5
Coordinating Care for Better Mental, Substance-Use, and General Health

Summary

Mental and substance-use problems and illnesses seldom occur in isolation. They frequently accompany each other, as well as a substantial number of general medical illnesses such as heart disease, cancers, diabetes, and neurological illnesses. Sometimes they masquerade as separate somatic problems. Consequently, mental, substance-use, and general health problems and illnesses are frequently intertwined, and coordination of all these types of health care is essential to improved health outcomes, especially for chronic illnesses. Moreover, mental and/or substance-use (M/SU) problems and illnesses frequently affect and are addressed by education, child welfare, and other human service systems. Improving the quality of M/SU health care—and general health care—depends upon the effective collaboration of all mental, substance-use, general health care, and other human service providers in coordinating the care of their patients.

However, these diverse providers often fail to detect and treat (or refer to other providers to treat) these co-occurring problems and also fail to collaborate in the care of these multiple health conditions—placing their patients’ health and recovery in jeopardy. Collaboration by mental, substance-use, and general health care clinicians is especially difficult because of the multiple separations that characterize mental and substance-use health care: (1) the greater separation of mental and substance-use health care from general health care; (2) the separation of mental and substance-



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Improving the Quality of Health Care for Mental and Substance-Use Conditions 5 Coordinating Care for Better Mental, Substance-Use, and General Health Summary Mental and substance-use problems and illnesses seldom occur in isolation. They frequently accompany each other, as well as a substantial number of general medical illnesses such as heart disease, cancers, diabetes, and neurological illnesses. Sometimes they masquerade as separate somatic problems. Consequently, mental, substance-use, and general health problems and illnesses are frequently intertwined, and coordination of all these types of health care is essential to improved health outcomes, especially for chronic illnesses. Moreover, mental and/or substance-use (M/SU) problems and illnesses frequently affect and are addressed by education, child welfare, and other human service systems. Improving the quality of M/SU health care—and general health care—depends upon the effective collaboration of all mental, substance-use, general health care, and other human service providers in coordinating the care of their patients. However, these diverse providers often fail to detect and treat (or refer to other providers to treat) these co-occurring problems and also fail to collaborate in the care of these multiple health conditions—placing their patients’ health and recovery in jeopardy. Collaboration by mental, substance-use, and general health care clinicians is especially difficult because of the multiple separations that characterize mental and substance-use health care: (1) the greater separation of mental and substance-use health care from general health care; (2) the separation of mental and substance-

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Improving the Quality of Health Care for Mental and Substance-Use Conditions use health care from each other; (3) society’s reliance on the education, child welfare, and other non–health care sectors to secure M/SU services for many children and adults; and (4) the location of services needed by individuals with more-severe M/SU illnesses in public-sector programs apart from private-sector health care. This mass of disconnected care delivery arrangements requires numerous patient interactions with different providers, organizations, and government agencies. It also requires multiple provider “handoffs” of patients for different services and transmittal of information to and joint planning by all these providers, organizations, and agencies if coordination is to occur. Overcoming these separations also is made difficult because of legal and organizational prohibitions on clinicians’ sharing information about mental and substance-use diagnoses, medications, and other features of clinical care, as well as a failure to implement effective structures and processes for linking the multiple clinicians and organizations caring for patients. To overcome these obstacles, the committee recommends that individual treatment providers create clinically effective linkages among mental, substance-use, and general health care and other human service agencies caring for these patients. Complementary actions are also needed from government agencies, purchasers, and accrediting bodies to promote the creation of these linkages. To enable these actions, changes are needed as well to address the less-evolved infrastructure for using information technology, some unique features of the M/SU treatment workforce that also have implication for effective care coordination, and marketplace practices. Because these issues are of such consequence, they are addressed separately in Chapters 6, 7, and 8, respectively. CARE COORDINATION AND RELATED PRACTICES DEFINED Crossing the Quality Chasm notes that the multiple clinicians and health care organizations serving patients in the American health care system typically fail to coordinate their care. That report further states that the resulting gaps in care, miscommunication, and redundancy are sources of significant patient suffering (IOM, 2001).1 The Quality Chasm’s health care quality framework addresses the need for better care coordination in 1   In a subsequent report, produced at the request of the U.S. Department of Health and Human Services, the Institute of Medicine identified “care coordination” as one of 20 priority health care areas deserving of immediate attention by all participants in American health care (IOM, 2003a).

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Improving the Quality of Health Care for Mental and Substance-Use Conditions one of its ten rules and in another rule calls attention to the need for provider communication and collaboration to achieve this goal: Cooperation among clinicians. Clinicians and institutions should actively collaborate and communicate to ensure an appropriate exchange of information and coordination of care. Shared knowledge and the free flow of information. Patients should have unfettered access to their own medical information and to clinical knowledge. Clinicians and patients should communicate effectively and share information. (IOM, 2001:62) These two rules highlight two prerequisites to coordination of care: communication and collaboration across providers and within and across institutions. Communication exists when each clinician or treatment provider caring for a patient shares needed treatment information with other clinicians and providers caring for the patient. Information can be shared verbally; manually in writing; or through information technology, such as a shared electronic health record. Collaboration is multidimensional and requires the aggregation of several behaviors, including the following: A shared understanding of goals and roles—Collaboration is enhanced by a shared understanding of an agreed-upon collective goal (Gittell et al., 2000) and clarity regarding each clinician’s role. Role confusion and role conflict are frequent barriers to interdisciplinary collaboration (Rice, 2000). Effective communication—Multiple studies have identified effective communication as a key feature of collaboration (Baggs and Schmitt, 1988; Knaus et al., 1986; Schmitt, 2001; Shortell et al., 1994). “Effective” is defined variously as frequent, timely, understandable, accurate, and satisfying (Gittell et al., 2000; Shortell et al., 1994). Shared decision making—In shared decision making, problems and strategies are openly discussed (Baggs and Schmitt, 1997; Baggs et al., 1999; Rice, 2000; Schmitt, 2001), and consensus is often used to arrive at a decision. Disagreements over treatment approaches and philosophies, roles and responsibilities, and ethical questions are common in health care settings. Positive ways of addressing these inevitable differences are identified as a key component of effective caregiver collaboration (Shortell et al., 1994). It is important to note that, according to health services researchers, collaboration is not a dichotomous variable, simply present or absent. Rather, it is present to varying degrees (Schmitt, 2001).

