McGinty Emma E, Daumit Gail L
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health (McGinty), and Division of General Internal Medicine, Johns Hopkins School of Medicine (Daumit), Baltimore.
Psychiatr Serv. 2020 Nov 1;71(11):1163-1169. doi: 10.1176/appi.ps.202000183. Epub 2020 Jun 3.
Interventions that integrate care for mental illness or substance use disorders into general medical care settings have been shown to improve patient outcomes in clinical trials, but efficacious models are complex and difficult to scale up in real-world practice settings. Existing payment policies have proven inadequate to facilitate adoption of effective integrated care models. This article provides an overview of evidence-based models of integrated care, discusses the key elements of such models, considers how existing policies have fallen short, and outlines future policy strategies. Priorities include payment policies that adequately support structural elements of integrated care and incentivize multidisciplinary team formation and accountability for patient outcomes, as well as policies to expand the specialty mental health and addiction treatment workforce and address the social determinants of health that disproportionately influence health and well-being among people with mental illness or substance use disorders.
将精神疾病或物质使用障碍的护理纳入普通医疗环境的干预措施在临床试验中已被证明能改善患者预后,但有效的模式很复杂,在现实世界的实践环境中难以扩大规模。事实证明,现有的支付政策不足以促进有效综合护理模式的采用。本文概述了循证综合护理模式,讨论了此类模式的关键要素,分析了现有政策的不足之处,并概述了未来的政策策略。优先事项包括充分支持综合护理结构要素、激励多学科团队组建以及对患者预后负责的支付政策,以及扩大专业心理健康和成瘾治疗劳动力队伍、解决对患有精神疾病或物质使用障碍的人群的健康和福祉有不成比例影响的健康社会决定因素的政策。