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Adaptation in Delivering Integrated Care: The Tension Between Care and Evidence-Based Practice
David Oslin1, Lisa Dixon1, David A Adler1
1Dr. Oslin is with the Department of Psychiatry, University of Pennsylvania, Philadelphia. Dr. Dixon is with the Department of Psychiatry, Columbia University Medical Center, New York. Dr. Adler is with the Department of Psychiatry, Tufts Medical Center, Boston. Dr. Winston is with the Department of Psychiatry, University of Colorado School of Medicine, Aurora. Dr. Erlich is with the Department of Psychiatry, Columbia University, and the New York State Psychiatric Institute. Dr. Levine is with the Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs, New York, and the James J. Peters Veterans Affairs Medical Center, Bronx, New York. Dr. Berlant is with Optum Health, Meridian, Idaho. Dr. Goldman is with Blue Cross-Blue Shield, Detroit. Dr. First is with the New York-Presbyterian Hospital, New York. Dr. Siris is with the Department of Psychiatry, Zucker-Hillside Hospital, Glen Oaks, New York.
Abstract:
Clinical practice is assumed to be informed and supported by evidence-based clinical research. Nonetheless, clinical practice often deviates from the research evidence base, sometimes leading and sometimes lagging. Two examples from integrated care in mental health care (care for serious mental illness and collaborative mental health care in primary care settings) illustrate the natural space and therefore tension between evidence and implementation that needs to be better understood. Using the tools and perspectives of both examples, the authors present a framework for the connected relationship between practice and research that is founded on measurement and uses iterative adaptation guided by oversight of and feedback from the stakeholders in this process.
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