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Improving the Quality of Health Care for Mental and Substance-Use Conditions Collaboration also is typically characterized by necessary precursors. Clinicians are more likely to collaborate when they perceive each other as having the knowledge necessary for good clinical care (Baggs and Schmitt, 1997). Mutual respect and trust are necessary precursors to collaboration as well (Baggs and Schmitt, 1988; Rice, 2000); personal respect and trust are intertwined with respect for and trust in clinical competence. Care coordination is the outcome of effective collaboration. Coordinated care prevents drug–drug interactions and redundant care processes. It does not waste the patient’s time or the resources of the health care system. Moreover, it promotes accurate diagnosis and treatment because all providers receive relevant diagnostic and treatment information from all other providers caring for a patient. Care integration is related to care coordination. As defined by experts in health care organization and management (Shortell et al., 2000), integration of care and services can be of three types: “Clinical integration is the extent to which patient care services are coordinated across people, functions, activities, and sites over time so as to maximize the value of services delivered to patients” (p. 129). Physician (or clinician) integration is the extent to which clinicians are economically linked to an organized delivery system, use its facilities and services, and actively participate in its planning, management and governance. Functional integration is “the extent to which key support functions and activities (such as financial management, strategic planning, human resources management, and information management) are coordinated across operating units so as to add the greatest overall value to the system” (p. 31). The most important of these functions and activities are human resources deployment strategies, information technologies, and continuous improvement processes. Shortell et al.’s clinical integration corresponds to care coordination as addressed in the Quality Chasm report. In the context of co-occurring mental and substance-use problems and illnesses, the Substance Abuse and Mental Health Services Administration (SAMHSA) similarly identifies three levels of integration (SAMHSA, undated): Integrated treatment refers to interactions between clinicians to address the individual needs of the client/patient, and consists of “any mechanism by which treatment interventions for co-occurring disorders are combined within the context of a primary treatment relationship or service setting” (p. 61).

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Improving the Quality of Health Care for Mental and Substance-Use Conditions Integrated program refers to an organizational structure that ensures the provision of staff or linkages with other programs to address all of a client’s needs. Integrated systems refers to an organizational structure that supports an array of programs for individuals with different needs through funding, credentialing/licensing, data collection/reporting, needs assessment, planning, and other system planning and operation functions. SAMHSA’s integrated treatment corresponds to Shortell et al.’s clinical integration; both appear to equate to coordination of care as used in the Quality Chasm report. In this report, we use the Quality Chasm terminology of care coordination and address the coordination of care at the level of the patient. We do not address issues surrounding the other levels of coordination or integration represented by Shortell et al.’s clinician and functional integration or SAMHSA’s integrated programs and systems. FAILED COORDINATION OF CARE FOR CO-OCCURRING CONDITIONS Co-Occurring Mental, Substance-Use, and General Health Problems and Illnesses Mental or substance-use problems and illnesses seldom occur in isolation. Approximately 15–43 percent of the time they occur together (Kessler et al., 1996; Kessler, 2004; Grant et al., 2004a,b; SAMHSA, 2004). They also accompany a wide variety of general medical conditions (Katon, 2003; Mertens et al., 2003), sometimes masquerade as separate somatic problems (Katon, 2003; Kroenke, 2003), and often go undetected (Kroenke et al., 2000; Saitz et al., 1997). As a result, individuals with M/SU problems and illnesses have a heightened need for coordinated care. Co-Occurring Mental and Substance-Use Problems and Illnesses The 1990–1992 National Comorbidity Survey well documented the high rates of co-occurring mental and substance use conditions, finding an estimated 42.7 percent of adults aged 15–54 with an alcohol or drug “disorder” also having a mental disorder, and 14.7 percent of those with a mental disorder also having an alcohol or drug disorder (Kessler et al., 1996; Kessler 2004). These findings are reaffirmed by more recent studies. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA) 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions, 19.7 percent of the general adult (18 and older) U.S. population with any substance-use disorder is estimated to have at least one

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Improving the Quality of Health Care for Mental and Substance-Use Conditions co-occurring independent (non–substance-induced) mood disorder, and 17.7 percent to have at least one co-occurring independent anxiety disorder. Among respondents with a mood disorder, 20 percent had at least one substance-use disorder, as did 15 percent of those with an anxiety disorder. Rates of co-occurrence are higher among individuals who seek treatment for substance-use disorders; 40.7 percent, 33.4 percent, and 33.1 percent of those who sought treatment for an alcohol-use disorder had at least one independent mood disorder, anxiety disorder, or other drug use disorder, respectively. Among those seeking treatment for a drug-use disorder, 60.3 percent had at least one independent mood disorder, 42.6 percent at least one independent anxiety disorder, and 55.2 percent a comorbid alcohol-use disorder (Grant et al., 2004a). Similar or higher rates of co-occurrence are found for other types of mental problems and illnesses (Grant et al., 2004b), as well as for serious mental illnesses generally. The 2003 National Survey on Drug Use and Health documented that among adults aged 18 and older not living in an institution or inpatient facility, an estimated 18 percent of those who had used illicit drugs in the past year also had a serious mental illness.2 Over 21 percent of adults with substance “abuse” or dependence were estimated to have a serious mental illness, and 21.3 percent of adults with such an illness had been dependent on or “abused” alcohol or illicit drugs in the past year (SAMHSA, 2004). One longitudinal study of patients in both mental health and drug treatment settings found that mental illnesses were as prevalent and serious among individuals treated in substance-use treatment facilities as among patients in mental health treatment facilities. Similarly, individuals served in mental health treatment facilities had substance-use illnesses at rates and severity comparable to those among individuals served in substance-use treatment facilities (Havassy et al., 2004). Co-occurrence with General Health Conditions M/SU problems and illnesses frequently accompany a substantial number of chronic general medical illnesses, such as diabetes, heart disease, neurologic illnesses, and cancers, sometimes masquerading as separate somatic problems (Katon, 2003). Approximately one in five patients hospitalized for a heart attack, for example, suffers from major depression, and evidence from multiple studies is “strikingly consistent” that post–heart attack depres- 2   A serious mental illness was defined for this study as a diagnosable mental, behavioral, or emotional disorder that met criteria in the Diagnostic and Statistical Manual, fourth edition (DSM-IV) and resulted in functional impairment that substantially interfered with or limited one or more major life activities.

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Improving the Quality of Health Care for Mental and Substance-Use Conditions sion significantly increases one’s risk for death: patients with depression are about three times more likely to die from a future attack or other heart problem (Bush et al., 2005:5). Depression and anxiety also are strongly associated with somatic symptoms such as headache, fatigue, dizziness, and pain, which are the leading cause of outpatient medical visits and often medically unexplained (Kroenke, 2003). They also are more often present in individuals with a number of medical conditions as yet not well understood, including chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome, and nonulcer dyspepsia (Henningsen et al., 2003). The converse also is true. Individuals with M/SU conditions often have increased prevalence of general medical conditions such as cardiovascular disease, high blood pressure, diabetes, arthritis, digestive disorders, and asthma (De Alba et al., 2004; Mertens et al., 2003; Miller et al., 2003; Sokol et al., 2004; Upshur, 2005). Persons with severe mental illnesses have much higher rates of HIV and hepatitis C than those found in the general population (Brunette et al., 2003; Rosenberg et al., 2001; Sullivan et al., 1999). Moreover, specific mental or substance-use diagnoses place individuals at higher risk for certain general medical conditions. For example, those in treatment for schizophrenia, depression, and bipolar illness are more likely than the general population to have asthma, chronic bronchitis, and emphysema (Sokol et al., 2004). Persons with anxiety disorders have higher rates of cardiac problems, hypertension, gastrointestinal problems, genitourinary disorders, and migraine (Harter et al., 2003). Individuals with schizophrenia are at increased risk for obesity, heart disease, diabetes, hyperlipidemia, hepatitis, and osteoporosis (American Diabetes Association et al., 2004; Goff et al., 2005; Green et al., 2003). And chronic heavy alcohol use is associated with liver disease, immune system disorders, cardiovascular diseases, and diabetes (Carlsson et al., 2000; Corrao et al., 2000; NIAAA, 2000). Substance use, particularly injection drug use, carries a high risk of other serious illnesses. In a large cohort study of middle-class substance-using patients, the prevalence of hepatitis C was 27 percent in all substance users and 76 percent in injection drug users (Abraham et al., 1999). Injection drug use accounts for about 60 percent of new cases of hepatitis C (Alter, 1999) and remains the second most common risk behavior for acquisition of HIV in the United States (CDC, 2001). Evidence of past infection with hepatitis B also is common in injection drug users (Garfein, et al., 1996). Hepatitis C and coinfection with HIV and active hepatitis B are associated with more-severe liver disease (Zarski et al., 1998). Alcohol use is prevalent among HIV-infected patients (Conigliaro et al., 2003), and accelerates cognitive impairment in HIV-associated dementia complex (Fein et al., 1998; Tyor and Middaugh, 1999). Given that patients with HIV infection are now living longer, the impact of comorbid conditions in these patients, including alcohol and drug-use

