Browsing by Subject "Collaborative care"
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Item Advancing the integration of mental and physical health care : overcoming barriers, demonstrating outcomes with vulnerable populations, and understanding implementation(2011-05) Sanchez, Katherine Elizabeth, Ph. D. in social work; Davis, King E.; Jones, Barbara; Pomeroy, Elizabeth; Thompson, Sanna; Watt, ToniThe objective of this dissertation is to describe a systematic approach to effectively treat common mental health disorders, which involves integrating care managers and mental health specialists into the primary care treatment team. Despite an extensive body of evidence demonstrating the effectiveness of collaborative care, implementation in various “real world” settings presents a number of barriers. Successful clinical trials have failed to result in widespread changes in practice. Gaps in the literature persist as to what the clinical, organizational and financial barriers to integration are. As a result, dissemination of the model lags far behind. This dissertation sought to contribute new information to the literature on integrated health care by examining various elements of dissemination efforts. The first article examined the experience among a group of health care providers in Texas who were attempting to integrate physical and behavioral health care. This article identified the barriers that they have encountered in addition to the strategies they have used to integrate mental and physical health services, and to determine whether the strategies reflect an evidence-based model of care delivery. In addition, the perceived clinical, organizational and financial barriers to integration were evaluated. The second article for this dissertation examined quantitative clinical outcomes of an integrated health care program in a community-based clinic with a low-income, uninsured population of Hispanics, a portion of which were Spanish-speaking. A socio-culturally adapted model for the provision of comprehensive health services may have a significant impact on the health and mental health outcomes of minority, non-English speaking populations. The third article offers an in-depth case study of an interdisciplinary collaborative care treatment team. Understanding the details of program implementation and the elements of the model that community based providers found useful, and those they found challenging, has implications for widespread implementation efforts. This qualitative article offered an analysis of how the treatment team organized itself to perform as a coordinated, high functioning effort that fit well with the needs of patients, and had each professional doing what they do best.Item Essays on decision science with applications to humanitarian logistics and healthcare(2020-05) Cronin, Paul Michael; Morrice, Douglas J. (Douglas John), 1962-; Anderson, Edward; Bard, Jonathan; Butler, John; Leykum, Luci; Shively, ThomasThis dissertation comprises a collection of essays on using decision science methods for decision-making under uncertainty with applications to operations management and healthcare. The first chapter provides an introduction to contemporary problems facing business leaders in healthcare and retail and how decision science methods are used to inform decision makers and contribute to the existing literature. The second chapter introduces a decision-theoretic approach to managing inventory during hurricane events using consumer demand estimates. Econometric models are developed to estimate baseline consumer demand for products that are critical during hurricane disasters. A state-space model leverages the econometric results and national weather data to estimate demand distributions for different hurricane threats. A two-stage stochastic dynamic programming model is solved as a mixed-integer problem to allocate inventory to retail stores before the storm hits. Patient-focused care has taken center stage in the healthcare system’s attempts to revolutionize healthcare delivery via improved patient outcomes and hospital operations. Chapter three examines how the recent collaborative care approach in inpatient medicine is impacting patient length of stay, readmission rates, and discharge planning. Elastic net regression is used to estimate the marginal effect of collaborative care on length of stay while controlling for physician learning and patient diagnosis in a novel way. Logistic regression is employed to model readmission rates and discharge planning. These results contribute quantitative empirical results on collaborative care to the medical and healthcare operations literature. The fourth chapter focuses on a different aspect of patient-focused care through the geographic localization of patient beds with different admission protocols. Both geographic localization and bed assignment problems have been studies in recent years, but this is one of the first papers to study the two combined. Working with a Texas teaching hospital, we used stochastic discrete event simulation to model the hospital’s approach while finding generalizable insights into how geographic localization can and cannot work with call rotation scheduling.Item Evaluation of a collaborative care model of mental healthcare for low-SES Latinx children and adolescents(2021-05-05) George-Jones, Julia; Rodríguez, Erin M.Integrated behavioral health (IBH) is a promising approach to improving access to mental healthcare. Low-SES Latinx and Black youth face various barriers when accessing mental healthcare, and current IBH research focuses more on patients with a single mental health condition as opposed to multiple conditions. The proposed study seeks to evaluate a collaborative care IBH model for primarily low-SES Latinx children at a clinic. Medical record data will be analyzed quantitatively to understand how Spanish-speaking families, patients with complex mental health concerns, and patients with chronic physical health conditions benefit from IBH, using regressions. A subset of parents and children will also be interviewed qualitatively to explore patient perspectives on receiving treatment through IBH.Item Testing the proposed benefits of integrated care : referral compliance, client satisfaction, and treatment adherence(2016-08) Irvin, Stuart Alan; Drum, David J.; Rude, Stephanie SOver the past two decades, in an effort to narrow the gap between the fields of medicine and mental health, researchers have increasingly studied models of health care featuring varying degrees of collaboration between the two disciplines. Throughout the literature, models featuring higher degrees of collaboration between primary care providers (PCPs) and mental health providers (MHPs) are hypothesized as having a number of benefits (e.g., higher mental health referral compliance rates, higher client satisfaction, increased treatment adherence, etc.) over models that feature little-to-no collaboration between said providers. This paper encourages future research to put that notion to the test by pitting two models of health care – an ‘integrated care’ model (featuring high collaboration), and a ‘traditional care’ model (featuring low collaboration) – directly against one another. After reviewing some of the current problems with our nation’s healthcare system, the history behind the biopsychosocial movement, and the literature on various models of collaborative care, the author outlines a proposal for how future experimental studies could be developed focusing on three specific outcomes: referral compliance, client satisfaction, and treatment adherence. Research questions, hypotheses, and implications for the health care marketplace are discussed in detail.