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Clinical Workflows and the Associated Tasks and Behaviors to Support Delivery of Integrated Behavioral Health and
Melinda M Davis1, Rose Gunn, Maribel Cifuentes
1Departments of Family Medicine (Drs Davis and Cohen and Ms Hall) and Medical Informatics and Clinical Epidemiology (Dr Cohen) and Oregon Rural Practice-based Research Network (Dr Davis and Ms Gunn), Oregon Health & Science University, Portland; OHSU-PSU School of Public Health, Oregon Health & Science University, Portland (Dr Davis); The Colorado Health Foundation, Denver (Ms Cifuentes); Cherokee Health Systems, Knoxville, Tennessee (Dr Khatri); Departments of Family Medicine (Ms Gilchrist) and Psychiatry (Dr Lazarus), University of Colorado School of Medicine, Aurora; Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis (Dr Peek); Jefferson Center for Mental Health, Lakewood, Colorado (Ms Klowden); and Well Being Trust, Oakland, California (Dr Miller).
Abstract:
Integrating primary care and behavioral health is an important focus of health system transformation. Cross-case comparative analysis of 19 practices in the United States describing integrated care clinical workflows. Surveys, observation visits, and key informant interviews analyzed using immersion-crystallization. Staff performed tasks and behaviors-guided by protocols or scripts-to support 4 workflow phases: (1) identifying; (2) engaging/transitioning; (3) providing treatment; and (4) monitoring/adjusting care. Shared electronic health records and accessible staffing/scheduling facilitated workflows. Stakeholders should consider these workflow phases, address structural features, and utilize a developmental approach as they operationalize integrated care delivery.
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