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Improving the Quality of Health Care for Mental and Substance-Use Conditions problems, has become increasingly important. Hepatitis C–related liver injury progresses more rapidly in both HIV coinfected persons and alcohol users. Laboratory and preliminary clinical evidence indicates that both alcohol use and hepatitis C can negatively affect immunologic and clinical HIV outcomes. Furthermore, both alcohol and drug use may adversely affect the prescription and efficacy of and adherence to HIV medications (Moore et al., 2004; Palepu et al., 2003; Samet et al., 2004). The co-occurrence of mental, substance-use, and general health problems and illnesses has important implications for the recovery of individuals with these illnesses. All of these conditions need to be to be detected and treated; however, this often does not happen, and even when it does, providers dealing with one condition often fail to detect and treat the co-occurring illness and to collaborate in the coordinated care of these patients. Failure to Detect, Treat, and Collaborate in the Care of Co-Occurring Illnesses Although detection of some common mental illnesses, such as depression, has increased over the past decade, general medical providers still too often fail to detect alcohol, drug, or mental problems and illnesses (Friedmann et al., 2000b; Miller et al., 2003; Saitz et al., 1997, 2002). In a nationally representative survey of general internal medicine physicians, family medicine physicians, obstetrician/gynecologists, and psychiatrists, for example, 12 percent reported that they did not usually ask their new patients whether they drank alcohol, and fewer than 20 percent used any formal screening tool to detect problems among those who did drink (Friedmann et al., 2000b). Moreover, evidence indicates that general medical providers often assume that the health complaints of patients with a prior psychiatric diagnosis are psychologically rather than medically based (Graber et al., 2000). Similarly, mental health and substance-use treatment providers frequently do not screen, assess, or address co-occurring mental or substance-use conditions (Friedmann et al., 2000b) or co-occurring general medical health problems. In a survey of patients of one community mental health center, 45 percent of respondents reported that their mental health provider did not ask about general medical issues (Miller et al., 2003). Evidence presented in Chapter 4 documents some of the failures of providers to treat co-occurring conditions. Other studies have added to the evidence that even when co-occurring M/SU conditions are known, they are not treated (Edlund et al., 2004; Friedmann et al., 2000b, 2001). The above-cited longitudinal study of patients with comorbid conditions at four public residential treatment facilities for seriously mentally ill patients and three residential treatment facilities for individuals with substance-use ill-

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Improving the Quality of Health Care for Mental and Substance-Use Conditions nesses found no listings of co-occurring problems or illnesses in patient charts despite the existence of significant comorbidity. “Patient charts in the public mental health system generally include a primary psychiatric disorder; co-occurring psychiatric or substance use disorders are not systematically included. Substance abuse treatment sites only documented substance use disorders” (Havassy et al., 2004:140). In the national survey of primary care providers and psychiatrists described above, 18 percent of physicians reported that they typically offered no intervention (including a referral) to their problem-drinking patients, in part because of misplaced concern about patients’ sensitivity on these issues (Friedmann et al., 2000b). Nearly the same proportion (15 percent) reported that they did not intervene when use of illicit drugs was detected (Friedmann et al., 2001). A 1997–1998 national survey found that among persons with probable co-occurring mental and substance-use disorders who received treatment for either condition, fewer than a third (28.6 percent) received treatment for the other (Watkins et al., 2001). Additional evidence of the failure to coordinate care is found in the complaints of consumers of M/SU services. The President’s New Freedom Commission reported that consumers often feel overwhelmed and bewildered when they must access and integrate mental health care and related services across multiple, disconnected providers in the public and private sectors (New Freedom Commission on Mental Health, 2003). These failures to detect and treat co-occurring conditions take place in a health care system that has historically and currently separates care for mental and substance-use problems and illnesses from each other and from general health care, to a greater extent than is the case for other specialty health care. Absent or poor linkages characterize these separate care delivery arrangements. Numerous demonstration projects and strategies have been developed to better link health care for general, mental, and substance-use health conditions and related services. These include The Robert Wood Johnson Foundation’s Depression in Primary Care: Linking Clinical and Systems Strategies Project (Upshur, 2005) and the MacArthur Foundation’s RESPECT—Depression Project (Dietrich et al., 2004). NUMEROUS, DISCONNECTED CARE DELIVERY ARRANGEMENTS “Every system is perfectly designed to achieve exactly the results it gets.” (Berwick, 1998) Organizations and providers offering treatment and services for mental, substance-use, and general health care conditions typically do so through separate care delivery arrangements:

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Improving the Quality of Health Care for Mental and Substance-Use Conditions Arrangements for the delivery of health care for mental and substance-use conditions are typically separate from general health care (financially and organizationally more so than other specialty health care services). In spite of the frequent co-occurrence of M/SU problems and illnesses, the delivery of health care for these conditions also typically occurs through separate treatment providers and organizations. Some health care for mental and substance-use conditions and related services are delivered through governmental programs that are separate from private insurance—requiring coordination across public and private sectors of care. Non–health care sectors—education, child welfare, and juvenile and criminal justice systems—also separately arrange for M/SU services. Traversing these separations is made difficult by a failure to put in place effective strategies for linking general, mental, and substance-use health care and the other human services systems that also deliver much-needed services for M/SU problems and illnesses; by a lack of agreement about which entity or entities should be held accountable for coordinating care; and by state and federal laws (and the policies and practices of some health care organizations) that limit information sharing across providers.3 Separation of M/SU Health Care from General Health Care Although the proportion has been declining in recent years, two-thirds of Americans (64 percent in 2002) under the age of 65 receive health care through private insurance offered by their or their family member’s employer (Fronstin, 2003). Over the past two decades, employers and other group purchasers of health care (e.g., state Medicaid agencies) have increasingly provided mental and substance-use health care benefits through health insurance plans that are separate administratively and financially from the plans through which individuals receive their general health care. These separate M/SU health plans are informally referred to as “carved out.” In payer carve-outs, an employer or other payer offers prospective enrollees one or more health plans encompassing all of their covered health care except that for mental and substance-use conditions. Covered individuals are then enrolled in another health plan that includes a network of M/SU 3   In addition, the less-evolved infrastructure for deploying information technology among mental health and substance-use treatment providers inhibits ease of coordination (see Chapter 6). Some of the unique features of the M/SU treatment workforce (e.g., the greater number of provider types, variation in their training and focus, and their greater location in solo or small group practices) that also contribute to this problem are addressed in Chapter 7.

