Department of Psychiatry, University of Colorado School of Medicine-Anschutz Medical Campus, Aurora, CO, USA.
Department of Medicine, Rocky Mountain Regional VA Medical Center, Aurora, CO, USA; Department of Medicine, Division of Health Care Policy and Research, University of Colorado School of Medicine-Anschutz Medical Campus, Aurora, CO, USA.
J Am Med Dir Assoc. 2022 Sep;23(9):1461-1467.e7. doi: 10.1016/j.jamda.2022.06.004. Epub 2022 Jul 2.
Behavioral health (BH) concerns are prevalent among residents (eg, depression, anxiety, and insomnia), family care partners (eg, depression and burden), and staff (eg, burnout and depression) in nursing home-based post-acute and subacute care, referred to as skilled nursing facility (SNF) care. When untreated, BH concerns can lead to negative care outcomes, including limited functional improvements, longer lengths of stay, and elevated risk of rehospitalization and mortality. Despite the high clinical need, the field lacks evidence and consensus regarding an optimal model of BH services and roles for BH clinicians in SNFs. Developing such a model can inform the testing of BH interventions that best align with clinical operations, moving the field toward answering questions regarding the effectiveness and implementation of BH services in SNFs. Evidence-based BH models from the primary care literature include coordinated, colocated, and integrated care, each of which present potential benefits and challenges for the SNF setting. In this special article, we argue that an integrated model of BH services in SNFs may (1) increase access to and engagement with BH; (2) strengthen positive biopsychosocial resident outcomes and quality of care; and (3) prevent or improve BH concerns among stakeholders involved in resident care, including family care partners and staff. From our evidence-based discussion, we propose a Stepped-Care Model of Integrated BH for SNFs that can help clarify the scope of practice and clinical roles for licensed BH clinicians in this setting (eg, psychologists, clinical social workers, master's-level counselors). We conclude with a discussion of policy and research implications with a focus on potential policy changes that may be necessary for BH integration in SNFs. Future research to establish feasibility, clinical benefit (eg, efficacy, effectiveness), and financial justification for our proposed model is needed. This article can serve as a guide for such future research endeavors.
行为健康（BH）问题在疗养院（例如，抑郁、焦虑和失眠）、家庭护理伙伴（例如，抑郁和负担）和员工（例如，倦怠和抑郁）中普遍存在，这些都是基于疗养院的急性后和亚急性护理，也被称为熟练护理设施（SNF）护理。如果不进行治疗，BH 问题可能会导致负面的护理结果，包括功能改善有限、住院时间延长，以及重新住院和死亡的风险增加。尽管临床需求很高，但该领域缺乏关于 BH 服务的最佳模式以及 BH 临床医生在 SNF 中的角色的证据和共识。制定这样的模式可以为 BH 干预措施的测试提供信息，这些干预措施最符合临床运营，使该领域能够回答关于 SNF 中 BH 服务的有效性和实施的问题。初级保健文献中的循证 BH 模型包括协调、共同定位和综合护理，每种模式都为 SNF 环境带来了潜在的益处和挑战。在这篇专题文章中，我们认为 SNF 中的 BH 服务综合模式可能（1）增加 BH 的可及性和参与度；（2）加强居民的积极生物心理社会结果和护理质量；（3）预防或改善参与居民护理的利益相关者（包括家庭护理伙伴和员工）的 BH 问题。从我们的循证讨论中，我们提出了一种 SNF 中综合 BH 的阶梯式护理模式，可以帮助澄清在这种环境中持照 BH 临床医生的实践范围和临床角色（例如，心理学家、临床社会工作者、硕士级咨询师）。最后，我们讨论了政策和研究的影响，重点是 BH 整合到 SNF 中可能需要的政策变化。需要进行未来的研究来确定我们提出的模型的可行性、临床效益（例如，疗效、有效性）和财务合理性。本文可以作为未来研究工作的指南。
