Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.
Ann Fam Med. 2021 Mar-Apr;19(2):148-156. doi: 10.1370/afm.2651.
We developed and implemented a new model of collaborative care that includes a triage and referral management system. We present initial implementation metrics using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework.
Primary care clinicians in 8 practices referred patients with any unmet mental health needs to the Penn Integrated Care program. Assessments were conducted using validated measures. Patients were primarily triaged to collaborative care (26%) or specialty mental health care with active referral management (70%). We conducted 50 qualitative interviews to understand the implementation process and inform program refinement. Our primary outcomes were reach and implementation metrics, including referral and encounter rates derived from the electronic health record.
In 12 months, 6,124 unique patients were referred. Assessed patients reported symptoms consistent with a range of conditions from mild to moderate depression and anxiety to serious mental illnesses including psychosis and acute suicidal ideation. Among patients enrolled in collaborative care, treatment entailed a mean of 7.2 (SD 5.1) encounters over 78.1 (SD 51.3) days. Remission of symptoms was achieved by 32.6% of patients with depression and 39.5% of patients with anxiety. Stakeholders viewed the program favorably and had concrete suggestions to ensure sustainability.
The Penn Integrated Care program demonstrated broad reach. Implementation was consistent with collaborative care as delivered in seminal studies of the model. Our results provide insight into a model for launching and implementing collaborative care to meet the needs of a diverse group of patients with the full range of mental health conditions seen in primary care.
我们开发并实施了一种新的协作式护理模式，其中包括分诊和转介管理系统。我们使用 Reach、Effectiveness、Adoption、Implementation、Maintenance（RE-AIM）框架呈现初步实施指标。
8 家诊所的初级保健临床医生将有任何未满足的心理健康需求的患者转介到宾夕法尼亚综合护理计划。评估采用经过验证的措施进行。患者主要分诊到协作护理（26%）或有积极转介管理的专业心理健康护理（70%）。我们进行了 50 次定性访谈，以了解实施过程并为计划改进提供信息。我们的主要结果是转介和实施指标，包括从电子健康记录中得出的转介和就诊率。
在 12 个月内，有 6124 名独特的患者被转介。接受评估的患者报告的症状与从轻度到中度抑郁和焦虑到严重精神疾病（包括精神病和急性自杀意念）等各种疾病一致。在接受协作护理的患者中，治疗涉及平均 7.2 次（SD=5.1）就诊，历时 78.1 天（SD=51.3）。32.6%的抑郁症患者和 39.5%的焦虑症患者症状缓解。利益相关者对该计划持积极态度，并提出了确保可持续性的具体建议。
宾夕法尼亚综合护理计划的覆盖范围很广。实施情况与协作式护理模式的开创性研究中提供的护理模式一致。我们的研究结果为启动和实施协作式护理以满足初级保健中各种精神健康状况患者的需求提供了深入了解。