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Improving the Quality of Health Care for Mental and Substance-Use Conditions providers chosen separately by the employer/payer. In health plan carve-outs, employees enroll in just one comprehensive health plan, and the administrators of that plan arrange internally to have M/SU health care provided and managed through a separate vendor. Estimates of the proportion of employees receiving M/SU health services through carve-out arrangements with managed behavioral health organizations (MBHOs) vary from 36 to 66 percent, reflecting differences in targeted survey respondents (e.g., employers, MBHOs, or employees) and what is being measured (e.g., carved-out services can include utilization review or case management only, or the provision of a full array of M/SU services) (Barry et al., 2003). The MBHOs that provide these carve-out M/SU services arose in part in response to financial concerns. In the 1980s, employers’ costs for behavioral health services were increasing at twice the rate of medical care overall and four times the rate of inflation. Evidence is clear that MBHOs have been successful in reducing these costs and also in achieving greater use of community-based care as opposed to institutionalization. They also have been credited with playing a role in keeping costs down in the face of broadened benefits, which has assisted in securing support for greater parity of mental health benefit coverage. Moreover, MBHOs have helped move clinicians from solo into group practices (Feldman, 2003), which, as discussed in Chapter 7, can facilitate quality improvement. Carve-out arrangements can nurture recognition and support for specialized knowledge of M/SU problems and illnesses and treatment expertise. They also can attenuate problems involving the adverse selection of individuals with M/SU illnesses in insurance plans (see Chapter 8). In contrast to the clear evidence for the benefits described above, evidence for the effects of carve-out arrangements on quality of care is limited and mixed (Donohue and Frank, 2000; Grazier and Eselius, 1999; Hutchinson and Foster, 2003). However, models of safety and errors in health care suggest that whenever individuals are cared for by separate organizations, functional units, or providers, discontinuities in care can result unless the unavoidable gaps in care are anticipated, and strategies to bridge those gaps are implemented (Cook et al., 2000). A previous Institute of Medicine (IOM) report found that carved-out M/SU services “do not necessarily lead to poor coordination of care…. However the separation of primary care and behavioral health care systems brings risks to coordination and integration…” (IOM, 1997:116). The President’s New Freedom Commission on Mental Health care deemed the separation between systems for mental and general health care so large as to constitute a “chasm” (New Freedom Commission on Mental Health, 2003). Several factors could help account for problems with coordinating care in the presence of M/SU carve-outs. First, under carve-out arrangements, primary care physicians generally are not expected to treat (and may not

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Improving the Quality of Health Care for Mental and Substance-Use Conditions Recommendations To address the complex obstacles to care coordination and collaboration described above, the committee recommends a set of related actions to be undertaken by individual clinicians, health care organizations, health plans, health care purchasers, accrediting organizations, and policy officials. Recommendation 5-1. To make collaboration and coordination of patients’ M/SU health care services the norm, providers of the services should establish clinically effective linkages within their own organizations and between providers of mental health and substance-use treatment. The necessary communications and interactions should take place with the patient’s knowledge and consent and be fostered by: Routine sharing of information on patients’ problems and pharmacologic and nonpharmacologic treatments among providers of M/SU treatment. Valid, age-appropriate screening of patients for comorbid mental, substance-use, and general medical problems in these clinical settings and reliable monitoring of their progress. Recommendation 5-2. To facilitate the delivery of coordinated care by primary care, mental health, and substance-use treatment providers, government agencies, purchasers, health plans, and accreditation organizations should implement policies and incentives to continually increase collaboration among these providers to achieve evidence-based screening and care of their patients with general, mental, and/or substance-use health conditions. The following specific measures should be undertaken to carry out this recommendation: Primary care and specialty M/SU health care providers should transition along a continuum of evidence-based coordination models from (1) formal agreements among mental, substance-use, and primary health care providers; to (2) case management of mental, substance-use, and primary health care; to (3) collocation of mental, substance-use, and primary health care services; and then to (4) delivery of mental, substance-use, and primary health care through clinically integrated practices of primary and M/SU care providers. Organizations should adopt models to which they can most easily transition from their current structure, that best meet the needs of their patient populations, and that ensure accountability.

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Improving the Quality of Health Care for Mental and Substance-Use Conditions DHHS should fund demonstration programs to offer incentives for the transition of multiple primary care and M/SU practices along this continuum of coordination models. Purchasers should modify policies and practices that preclude paying for evidence-based screening, treatment, and coordination of M/SU care and require (with patients’ knowledge and consent) all health care organizations with which they contract to ensure appropriate sharing of clinical information essential for coordination of care with other providers treating their patients. Organizations that accredit mental, substance-use, or primary health care organizations should use accrediting practices that assess, for all providers, the use of evidence-based approaches to coordinating mental, substance-use, and primary health care. Federal and state governments should revise laws, regulations, and administrative practices that create inappropriate barriers to the communication of information between providers of health care for mental and substance-use conditions and between those providers and providers of general care. With respect to the need for purchasers to modify practices that preclude paying for evidence-based screening, treatment, and coordination of health care for mental and substance-use conditions, the committee calls particular attention to practices that prevent primary care providers from receiving payment for delivery of the M/SU health services they provide and the failure of some benefit plans to cover certain evidence-based treatments. Recommendation 5-3. To ensure the health of persons for whom they are responsible, M/SU providers should: Coordinate their services with those of other human services and education agencies, such as schools, housing and vocational rehabilitation agencies, and providers of services for older adults. Establish referral arrangements for needed services. Providers of services to high-risk populations—such as child welfare agencies, criminal and juvenile justice agencies, and long-term care facilities for older adults—should use valid, age-appropriate, and culturally appropriate techniques to screen all entrants into their systems to detect M/SU problems and illnesses. Recommendation 5-4. To provide leadership in coordination, DHHS should create a high-level, continuing entity reporting directly to the secretary to improve collaboration and coordination across its mental,

