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ICH Impact Case Examples: Researching Primary Care Models to Improve Patient Care
For the past few years, ICH has taken part in a number of innovative primary care research and evaluation projects focused on improving primary care, for example through integrating primary care and behavioral health. Several case examples of ICH’s work in this area are outlined below:
Commonwealth Fund Safety-Net Transformation to an Accountable Care Organization Case Study: Funded by The Commonwealth Fund, in 2012 ICH led and completed a mixed-methods case study examining key strategies, progress to date, challenges, and lessons learned throughout the CHA’s transformation to an accountable care organization/patient-centered medical home as a safety-net provider system. As part of this case study, ICH conducted extensive document review and supported individual and site interviews conducted with over 30 CHA leaders and staff by partners at Brandeis University. The case study also included assessment of the external market, context, and per-capita spending for CHA patients in risk contracts before and after global payment. Case study findings have been published by The Commonwealth Fund, at the 2013 Academy Health conference, and in the Journal of Health Politics, Policy, and Law. Click here to view the complete report.
Cambridge Health Alliance Primary Care/Behavioral Health Integration Evaluation Planning and Reporting: Since 2012, ICH has supported evaluation planning and analysis for implementation of primary care/behavioral health (PC/BH) integration across clinics at the Cambridge Health Alliance (CHA), a public safety-net health system affiliated with Harvard and Tufts medical schools and serving diverse communities in Eastern Massachusetts. As PC/BH integration to coordinate and provide behavioral health care for mental and physical health conditions is rolled out across CHA, ICH is working with the PC/BH implementation team to create a multi-level logic model and process/ outcome evaluation plan grounded in the quadruple aim of impacting patient outcomes, patient satisfaction, provider satisfaction and cost. ICH has also supported analysis and reporting of PC/BH outcomes at pilot sites to meet the state’s Delivery System Transformation Initiative (DSTI) requirements and for local quality improvement.
Qualitative Evaluation of Primary Care and Mental Health Integration Initiative at Dimock Community Health Center: In July 2011, in response to high self-reported depression and suicidal ideation rates amongst Boston Public Schools high school students, Dimock Community Health Center piloted the Behavioral Health-Pediatrics Integrated Program (BHPIP) – a clinically and operationally integrated multidisciplinary model of pediatric primary care and behavioral health care – as part of their Patient-Centered Medical Home initiative. ICH partnered with Dimock to build the capacity of health center staff to evaluate these integration efforts, including collaboratively developing an interview protocol, analyzing and synthesizing interview findings, and communicating progress in meetings and in writing to program funders. Since this time, Dimock has requested ICH collaboration on additional grant proposals.
Integrated Comprehensive Care for Children (IC3) Evaluation: Only a minority of children with mental disorders receive needed services, making it an important goal to find care models that increase access to and continuity of mental health care. In 2003, with funding from the Maternal and Child Health Bureau of the Health Resources Services Administration, the Cambridge Health Alliance (CHA) began a pediatric mental health screening and intervention project called Integrated Comprehensive Care for Children (IC3), with goals of implementing mental health screenings at annual physicals for all children 5 to 19 years of age and referring any child in need to a co-located social worker for assessment and treatment. ICH led a comprehensive evaluation of IC3, with components ranging from measuring training needs to screening rates and parental and provider perceptions of integrated care. Lessons learned through the evaluation allowed the initiative to make changes as needed to improve results. Findings such as high screening rates accompanied by low referral completion led to the creation of valuable support activities, like a patient navigator program.