title: Improving integrated general medical and mental health services in community-based practices.
abstract: The historical fragmentation of physical and mental health services has impeded efforts to improve quality and outcomes of care for persons with mental disorders. However, there is little information on effective strategies that might reduce fragmentation and improve integrated services within non-academic, community-based healthcare settings. Twenty-three practices from across the U.S. participated in a learning community meeting designed to identify barriers to integrated care and strategies for reducing such barriers. Barriers were initially identified based on a quantitative survey of organizational factors. Focus groups were used to elaborate on barriers to integrated care and to identify strategies for reducing barriers that are feasible in community-based settings. Participants identified key barriers, including administrative (e.g., lack of common medical records for mental health and general medical conditions), financial (e.g., lack of reimbursement codes to bill for mental health and general medical care in the same setting), and clinical (e.g., lack of an integrated care protocol). Top strategies recommended by participants included templates (i.e., for memoranda of understanding) to allow providers to work across practice settings, increased medical record security to enable a common medical record between mental health and general medical care, working with state Medicaid agencies to establish integrated care reimbursement codes, and guidance in establishing workflows between different providers (i.e., avoid duplication of tasks). Strategies to overcome barriers to integrated care may require cooperation across different organizational levels, including administrators, providers, and health care payers in order for integrated care to be established and sustained over time.
authors.affiliation: Department of Veterans Affairs, National Serious Mental Illness Treatment Research and Evaluation Center, Ann Arbor, MI, USA. amykilbo@umich.edu
authors.forename: Amy M
authors.initials: AM
authors.lastname: Kilbourne
authors.forename: Cheryl
authors.initials: C
authors.lastname: Irmiter
authors.forename: Jeff
authors.initials: J
authors.lastname: Capobianco
authors.forename: Kathleen
authors.initials: K
authors.lastname: Reynolds
authors.forename: Karen
authors.initials: K
authors.lastname: Milner
authors.forename: Kristen
authors.initials: K
authors.lastname: Barry
authors.forename: Frederic C
authors.initials: FC
authors.lastname: Blow
mesh_terms: D003156:Community Mental Health Services / Q000458:organization & administration*; D019033:Delivery of Health Care, Integrated; D006298:Health Services Administration; D006801:Humans; D007400:Interprofessional Relations; D008484:Medicaid; D008499:Medical Records; D001523:Mental Disorders; D008824:Michigan; D010818:Practice Patterns, Physicians' / Q000458:organization & administration*; D019035:Rural Health Services / Q000458:organization & administration; D014481:United States; D019037:Urban Health Services / Q000458:organization & administration