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Improving the Quality of Health Care for Mental and Substance-Use Conditions substance-use, and general health care agencies, including the Substance Abuse and Mental Health Services Administration; the Agency for Healthcare Research and Quality; the Centers for Disease Control and Prevention; and the Administration for Children, Youth, and Families. DHHS also should implement performance measures to monitor its progress toward achieving internal interagency collaboration and publicly report its performance on these measures annually. State governments should create analogous linkages across state agencies. With respect to recommendation 5-4, the committee notes that this recommendation echoes the call made in the report Leadership by Example: Coordinating Government Roles in Improving Health Care Quality for Congress to consider directing the Secretary of DHHS to produce an annual progress report “detailing the collaborative and individual efforts of the various government programs to redesign their quality enhancement processes” (IOM, 2002:11). REFERENCES Aarons GA, Brown SA, Hough RL, Garland AF, Wood PA. 2001. Prevalence of adolescent substance use disorders across five sectors of care. Journal of the American Academy of Child & Adolescent Psychiatry 40(4):419–426. Abraham HD, Degli-Esposti S, Marino L. 1999. Seroprevalence of hepatitis C in a sample of middle class substance abusers. Journal of Addictive Diseases 18(4):77–87. AHRQ (Agency for Healthcare Research and Quality). 2002–2003. U.S. Preventive Services Task Force Ratings: Strength of Recommendations and Quality of Evidence. Guide to Clinical Preventive Services. Periodic updates, 2002–2003. Rockville, MD: AHRQ. [Online]. Available: http:www.ahrq.gov/clinic/3rduspstf/ratings.htm [accessed February 28, 2005]. Alter MJ. 1999. Hepatitis C virus infection in the United States. Journal of Hepatology 31 (Supplement 1):88–91. American Academy of Child & Adolescent Psychiatry and Child Welfare League of America. 2003. Policy Statement: AACAP/CWLA Policy Statement on Mental Health and Use of Alcohol and Other Drugs, Screening and Assessment of Children in Foster Care. [Online]. Available: http://www.aacap.org/publications/policy/collab02.htm [accessed December 2, 2005]. American Diabetes Association, American Psychiatric Association, American Association of Clinical Endocrinologists, North American Association for the Study of Obesity. 2004. Consensus development conference on antipsychotic drugs and obesity and diabetes. Journal of Clinical Psychiatry 65(2):267–272. Anonymous. 2004. Depression in Primary Care—Linking Clinical & System Strategies. [Online]. Available: http://www.wpic.pitt.edu/dppc [accessed December 23, 2004]. Badamgarev E, Weingarten S, Henning J, Knight K, Hasselblad V, Gano A Jr, Ofman J. 2003. American Journal of Psychiatry 160(12):2080–2090. Baggs J, Schmitt M. 1988. Collaboration between nurses and physicians. IMAGE: Journal of Nursing Scholarship 20(3):145–149. Baggs J, Schmitt M. 1997. Nurses’ and resident physicians’ perception of the process of collaboration in an MICU. Research in Nursing & Health 20(1):71–80.

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Improving the Quality of Health Care for Mental and Substance-Use Conditions Baggs J, Schmitt M, Mushlin A, Mitchell PH, Eldredge DH, Oakes D, Hutson AD. 1999. Association between nurse-physician collaboration and patient outcomes in three intensive care units. Critical Care Medicine 27(9):1991–1998. Baldridge National Quality Program. 2003. Criteria for Performance Excellence. National Institute of Standards and Technology, U.S. Department of Commerce. [Online]. Available: http://www.quality.nist.gov/PDF_files/2003_Business_Criteria.pdf [accessed April 24, 2003]. Barry CL, Gabel JR, Frank RG, Hawkins S, Whitmore HH, Pickreign JD. 2003. Design of mental health benefits: Still unequal after all these years. Health Affairs 22(5):127–137. Berwick DM. 1998. Keynote Address: Taking action to improve safety: How to increase the odds of success. 1998 Conference: Enhancing Patient Safety and Reducing Errors in Health Care. National Patient Safety Foundation. Rancho Mirage, CA, on November 8–10, 1998. [Online]. Available: http://www.npsf.org/congress_archive/1998/html/keynote.html [accessed December 16, 2004]. Bodenheimer T, Wagner EH, Grumbach K. 2002. Improving primary care for patients with chronic illness. Journal of the American Medical Association 288(14):1775–1779. Brailer DJ, Terasawa E. 2003. Use and Adoption of Computer-Based Patient Records in the United States. Presentation to IOM Committee on Data Standards for Patient Safety on January 23, 2003. [Online]. Available: http://www.iom.edu/file.asp?id=10988 [accessed October 17, 2004]. Brunette MF, Drake RE, Marsh BJ, Torrey WC, Rosenberg SD. 2003. Five-Site Health and Risk Study Research Committee. Responding to blood-borne infections among persons with severe mental illness. Psychiatric Services 54(6):860–865. Burns BJ, Phillips SD, Wagner R, Barth RP, Kolko DJ, Campbel Y, Landsverk J. 2004. Mental health need and access to mental health services by youths involved with child welfare: A national survey. Journal of the American Academy of Child and Adolescent Psychiatry 43(8):960–970. Bush DE, Ziegeldtein RC, Patel UV, Thombs BD, Ford DE, Fauerbach JA, McCann UD, Stewart KJ, Tsilidis KK, Patel AL, Feuerstein CJ, Bass EB. 2005. Post-Myocardial Infarction Depression. Summary. AHRQ Publication Number 05-E018-1. Evidence Report/Technology Assessment Number 123. Rockville, MD: Agency for Healthcare Research and Quality. Canagasaby A, Vinson DC. 2005. Screening for hazardous or harmful drinking using one or two quantity-frequency questions. Alcohol and Alcoholism 40(3):208–213. CARF (Commission on Accreditation of Rehabilitation Facilities). 2005. Standards Manual with Survey Preparation Questions, July 2005–June 2006. Washington, DC: CARF. Carlsson S, Hammar N, Efendic S, Persson PG, Ostenson CG, Grill V. 2000. Alcohol consumption, Type 2 diabetes mellitus and impaired glucose tolerance in middle-aged Swedish men. Diabetes Medicine 17(11):776–781. CDC (Centers for Disease Control and Prevention). 2001. HIV Prevention Strategic Plan through 2005. [Online]. Available: www.cdc.gov/nchstp/od/hiv_plan [accessed October 13, 2005]. COA (Council on Accreditation for Children and Family Services, Inc). 2001. Standards and Self-Study Manual, 7th ed., version1.1. New York: COA. Cocozza JJ. 2004. Juvenile Justice Systems: Improving Mental Health Treatment Services for Children and Adolescents. Paper commissioned by the Institute of Medicine Committee on Crossing the Quality Chasm: Adaptation to Mental Health and Addictive Disorders. Available from the Institute of Medicine. Cocozza JJ, Skowyra K. 2000. Youth with mental disorders: Issues and emerging responses. Juvenile Justice 7(1):3–13.

