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首页> 外文期刊>Administration and Policy in Mental Health and Mental Health Services Research >Improving Integrated General Medical and Mental Health Services in Community-based Practices
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Improving Integrated General Medical and Mental Health Services in Community-based Practices

机译：在社区实践中改善综合的一般医疗和心理健康服务

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The historical fragmentation of physical and mental health services has impeded efforts to improve quality and outcomes of care for persons with mental disorders. However, there is little information on effective strategies that might reduce fragmentation and improve integrated services within non-academic, community-based healthcare settings. Twenty-three practices from across the U.S. participated in a learning community meeting designed to identify barriers to integrated care and strategies for reducing such barriers. Barriers were initially identified based on a quantitative survey of organizational factors. Focus groups were used to elaborate on barriers to integrated care and to identify strategies for reducing barriers that are feasible in community-based settings. Participants identified key barriers, including administrative (e.g., lack of common medical records for mental health and general medical conditions), financial (e.g., lack of reimbursement codes to bill for mental health and general medical care in the same setting), and clinical (e.g., lack of an integrated care protocol). Top strategies recommended by participants included templates (i.e., for memoranda of understanding) to allow providers to work across practice settings, increased medical record security to enable a common medical record between mental health and general medical care, working with state Medicaid agencies to establish integrated care reimbursement codes, and guidance in establishing workflows between different providers (i.e., avoid duplication of tasks). Strategies to overcome barriers to integrated care may require cooperation across different organizational levels, including administrators, providers, and health care payers in order for integrated care to be established and sustained over time.
机译：身体和精神卫生服务的历史分散，阻碍了努力提高精神障碍患者的护理质量和结果。但是，关于有效策略的信息很少，这些策略可以减少非学术性，基于社区的医疗机构中的分散化并改善综合服务。来自美国各地的23种实践方式参加了一次学习社区会议，该会议旨在确定综合护理的障碍和减少此类障碍的策略。最初是根据组织因素的定量调查确定障碍的。焦点小组被用来详细说明综合护理的障碍，并确定在社区环境中可行的减少障碍的策略。参与者确定了主要障碍，包括行政管理（例如，缺乏用于精神健康和一般医疗状况的通用医疗记录），财务（例如，缺乏用于在相同环境下为精神健康和一般医疗提供费用的报销代码）以及临床（例如，缺乏综合护理方案）。参与者推荐的主要策略包括模板（例如，用于谅解备忘录），以允许提供者跨实践场所工作，提高病历安全性，以实现心理健康和一般医疗之间的共同病历，与州医疗补助机构合作建立综合护理报销代码，以及在不同提供商之间建立工作流程的指导（即避免重复任务）。克服整合护理障碍的策略可能需要跨不同组织级别的合作，包括管理员，提供者和医疗保健支付者，以便随着时间的推移建立和维持整合护理。

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