Thursday, March 15, 2018

Parinda Khatri on Barriers to Integrated Care

Parinda Khatri, MD, Chief Clinical Officer at Cherokee Health Systems and a member of our Stakeholder Advisory Group, was interviewed recently by NEJM Catalyst for their article on Care Redesign. Among the many insightful things she says is:
"We used to go around the country and explain why integration is important — really having to explain the need. Everyone now knows why; they just want to know how.”
Of course, that is the main reason we are doing the IBH-PC project - to sort out how best to achieve high-quality integration. Cherokee is an exemplar of excellent integration and has served as a model for our own efforts. It's good to see Parinda and company get the credit they deserve!

(Thanks to Jen Lavoie for sharing this link.)

- Ben Littenberg

Monday, December 18, 2017

2017 Annual Meeting

2017 Annual Meeting

On Thursday, August 1st, and Friday, August 2nd, the 2017 IBHPC Annual Meeting was held in Burlington, Vermont, at the University of Vermont Alumni House and Hilton Garden Inn. The meeting brought together members of the Executive Team, Co-Investigators, Consultants, Cluster Site Leaders, Patient Partners, and staff from PCORI (our funders).

This was a chance for those involved with the project to meet face to face and exchange ideas, concerns, and tips as we review the experiences of our Vanguard sites and prepare to deliver the intervention at experimental sites that will soon be randomized. The meeting was also an opportunity to bring the participants to the Green Mountain State to see a glorious New England summer and take inspiration from the natural beauty of Vermont. 

After opening remarks from Rodger Kessler, we heard progress reports from Ben Littenberg and Connie van Eeghen. Gail Rose then introduced members of the two Vanguard sites who reported on their experiences with the intervention so far. Much discussion ensued, including clarification of the role of cluster leader and suggestions for improvements to make with the randomized sites.

The remainder of Thursday was devoted to two separate working groups, which attendees self-selected into according to their interests: 1) Lean Intervention Development, and 2) Site Management. 

With a diverse mix of all the represented participants, the groups took the rest of the day to both pose and answer the questions on what is still needed to refine the IBHPC intervention and to facilitate the smooth implementation of the initiative at each clinical site.  

The Lean Intervention Development team reviewed issues related to the Stage 2 Planning Workbook, one of the key elements of the intervention.

The Site Management team further subdivided into groups focused on a) responsibilities and specific steps involved once a site is randomized to the intervention; b) the IBHPC curriculum; c) patient engagement on IBHPC planning groups, and d) development of an Aim 3 analytic strategy.    

Day 2 opened with a lively discussion about the composition of “Community Panels” at the clinic sites and how this may affect outcomes of the research. We also had a workshop by Kari Stephens regarding Core Elements of integrated care. In small groups, attendees were asked to consider which aspects of several definitions of integrated, patient-oriented, and behavioral health care were central to our meaning of integrated care, vs. simply being attributes of quality primary care.

Please check out the PowerPoint documents for evidence of our small group hard work!

The general consensus from the meeting was that although there were still issues needing resolution, the project was on the right track. The PCORI Representatives mentioned how excited they were to see where the project was leading and could not wait for randomization to begin. Then, just like the local children seen outside the venue’s windows, the participants scampered out into the sun to enjoy a beautiful Vermont summer afternoon. A productive meeting that left all involved energized and inspired to kick this project into drive!

 Follow-ups to the August meeting, as of December 13, 2017

  1. Randomization status: 15 practices have been randomized. 
  2. Lean Intervention Development: The Stage 2 Planning Workbook has been completed and is being trialed in the Vanguard sites. 
  3. Start Up: The Start Up Guide is in use by randomized practices. Cluster leaders have been meeting regularly to refine their role with the sites with respect to the intervention and research aspects of the initiative. Kari Stephens is drafting a Leadership Manual for cluster leaders to reference as their sites get randomized and begin preparations for the initiative. 
  4. Patient Partners: Jen Lavoie is writing a Patient Engagement Guide to orient practices and patients as they collaborate on the redesign process. 
  5. IBHPC curriculum: The migration from Blackboard to Canvas learning management system is complete. Final versions of all modules will be available on Canvas by the end of the year. 
  6. Aim 3 design and analysis: Abby Crocker has been working with the Executive Team and IBHPC consultants to design a plan for data collection and analysis that allows us to explore how contextual factors affect the implementation and patient-centeredness of integrated BH care.

Stay tuned for more outcomes resulting from the great issues that came up in August!

-Gail Rose

Thursday, June 1, 2017

And we're off....

We are all very excited here.  We have engaged 2 primary care practices in the study and they have begun the intervention. Both practices are about a month into the study and are on opposite sides of the country – Barre, Massachusetts and San Diego, California.

UCSD Scripps Ranch Family Medicine
Cluster Leader: Bill Sieber

UMASS Barre Family Health Center
Cluster Leader: Dan Mullin

We would like to take this moment of celebration to thank everyone involved at every step of the way that has made this even possible!
Thank you!