title: Integrating behavioral and physical health care in the real world: early lessons from advancing care together.
abstract: BACKGROUND
  More than 20 years ago the Institute of Medicine advocated for integration of physical and behavioral health care. Today, practices are integrating care in response to recent policy initiatives. However, few studies describe how integration is accomplished in real-world practices without the financial or research support available for most randomized controlled trials.
  
  
  METHODS
  To study how practices integrate care, we are conducting a cross-case comparative, mixed-methods study of 11 practices participating in Advancing Care Together (ACT). Using a grounded theory approach, we analyzed multiple sources of data (eg, documents, practice surveys, field notes from observation visits, semistructured interviews, online diaries) collected from each ACT innovator.
  
  
  RESULTS
  Integration requires making changes in organization and interpersonal relationships. During early integration efforts, challenges related to workflow and access, leadership and culture change, and tracking and using data to evaluate patient- and practice-level improvement emerged for ACT innovators. We describe the strategies innovators are developing to address these challenges.
  
  
  CONCLUSIONS
  Integrating care is a fundamental and difficult change for practices and health care professionals. Research identifying common challenges that manifest in early efforts can help others attempting integration and inform state, local, and federal policies aimed at achieving wide-spread implementation.
authors.affiliation: Department of Family Medicine, Oregon Health & Science University, Portland, OR 97239, USA. davismel@ohsu.edu
authors.forename: Melinda
authors.initials: M
authors.lastname: Davis
authors.forename: Bijal A
authors.initials: BA
authors.lastname: Balasubramanian
authors.forename: Elaine
authors.initials: E
authors.lastname: Waller
authors.forename: Benjamin F
authors.initials: BF
authors.lastname: Miller
authors.forename: Larry A
authors.initials: LA
authors.lastname: Green
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Cohen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003156:Community Mental Health Services / Q000458:organization & administration*; D003299:Cooperative Behavior; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007400:Interprofessional Relations; D007857:Leadership; D008297:Male; D008875:Middle Aged; D015279:Organizational Culture; D010561:Personnel Staffing and Scheduling; D011320:Primary Health Care / Q000458:organization & administration*; D015397:Program Evaluation; D014481:United States; D055815:Young Adult
keywords: Implementation Research; Integrated Care; Mental Health; Mixed Methods; Primary Health Care