OCR for page 210
Improving the Quality of Health Care for Mental and Substance-Use Conditions Conigliaro J, Gordon AJ, McGinnis KA, Rabeneck L, Justice AC. 2003. How harmful is hazardous alcohol use and abuse in HIV infection: Do health care providers know who is at risk? JAIDS: Journal of Acquired Immune Deficiency Syndromes 33(4):521–525. Cook RI, Render M, Woods DD. 2000. Gaps in the continuity of care and progress on patient safety. British Medical Journal 320(7237):791–794. Corrao G, Rubbiati L, Bagnardi V, Zanbon A, Poikolainen K. 2000. Alcohol and coronary heart disease: A meta-analysis. Addiction 95(10):1505–1523. Curley C, McEachern JE, Speroff T. 1998. A firm trial of interdisciplinary rounds on the inpatient medical wards: An intervention designed using continuous quality improvement. Medical Care 36(8 Supplement):AS4–AS12. D’Aunno TA. 1997. Linking substance abuse treatment and primary health care. In: Egertson JA, Fox DM, Leshman AI, eds. Treating Drug Users Effectively. Malden, MA: Blackwell. Pp. 311–351. Davenport T, DeLong D, Beers M. 1998. Successful knowledge management projects. Sloan Management Review Winter(1):43–57. De Alba I, Samet J, Saitz R. 2004. Burden of medical illness in drug- and alcohol-dependent persons without primary care. The American Journal on Addiction 13(1):33–45. DHHS (U.S. Department of Health and Human Services). 1999. Mental Health: A Report of the Surgeon General. Rockville, MD: DHHS. Dietrich AJ, Oxman TE, Williams JW Jr, Kroenke K, Schulberg HC, Bruce M, Barry SL. 2004. Going to scale: Re-engineering systems for primary care treatment of depression. Annals of Family Medicine 2(4):301–304. Disch J, Beilmann G, Ingbar D. 2001. Medical directors as partners in creating healthy work environments. AACN Clinical Issues 12(3):366–377. Ditton P. 1999. Mental Health and Treatment of Inmates and Probationers. Bureau of Justice Statistics, NCJ 174463. Washington, DC: Department of Justice. Donohue J, Frank RG. 2000. Medicaid behavioral health carve-outs: A new generation of privatization decisions. Harvard Review of Psychiatry 8(5):231–241. Druss B, Rohrbaugh R, Levinson C, Rosenheck R. 2001. Integrated medical care for patients with serious psychiatric illness: A randomized trial. Archives of General Psychiatry 58(9):861–868. Edlund MJ, Unutzer J, Wells KB. 2004. Clinician screening and treatment of alcohol, drug, and mental problems in primary care: Results from Healthcare for Communities. Medical Care 42(12):1158–1166. Fein G, Fletcher DJ, Di Sclafani V. 1998. Effect of chronic alcohol abuse on the CNS morbidity of HIV disease. Alcoholism: Clinical and Experimental Research 22(5 Supplement): 196S–200S. Feldman MD, Ong MK, Lee DL, Perez-Stable EJ. 2005. Realigning economic incentives for depression care at UCSF. Administration and Policy in Mental Health and Mental Health Services Research 33(1):35–39. Feldman S. 2003. Choices and challenges. In: Feldman S, ed. Managed Behavioral Health Services: Perspectives and Practice. Springfield, IL: Charles C. Thomas Publisher, Pp. 3–23. Fox A, Oss M, Jardine E. 2000. OPEN MINDS Yearbook of Managed Behavioral Health Market Share in the United States 2000-2001. Gettysburg, PA: OPEN MINDS. Friedmann PD, D’Aunno TA, Jin L, Alexander J. 2000a. Medical and psychosocial services in drug abuse treatment: Do stronger linkages promote client utilization? HSR: Health Services Research 35(2):443–465. Friedmann PD, McCulloch D, Chin MH, Saitz R. 2000b. Screening and intervention for alcohol problems: A national survey of primary care physicians and psychiatrists. Journal of General Internal Medicine 15(2):84–91.

OCR for page 210
Improving the Quality of Health Care for Mental and Substance-Use Conditions Friedmann PD, McCullough D, Saitz R. 2001. Screening and intervention for illicit drug abuse: A national survey of primary care physicians and psychiatrists. Archives of Internal Medicine. 161(2):248–251. Fronstin P. 2003. Sources of Health Insurance and Characteristics of the Uninsured: Analysis of the March 2003 Current Population Survey. Washington, DC: Employee Benefit Research Institute. GAO (U.S. General Accounting Office). 2003. Child Welfare and Juvenile Justice: Federal Agencies Could Play a Stronger Role in Helping States Reduce the Number of Children Placed Solely to Obtain Mental Health Services. GAO-03-397. [Online]. Available: http://www.gao.gov/new.items/d03397.pdf [accessed October 25, 2004]. Garfein RS, Vlahov D, Galai N, Doherty MC, Nelson KE. 1996. Viral infections in short-term injection drug users and the prevalence of the hepatitis C, hepatitis B, human immunodeficiency, and human T-lymphotropic viruses. American Journal of Public Health 86(5):655–661. Gilbody S, Whitty P, Grimshaw J, Thomas R. 2003. Educational and organizational interventions to improve the management of depression in primary care: A systematic review. JAMA 289(23):3145–3151. Gittell J, Fairfield K, Bierbaum B, Head W, Jackson R, Kelly M, Laskin R, Lipson S, Siliski J, Thornhill T, Zuckerman J. 2000. Impact of relational coordination on quality of care, postoperative pain and functioning, and length of stay. Medical Care 38(8):807–819. Goff DC, Cather C, Evins AE, Henderson DC, Freudenreich O, Copeland PM, Bierer M, Duckworth K, Sacks FM. 2005. Medical morbidity and mortality in schizophrenia: Guidelines for psychiatrists. Journal of Clinical Psychiatry 66(2):183–194. Goldstrom I, Jaiquan F, Henderson M, Male A, Mandersheid R. 2001. The Availability of Mental Health Services to Young People in Juvenile Justice Facilities: A National Survey. In: Manderscheid RW, Henderson MJ, eds. Mental Health, United States 2000. (SMA) 01-3537. Washington, DC: U.S. Government Printing Office. Graber M, Bergus G, Dawson J, Wood G, Levy B, Levin I. 2000. Effect of a patient’s psychiatric history on physicians’ estimation of probability of disease. Journal of General Internal Medicine 15(3):204–206. Grant BF, Stinson FS, Dawson DA, Chou P, Dufour MC, Compton W, Pickering RP, Kaplan K. 2004a. Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Archives of General Psychiatry 61(8):807–816. Grant BF, Stinson FS, Dawson DA, Chou SP, Ruan WJ, Pickering RP. 2004b. Co-occurrence of 12-month alcohol and drug use disorders and personality disorders in the United States: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Archives of General Psychiatry 61(4):361–368. Grazier KL, Eselius LL. 1999. Mental health carve-outs: Effects and implications. Medical Care Research and Review 56 (Supplement 2):37–59. Green AI, Canuso CM, Brenner MJ, Wojcik JD. 2003. Detection and management of comorbidity in patients with schizophrenia. Psychiatric Clinics of North America 26(1):115–138. Grisso T. 2004. Double Jeopardy: Adolescent Offenders with Mental Disorders. Chicago, IL: University of Chicago Press. Haney C, Specter D. 2003. Treatment rights in uncertain legal times. In: Ashford JB, Sales BD, Reid WH, eds. Treating Adult and Juvenile Offenders with Special Needs. Washington, DC: American Psychological Association. Pp. 51–80. Harrison PM, Karberg JC. 2004. Prison and Jail Inmates at Midyear 2003. Bureau of Justice Statistics Bulletin, Office of Justice Programs, NCJ 203947. Washington, DC: U.S. Department of Justice. [Online]. Available: http://www.ojp.usdoj.gov/bjs/pub/pdf/pjim03.pdf [accessed August 4, 2004].

