Clinician Staffing, Scheduling, and Engagement Strategies Among Primary Care Practices Delivering Integrated Care
- 1 September 2015
- journal article
- research article
- Published by American Board of Family Medicine (ABFM) in The Journal of the American Board of Family Medicine
- Vol. 28 (Supplement), S32-S40
- https://doi.org/10.3122/jabfm.2015.s1.150087
Abstract
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.Keywords
This publication has 17 references indexed in Scilit:
- Integrating Behavioral and Physical Health Care in the Real World: Early Lessons from Advancing Care TogetherThe Journal of the American Board of Family Medicine, 2013
- A needs-based method for estimating the behavioral health staff needs of community health centersBMC Health Services Research, 2013
- Integrating Primary Care Into Community Behavioral Health Settings: Programs and Early Implementation ExperiencesPsychiatric Services, 2013
- Behavioral health providers' perspectives of delivering behavioral health services in primary care: a qualitative analysisBMC Health Services Research, 2012
- Tilling the Soil While Sowing the Seeds: Combining Resident Education with Medical Home TransformationSubstance Abuse, 2012
- The description and evaluation of the implementation of an integrated healthcare model.Families, Systems, & Health, 2010
- Using a multi-level approach to implement a primary care mental health (PCMH) program.Families, Systems, & Health, 2010
- Operational and clinical components for integrated-collaborative behavioral healthcare in the patient-centered medical home.Families, Systems, & Health, 2010
- The Triple Aim: Care, Health, And CostHealth Affairs, 2008
- Case Study Research: The View From Complexity ScienceQualitative Health Research, 2005