Data from an epidemiological survey from four brazilian regions. PLoS ONE, 9(2), e88241

    Article  Google Scholar 

  • Schouten, L. M., Hulscher, M. E., Everdingen, J. J., Huijsman, R., & Grol, R. P. (2008). Evidence for the impact of quality improvement collaboratives: Systematic review. BMJ, 336(7659), 1491–1494.

    Article  Google Scholar 

  • Stephan, S. H., Connors, E. H., Arora, P., & Brey, L. (2013). A learning collaborative approach to training school-based health providers in evidence-based mental health treatment. Children and Youth Services Review, 35(12), 1970–1978.

    Article  Google Scholar 

  • Unützer, J., Katon, Callahan, Williams, Jr., Hunkeler, & Harpole, … For the IMPACT Investigators. (2002). Collaborative care management of late-life depression in the primary care setting. JAMA: The Journal of the American Medical Association, 288(22), 2836.

    Article  Google Scholar 

  • Urada, D., Schaper, E., Alvarez, L., Reilly, C., Dawar, M., Field, R., … Rawson, R. A. (2012). Perceptions of mental health and substance use disorder services integration among the workforce in primary care settings. Journal of Psychoactive Drugs, 44(4), 292–298.

    Article  Google Scholar 

  • Van der Voort, T. Y., Meijel, B. V., Hoogendoorn, A. W., Goossens, P. J., Beekman, A. T., & Kupka, R. W. (2015). Collaborative care for patients with bipolar disorder: Effects on functioning and quality of life. Journal of Affective Disorders, 179, 14–22.

    Article  Google Scholar 

  • Versteeg, M. H., Laurant, M. G., Franx, G. C., Jacobs, A. J., & Wensing, M. J. (2012). Factors associated with the impact of quality improvement collaboratives in mental healthcare: An exploratory study. Implementation Science, 7(1), 1.

    Article  Google Scholar 

  • Wilson, C., Yasamy, M. T., Morris, J., Novin, A., Saeed, K., & Nkomo, S. D. (2014). Mental health services: The African gap. Journal of Public Mental Health, 13(3), 132–141.

    Article  Google Scholar 

Download references

Acknowledgements

Integrated Care Practice Change and Quality Improvement (ICPCQI) initiative was funded by Grants from Kaiser Permanente and Georgia State Department of Behavioral Health and Developmental Disabilities (DBHDD). We thank the patients, staff, and providers at Asa G. Yancey Health Center, Mercy Care Services, Neighborhood Union Health Center, North Fulton Service Center, Cobb County Community Service Board (CSB) and McIntosh Trail CSB for their participation in the Learning Community and ICPCQI.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Victor Ede.

Ethics declarations

Conflict of interest

There are no commercial associations that might pose a conflict of interest in connection with this manuscript. All authors certified responsibility for the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Okafor, M., Ede, V., Kinuthia, R. et al. Explication of a Behavioral Health-Primary Care Integration Learning Collaborative and Its Quality Improvement Implications. Community Ment Health J 54, 1109–1115 (2018). https://doi.org/10.1007/s10597-017-0230-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10597-017-0230-8

Keywords

Navigation