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Building a Culture of Improvement at East London NHS Foundation Trust
East London NHS Foundation Trust (ELFT) in the UK provides mental health and community services to a diverse and largely low-income population. By establishing an organization-wide culture of continuous improvement, and integrating quality improvement methodology and training at every level of work, ELFT has significantly reduced incidents of inpatient violence and improved staff satisfaction, among other achievements.
Behavioral Health Integration in Acute Medical Settings: An Opportunity to Improve Outcomes and Reduce Costs
Psychiatric comorbidities in acute medical settings are prevalent, but compared to ambulatory care, there are few models of integration of behavioral health. This article describes suggested barriers to better integration, core components of successful approaches, and the business case for this model of care based on a non-systematic literature review and expert interviews.
Community Health Workers for Patients with Medical and Behavioral Needs: Challenges and Opportunities
This article by IHI authors outlines challenges to successful community health worker programs for patients with medical and behavioral needs, proposes two design considerations for community-based behavioral health integration, and suggests ways in which quality improvement methods might help with both challenges.
Community-Based Behavioral Health Integration: A Focus on Community Health Workers to Support Individuals with Behavioral Health and Medical Needs
The aim of the IHI 90-day innovation project described in this report was to develop an approach to managing patients with comorbid behavioral health and medical needs in community-based settings. The report identifies four populations who could be well-served by community-based behavioral health integration and potential interventions to support these populations; describes the role and key functions of community health workers; and discusses key areas for future research and improvement.
Behavioral Health Integration: A Key Component of the Triple Aim
Organizations seeking to move toward the Triple Aim must develop an integrated behavioral health strategy across the continuum of care. This article discusses an Institute for Healthcare Improvement research project that examined the core principles underlying several successful approaches to behavioral health integration around the US.
WIHI: When Everyone Knows Your Name: Identifying Patients with Complex Needs
January 29, 2015 | A relatively small percentage of the US population accounts for the largest share of health care costs. Everyone knows who we're talking about, right? Well, not exactly.
WIHI: The Road to Team-Based Primary Care and Behavioral Health
December 4, 2014 | Primary care practices across the US are facing a number of important challenges right now; prominent among them is doing a much better job at recognizing and helping patients with behavioral health issues.
WIHI: Mental Health Care in the Hospital: Preventing Harm, Promoting Safety
October 9, 2014 | This WIHI explores work that's underway in hospitals to prevent harm and promote safety for patients with psychiatric conditions and needs.
Behavioral Health Integration Capacity Assessment Tool
This tool is designed to assist behavioral health organizations in evaluating their ability to implement integrated care (specifically processes related to three approaches to integrated care: coordinate care, co-locate care, or build primary care capacity in-house), and enable them to assess existing operational and cultural infrastructure to support greater integration.
Integrating Behavioral Health and Primary Care: IHI 90-Day R&D Project Final Summary Report
This IHI 90-day R&D project report examines the basic principles underlying existing, exemplary integration models and integrated organizations, identifies the core components required for success, and assesses how (or if) they are operationalized by each of the different models. The aim is to understand the core principles underlying successful integration of behavioral health services into primary care.
Approaches to Integrating Primary Care Services into Behavioral Health Organizations
The guide lays out a continuum of primary care and behavioral health integration, beginning with engaging individuals with severe mental illness in discussions about their physical health to full integration.
Integrating Behavioral Health into Primary Care
This article discusses ideas for overcoming common challenges in treating patients with medical and behavioral issues in a more integrated fashion; presents a set of Collaborative Care Components for Integrated Care that have shown results in reducing cost and improving outcomes and satisfaction; and describes layers of service in full-spectrum integrated care.
WIHI: Integrating Physical and Behavioral Health
July 25, 2013 | This WIHI showcases leaders and organizations that are at the forefront of redesigning care for patients and populations in need of primary care and mental health services. Research has begun to demonstrate that this approach leads to improved chronic conditions and fewer trips to the ED.
Author in the Room: Evidence-Based Management of Behavioral Symptoms in Dementia Using Nonpharmacologic Approaches
December 2012 | A discussion with the authors of the JAMA article "Evidence-Based Management of Behavioral Symptoms in Dementia Using Nonpharmacologic Approaches."
Author in the Room: Diagnosis and Treatment of Depression in Adults with Comorbid Medical Conditions
June 2012 | A discussion with the author of the JAMA article "Diagnosis and Treatment of Depression in Adults with Comorbid Medical Conditions."
Author in the Room: Alcohol Consumption in Older Adults and Health Effects
July 2010 | A discussion with the author of the JAMA article "A 42-Year-Old Man Considering Whether to Drink Alcohol for His Health."
Author in the Room: Therapy for Persistent Insomnia
July 2009 | A discussion with the author of the JAMA article "Cognitive-Behavior Therapy, Singly and Combined with Medication, for Persistent Insomnia."
Author in the Room: Smoking Cessation in Patients with Psychiatric Illness
March 2009 | A discussion with the author of the JAMA article "Smoking Cessation in Patients with Psychiatric Illness."
Author in the Room: Depression Screening for Patients with Cardiovascular Disease
December 2008 | A discussion with the authors of the JAMA article "Depression Screening for Patients with Cardiovascular Disease."
Author in the Room: Antidepressant-Associated Sexual Dysfunction
September 2008 | A discussion with the author of the JAMA article "Sildenafil Treatment of Women with Antidepressant-Associated Sexual Dysfunction: A Randomized Controlled Trial."
Author in the Room: Association Between Depressive Symptoms and Diabetes
July 2008 | A discussion with the author of the JAMA article "Examining a Bidirectional Association Between Depressive Symptoms and Diabetes."
Improvement Report: Reducing Length of Stay in the Emergency Department for Psychiatric Patients
For psychiatric patients requiring admission to the emergency department (ED), a multidisciplinary team at Maine Medical Center (Portland, Maine, USA) decreased ED length of stay by over 40 percent — from over 10 hours on average to 6 hours — despite a steady increase in the overall number of patients requiring admission.
Profiles in Improvement: Marianne Olsson from the Federation of Swedish County Councils
improving health care? People are at hospitals and in office practices all across the US and internationally. IHI decided to share the stories of these individuals. Here is a profile of Marianne Olsson of the Federation of Swedish County Councils(Gothenburg, Sweden).">
Using a Provisional Transition Date for Behavioral Health Inpatients at the VAMC
The inpatient Behavioral Health Unit at the Department of Veterans Affairs Medical Center in Canandaigua, New York, used the flow concept of “Transition Date” to ensure more timely, planned discharges/transitions from inpatient care, and to reduce the unit’s average length of stay.
When Less Is More: Reducing the Incidence of Antipsychotic Poly-Pharmacy
With the introduction of an array of newer or “second-generation” antipsychotics over a decade ago, psychiatrists and primary care physicians are generally using ever-higher doses and ever-more complex combinations of these medications. The physicians’ rationale is that as long as psychotic symptoms remain, more medication is the necessary response — despite a wealth of studies of the older medications revealing that time-on-medication, not dosage, is usually the deciding factor.