Kilbourne Amy M, Irmiter Cheryl, Capobianco Jeff, Reynolds Kathleen, Milner Karen, Barry Kristen, Blow Frederic C
Department of Veterans Affairs, National Serious Mental Illness Treatment Research and Evaluation Center, Ann Arbor, MI, USA.
Adm Policy Ment Health. 2008 Sep;35(5):337-45. doi: 10.1007/s10488-008-0177-8. Epub 2008 May 28.
The historical fragmentation of physical and mental health services has impeded efforts to improve quality and outcomes of care for persons with mental disorders. However, there is little information on effective strategies that might reduce fragmentation and improve integrated services within non-academic, community-based healthcare settings. Twenty-three practices from across the U.S. participated in a learning community meeting designed to identify barriers to integrated care and strategies for reducing such barriers. Barriers were initially identified based on a quantitative survey of organizational factors. Focus groups were used to elaborate on barriers to integrated care and to identify strategies for reducing barriers that are feasible in community-based settings. Participants identified key barriers, including administrative (e.g., lack of common medical records for mental health and general medical conditions), financial (e.g., lack of reimbursement codes to bill for mental health and general medical care in the same setting), and clinical (e.g., lack of an integrated care protocol). Top strategies recommended by participants included templates (i.e., for memoranda of understanding) to allow providers to work across practice settings, increased medical record security to enable a common medical record between mental health and general medical care, working with state Medicaid agencies to establish integrated care reimbursement codes, and guidance in establishing workflows between different providers (i.e., avoid duplication of tasks). Strategies to overcome barriers to integrated care may require cooperation across different organizational levels, including administrators, providers, and health care payers in order for integrated care to be established and sustained over time.
身心健康服务在历史上的分散状态阻碍了提高精神障碍患者护理质量和治疗效果的努力。然而，关于可能减少分散状态并改善非学术性、社区医疗环境中综合服务的有效策略，几乎没有相关信息。来自美国各地的23家医疗机构参加了一次学习社区会议，旨在确定综合护理的障碍以及减少此类障碍的策略。障碍最初是根据对组织因素的定量调查确定的。焦点小组用于详细阐述综合护理的障碍，并确定在社区环境中可行的减少障碍的策略。参与者确定了关键障碍，包括行政方面的（例如，缺乏心理健康和一般医疗状况的通用病历）、财务方面的（例如，缺乏在同一环境中为心理健康和一般医疗护理计费的报销代码）以及临床方面的（例如，缺乏综合护理方案）。参与者推荐的首要策略包括模板（即用于谅解备忘录），以使提供者能够跨医疗机构开展工作；提高病历安全性，以便在心理健康和一般医疗护理之间建立通用病历；与州医疗补助机构合作，建立综合护理报销代码；以及在不同提供者之间建立工作流程的指导（即避免任务重复）。克服综合护理障碍的策略可能需要不同组织层面的合作，包括管理人员、提供者和医疗保健支付方，以便综合护理能够建立并长期维持。