OCR for page 210
Improving the Quality of Health Care for Mental and Substance-Use Conditions Harter MC, Conway KP, Merikangas KR. 2003. Associations between anxiety disorders and physical illness. European Archives of Psychiatry and Clinical Neurosciences 253(6): 313–320. Havassy BE, Alvidrez J, Own KK. 2004. Comparisons of patients with comorbid psychiatric and substance use disorders. Implications for treatment and service delivery. American Journal of Psychiatry 161(1):139–145. Henningsen P, Zimmerman T, Sattel H. 2003. Medically unexplained physical symptoms, anxiety, and depression: A meta-analytic review. Psychosomatic Medicine 65(4):528–533. Hogan MF. 1999. Public-sector mental health care: New challenges. Health Affairs 18(5): 106–111. Hughes TA, Wilson DJ, Beck AJ. 2001. Trends in State Parole, 1990–2000. Bureau of Justice Statistics, NCJ 184735. Washington, DC: Department of Justice. [Online]. Available: http://www.Ojp.Usdoj.Gov/Bjs/Pub/Pdf/Tsp00.Pdf [accessed July 31, 2005]. Hurlburt MS, Leslie LK, Landsverk J, Barth RP, Burns BJ, Gibbons RD, Slymen DJ, Zhang J. 2004. Contextual predictors of mental health service use among children open to child welfare. Archives of General Psychiatry 61(12):1217–1224. Hutchinson AB, Foster EM. 2003. The effect of Medicaid managed care on mental health care for children: A review of the literature. Mental Health Services Research 5(1): 39–54. IOM (Institute of Medicine). 1997. Edmunds M, Frank, R, Hogan M, McCarty D, Robinson-Beale R, Weisner C, eds. Managing Managed Care—Quality Improvement in Behavioral Health. Washington, DC: National Academy Press. IOM. 2001. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press. IOM. 2002. Eden J, Smith BM, eds. Leadership by Example: Coordinating Government Roles in Improving Health Care Quality. Washington, DC: The National Academies Press. IOM. 2003a. Corrigan JM, Adams K, eds. Priority Areas for National Attention: Transforming Health Care Quality. Washington, DC: The National Academies Press. IOM. 2003b. Key Capabilities of an Electronic Health Record System. Washington, DC: The National Academies Press. IOM. 2004a. Fostering interdisciplinary collaboration. Keeping Patients Safe: Transforming the Work Environment of Nurses. Washington, DC: The National Academies Press. Pp. 212–217. IOM. 2004b. Page A, ed. Keeping Patients Safe: Transforming the Work Environment of Nurses. Washington, DC: The National Academies Press. Jaycox LH, Morral AR, Juvonen J. 2003. Mental health and medical problems and service use among adolescent substance users. Journal of the American Academy of Child & Adolescent Psychiatry 42(6):701–719. JCAHO (Joint Commission for the Accreditation of Healthcare Organizations). 2004. Comprehensive Accreditation Manual for Behavioral Health Care 2004–2005. Oakbrook Terrace, IL: Joint Commission Resources. Katon W. 2003. Clinical and health services relationships between major depression, depressive symptoms, and general medical illness. Biological Psychiatry 54(3):216–226. Katon W, Von Korff M, Lin E, Simon G. 2001. Rethinking practitioner roles in chronic illness: The specialist, primary care physician, and the practice nurse. General Hospital Psychiatry 23(3):138–144. Kessler RC. 2004. The epidemiology of dual diagnosis. Biological Psychiatry 56(10): 730–737.

OCR for page 210
Improving the Quality of Health Care for Mental and Substance-Use Conditions Kessler RC, Nelson CB, McGonagle KA, Edlund MJ, Frank, RG, Leaf PJ. 1996. The epidemiology of co-occurring addictive and mental disorders: Implications for prevention and service utilization. American Journal of Orthopsychiatry 66(1):17–31. Kessler RC, Costello EJ, Merikangas KR, Ustun TB. 2001. Psychiatric epidemiology: Recent advances and future directions. In: Manderscheid RW, Henderson MJ, eds. Mental Health, United States, 2000. DHHS Publication Number: (SMA) 01-3537. Washington, DC: U.S. Government Printing Office. Pp. 29–42. Knaus W, Draper E, Wagner D, Zimmerman J. 1986. An evaluation of outcome from intensive care in major medical centers. Annals of Internal Medicine 104(3):410–418. Kroenke K. 2003. Patients presenting with somatic complaints: Epidemiology, psychiatric comorbidity and management. International Journal of Methods in Psychiatric Research 12(1):34–43. Kroenke K, Taylor-Vaisey A, Dietrich AJ, Oxman TE. 2000. Interventions to improve provider diagnosis and treatment of mental disorders in primary care: A critical review of the literature. Psychosomatics 41(1):39–52. Landsverk J. 2005. Improving the Quality of Mental Health and Substance Use Treatment Services for Children Involved in Child Welfare. Paper commissioned by the Institute of Medicine Committee on Crossing the Quality Chasm: Adaptation to Mental Health and Addictive Disorders. Leslie LK, Hurlburt MS, Landsverk J, Rolls JA, Wood PA, Kelleher KJ. 2003. Comprehensive assessments for children entering foster care: A national perspective. Pediatrics 112(1): 134–142. Marshall M, Gray A, Lockwood A, Green R. 2004. Case Management for People with Severe Mental Disorders (Cochrane Review). Chichester, UK: John Wiley & Sons. Issue 4. Masi D. 2004. Issues in Delivering Mental Health and Substance Abuse Services through Employee Assistance Programs (EAPs). Testimony to the Institute of Medicine Committee on Crossing the Quality Chasm: Adaptation to Mental Health and Addictive Disorders on November 15, 2004. Irvine, California. Masi D, Altman L, Benayon C, Healy H, Jorgensen DG, Kennish R, Keary D, Thompson C, Marsden B, McCann B, Watkins G, Williams C. 2004. Employee assistance programs in the year 2002. In: Manderscheid RW, Henderson MJ, eds. Mental Health, United States, 2002. DHHS Publication Number: SMA 3938. Rockville, MD: Substance Abuse and Mental Health Services Administration. Mertens JR, Lu YW, Parthasarathy S, Moore C, Weisner CM. 2003. Medical and psychiatric conditions of alcohol and drug treatment patients in an HMO: Comparison with matched controls. Archives of Internal Medicine 163(20):2511–2517. Metzner JL. 2002. Class action litigation in correctional psychiatry. Journal of the American Academy of Psychiatry and the Law 30(1):19–29. Mickus M, Colenda CC, Hogan AJ. 2000. Knowledge of mental health benefits and preferences for type of mental health providers among the general public. Psychiatric Services 51(2):199–202. Miller AL, Crismon ML, Rush AJ, Chiles J, Kashner TM, Toprac M, Carmody T, Biggs M, Shores-Wilson K, Chiles J, Witte B, Bow-Thomas C, Velligan DI, Trivedi M, Suppes T, Shon S. 2004. The Texas medication algorithm project: Clinical results for schizophrenia. Schizophrenia Bulletin 30(3):627–647. Miller CL, Druss BG, Dombrowski EA, Rosenheck RA. 2003. Barriers to primary medical care at a community mental health center. Psychiatric Services 54(8):1158–1160. Moore RD, Keruly JC, Chaisson RE. 2004. Differences in HIV disease progression by injecting drug use in HIV-infected persons in care. JAIDS Journal of Acquired Immune Deficiency Syndromes 35(1):46–51.

