An external facilitation case study analysis of an implementation trial of FLOW: A program for improving the transition of patients with mental health disorders back to primary care.

FLOW (not an acronym) is a program that aims to improve mental health (MH) access using an algorithm that extracts electronic medical record data to identify recovered or stabilized MH patients who may be eligible to transition to primary care. The purpose of this case study was to describe and understand the factors that contributed to success or struggles in implementing FLOW. We conducted a posthoc evaluation of four health care sites implementing FLOW, using a mixed-method formal case study analysis. Qualitative data included written process notes, teleconference minutes, and interviews with internal facilitators (IF), MH providers, and patients who were transitioned. The external facilitation team also examined the degree to which IF characteristics matched suggested criteria. Quantitative data included discharge percentages and the percentage of providers who transitioned ≥ three patients during implementation. Sites were considered successful if they: (a) discharged ≥ 3% of their unique MH patients and (b) had a preponderance of patients who were satisfied with their MH to primary care transition. This article discusses two successful and two struggling FLOW sites based on these and other criteria and the factors that contributed to these outcomes. These case study findings increased understanding of how to successfully implement FLOW. The importance of shared decision making, selection of the IF, role definition, as well as leadership and organizational support are key elements in fostering appropriate transitions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).