delivery of health care

Ensuring accessibility helps reduce missed health care for autistic people. Health care delivery should be adapted in light of autism-related sensory profiles. Tailored accommodations should be implemented for each autistic patient’s unique communication profiles and preferences. Health care encounters should be as predictable, clear, and unrushed as possible. Autistic people with intersectional (e.g., cultural, gender) identities often experience discrimination in health care settings, which should be mitigated.

Author/s:

Louisa Lok Yee Man, Adeline Lacroix, Meng-Chuan Lai

Obesity in adults: a clinical practice guideline

Carly Hughes — Sat, 16 Jan 2021 19:54:29 +0000

Date Added:

January 16, 2021

Journal/Publication:

Canadian Medical Association Journal

Publisher:

Canadian Medical Association Journal

Publication Date:

August 4, 2020

Issue:

Volume:

192

Pages:

E875-E891

URL:

Obesity in adults: a clinical practice guideline

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

https://doi.org/10.1503/cmaj.191707

Keywords

obesity

outcomes

delivery of health care

PMID (1):

32753461

MeSH

Obesity Management

Outcome Assessment (Health Care)

An excellent guideline for management of obesity in adults from the Canadians. James W. Mold, MD, MPH

Free full text

View

Not available

Author/s:

Wharton, Sean, Lau, David, Vallis, Michael, Sharma, Arya, Biertho, Laurent, Campbell-Scherer, Denise, Adamo, Kristi

Start-Up and Ongoing Practice Expenses of Behavioral Health and Primary Care Integration Interventions in the Advancing Care Together (ACT) Program

Jeffrey Wilson — Wed, 03 Oct 2018 16:25:07 +0000

Date Added:

October 3, 2018

Journal/Publication:

Journal of the American Board of Family Medicine

Publisher:

American Board of Family Medicine

Publication Date:

September 1, 2015

Issue:

Supplement 1

Volume:

Pages:

S86-S97

URL:

Start-Up and Ongoing Practice Expenses of Behavioral Health and Primary Care Integration Interventions in the Advancing Care Together (ACT) Program

Format:

Article

DOI (1):

10.3122/jabfm.2015.S1.150052

Keywords

delivery of health care

PMID (1):

26359476

MeSH

behavioral medicine

primary health care

Integration of behavioral health and primary care can be extremely helpful to both patients and clinicians. This article summarizes lessons learned from those who have accomplished it.

Free full text

PURPOSE:

Provide credible estimates of the start-up and ongoing effort and incremental practice expenses for the Advancing Care Together (ACT) behavioral health and primary care integration interventions.

METHODS:

Expenditure data were collected from 10 practice intervention sites using an instrument with a standardized general format that could accommodate the unique elements of each intervention.

RESULTS:

Average start-up effort expenses were $44,076 and monthly ongoing effort expenses per patient were $40.39. Incremental expenses averaged $20,788 for start-up and $4.58 per patient for monthly ongoing activities. Variations in expenditures across practices reflect the differences in intervention specifics and organizational settings. Differences in effort to incremental expenditures reflect the extensive use of existing resources in implementing the interventions.

CONCLUSIONS:

ACT program incremental expenses suggest that widespread adoption would likely have a relatively modest effect on overall health systems expenditures. Practice effort expenses are not trivial and may pose barriers to adoption. Payers and purchasers interested in attaining widespread adoption of integrated care must consider external support to practices that accounts for both incremental and effort expense levels. Existing knowledge transfer mechanisms should be employed to minimize developmental start-up expenses and payment reform focused toward value-based, Triple Aim-oriented reimbursement and purchasing mechanisms are likely needed.

Author/s:

Wallace, Neal T., Cohen, Deborah J., Gunn, Rose, Beck, Arne, Melek, Steve, Bechtold, Donald, Green, Larry A.

Clinician Staffing, Scheduling, and Engagement Strategies Among Primary Care Practices Delivering Integrated Care

Jeffrey Wilson — Wed, 03 Oct 2018 16:17:54 +0000

Date Added:

October 3, 2018

Journal/Publication:

Journal of the American Board of Family Medicine

Publisher:

American Board of Family Medicine

Publication Date:

September 1, 2015

Issue:

Supplement 1

Volume:

Pages:

S32-S40

URL:

Clinician Staffing, Scheduling, and Engagement Strategies Among Primary Care Practices Delivering Integrated Care

Format:

Article

DOI (1):

10.3122/jabfm.2015.S1.150087

Keywords

integrated

behavioral medicine

delivery of health care

primary health care

primary care

PMID (1):

26359470

MeSH

personnel staffing and scheduling

behavioral medicine

primary health care

Integration of behavioral health and primary care can be extremely helpful to both patients and clinicians. This article summarizes lessons learned from those who have accomplished it.

Free full text

PURPOSE:

To examine the interrelationship among behavioral health clinician (BHC) staffing, scheduling, and a primary care practice's approach to delivering integrated care.

METHODS:

Observational cross-case comparative analysis of 17 primary care practices in the United States focused on implementation of integrated care. Practices varied in size, ownership, geographic location, and integrated care experience. A multidisciplinary team analyzed documents, practice surveys, field notes from observation visits, implementation diaries, and semistructured interviews using a grounded theory approach.

RESULTS:

Across the 17 practices, staffing ratios ranged from 1 BHC covering 0.3 to 36.5 primary care clinicians (PCCs). BHC scheduling varied from 50-minute prescheduled appointments to open, flexible schedules slotted in 15-minute increments. However, staffing and scheduling patterns generally clustered in 2 ways and enabled BHCs to be engaged by referral or warm handoff. Five practices predominantly used warm handoffs to engage BHCs and had higher BHC-to-PCC staffing ratios; multiple BHCs on staff; and shorter, more flexible BHC appointment schedules. Staffing and scheduling structures that enabled warm handoffs supported BHC engagement with patients concurrent with the identification of behavioral health needs. Twelve practices primarily used referrals to engage BHCs and had lower BHC-to-PCC staffing ratios and BHC schedules prefilled with visits. This enabled some BHCs to bill for services, but also made them less accessible to PCCs in when patients presented with behavioral health needs during a clinical encounter. Three of these practices were experimenting with open scheduling and briefer BHC visits to enable real-time access while managing resources.

CONCLUSION:

Practices' approaches to PCC-BHC staffing, scheduling, and delivery of integrated care mutually influenced each other and were shaped by the local context. Practice leaders, educators, clinicians, funders, researchers, and policy makers must consider these factors as they seek to optimize integrated systems of care.

Author/s:

Davis, Melinda M., Balasubramanian, Bijal A., Cifuentes, Maribel, Hall, Jennifer, Gunn, Rose, Fernald, Douglas, Gilchrist, Emma, Miller, Benjamin F., DeGruy, Frank, III