OCR for page 210
Improving the Quality of Health Care for Mental and Substance-Use Conditions NASMHPD, NASADAD (National Association of State Mental Health Program Directors and National Association of State Alcohol and Drug Abuse Directors). 2002. Final report of the NASMHPD-NASADAD Task Force on Co-Occurring Mental Health and Substance Use Disorders. Exemplary Methods of Financing Integrated Service Programs for Persons with Co-Occurring Mental Health and Substance Use Disorders. Alexandria, VA and Washington, DC: NASMHPD, NASADAD. [Online]. Available: http://www.nasmhpd.org/general_files/publications/NASADAD%20NASMHPD%20PUBS/Exemplary%20methods_3.pdf [accessed August 14, 2005]. NCQA (National Committee for Quality Assurance). 2004. Standards and Guidelines for the Accreditation of MBOs. Washington, DC: NCQA. New Freedom Commission on Mental Health. 2003. Achieving the Promise: Transforming Mental Health Care in America. Final Report. DHHS Publication Number SMA-03-3832. Rockville, MD: U.S. Department of Health and Human Services. NIAAA (National Institute on Alcohol Abuse and Alcoholism). 2000. 10th Special Report to the U.S. Congress on Alcohol and Health. [Online]. Available: http://www.niaaa.nih.gov/publications/10report [accessed May 6, 2005]. NIAAA. 2002. Screening for Alcohol Problems: An Update. Alcohol Alert. 56. [Online]. Available: http://pubs.niaaa.nih.gov/publications/aa56.htm [accessed October 13, 2005]. NIAAA. 2005. Helping Patients Who Drink Too Much: A Clinician’s Guide. [Online]. Available: http://pubs.niaaa.nih.gov/publications/Practitioner/CliniciansGuide2005/guide.pdf [accessed October 12, 2005]. Palepu A, Tyndall M, Yip B, Shaughnessy MV, Hogg RS, Montaner JSG. 2003. Impaired virologic response to highly active antiretroviral therapy associated with ongoing injection drug use. JAIDS Journal of Acquired Immune Deficiency Syndromes 32(5): 522–526. Peele PB, Lave JR, Kelleher KJ. 2002. Exclusions and limitations in children’s behavioral health care coverage. Psychiatric Services 53(5):591–594. Pignone MP, Gaynes BN, Rushton JL, Burchell CM, Orleans TC, Mulrow CD, Lohr KN. 2002. Screening for depression in adults: A summary of the evidence for the U.S. Preventive Services Task Force. Annals of Internal Medicine 136(10):765–776. Pincus HA. 2003. The future of behavioral health and primary care: Drowning in the mainstream or left on the bank? Psychosomatics 44(1):1–11. Pincus HA, Hough L, Houtsinger JK, Rollman BL, Frank R. 2003. Emerging models of depression care: Multi-level (‘6P’) strategies. International Journal of Methods in Psychiatric Research 12(1):54–63. Rice A. 2000. Interdisciplinary collaboration in health care: Education, practice, and research. National Academies of Practice Forum: Issues in Interdisciplinary Care 2(1): 59–73. Rollman BL, Belnap BH, Reynolds CF, Schulberg HC, Shear MK. 2003. A contemporary protocol to assist primary care physicians in the treatment of panic and generalized anxiety disorders. General Hospital Psychiatry 25(2):74–82. Rones M, Hoagwood K. 2000. School-based mental health services: A research review. Clinical Child and Family Psychology Review 3(4):223–241. Rosenberg SD, Goodman LA, Osher FC, Swartz MS, Essock SM, Butterfield MI, Constantine NT, Wolford GL, Salyers MP. 2001. Prevalence of HIV, hepatitis B, and hepatitis C in people with severe mental illness. American Journal of Public Health 91(1):31–37. Rost K, Smith R, Matthews DB, Guise B. 1994. The deliberate misdiagnosis of major depression in primary care. Archives of Family Medicine 3(4):333–337. Rush AJ, Crismon ML, Kashner TM, Toprac MG, Carmody TJ, Trivedi MH, Suppes T, Miller AL, Biggs MM, Shores-Wilson K, Witte BP, Shon SP, Rago WV, Altshuler KZ, TMAP Research Group. 2003. Texas Medication Algorithm Project, phase 3 (TMAP-3): Rationale and study design. Journal of Clinical Psychiatry 64(4):357–369.

OCR for page 210
Improving the Quality of Health Care for Mental and Substance-Use Conditions Saitz R, Mulvey KP, Plough A, Samet JH. 1997. Physician unawareness of serious substance abuse. American Journal of Drug and Alcohol Abuse 23(3):343–354. Saitz R, Friedman PD, Sullivan LM, Winter MR, Lloyd-Travaglini C, Moskowitz MA, Samet J. 2002. Professional satisfaction experienced when caring for substance-abusing patients: Faculty and resident physician perspectives. Journal of General Internal Medicine 17(5):373–376. Samet JH, Friedmann P, Saitz R. 2001. Benefits of linking primary medical care and substance abuse services: Patient, provider, and societal perspectives. Archives of Internal Medicine 161(1):85–91. Samet JH, Horton NJ, Meli S, Freedberg KA, Palepu A. 2004. Alcohol consumption and antiretroviral adherence among HIV-infected persons with alcohol problems. Alcoholism: Clinical and Experimental Research 28(4):572–577. SAMHSA (Substance Abuse and Mental Health Services Administration). 2004. Results from the 2003 National Survey on Drug Use and Health: National Findings. DHHS Publication Number SMA 04-3964. NSDUH Series H-25. Rockville, MD: SAMHSA. SAMHSA. 2005. Transforming Mental Health Care in America. The Federal Action Agenda: First Steps. [Online]. Available: http://www.samhsa.gov/Federalactionagenda/NFC_TOC.aspx [accessed July 23, 2005]. SAMHSA. undated. Report to Congress on the Prevention and Treatment of Co-Occurring Substance Abuse Disorders and Mental Disorders. [Online]. Available: http://www.samhsa.gov/reports/congress2002/CoOccurringRpt.pdf [accessed April 25, 2004]. Schmitt M. 2001. Collaboration improves the quality of care: Methodological challenges and evidence from U.S. health care research. Journal of Interprofessional Care 15(1): 47–66. Shortell S, Zimmerman J, Rousseau D, Gillies RR, Wagner DP, Draper EA, Knaus WA, Duffy J. 1994. The performance of intensive care units: Does good management make a difference? Medical Care 32(5):508–525. Shortell SM, Gillies RR, Anderson DA, Erickson KM, Mitchell JB. 2000. Remaking Health Care in America: The Evolution of Organized Delivery Systems 2nd ed. San Francisco, CA: Jossey-Bass. Sokol J, Messias E, Dickerson FB, Kreyenbuhl J, Brown CH, Goldberg RW, Dixon LB. 2004. Comorbidity of medical illnesses among adults with serious mental illness who are receiving community psychiatric services. Journal of Nervous and Mental Diseases 192(6): 421–427. Spitzer RL, Kroenke K, Williams JBW. 1999. Validation and utility of a self-report version of PRIME-MD: The PHQ Primary Care Study. Journal of the American Medical Association 282(18):1737–1744. Strosahl KD. 2005. Training behavioral health and primary care providers for integrated care: A core competencies approach. In: O’Donohue WT, Byrd M, Cummings N, Henderson D, eds. Behavioral Integrative Care: Treatments That Work in the Primary Care Setting. New York: Brunner-Routledge. Sullivan G, Koegel P, Kanouse DE, Cournos F, McKinnon K, Young AS, Bean D. 1999. HIV and people with serious mental illness: The public sector’s role in reducing HIV risk and improving care. Psychiatric Services 50(5):648–652. Teplin L, Abram K, McClelland G, Dulcan M, Mericle A. 2002. Psychiatric disorders in youth in juvenile detention. Archives of General Psychiatry 59(12):1133–1143. The National Coalition on Health Care, The Institute for Healthcare Improvement. 2002. Curing the System: Stories of Change in Chronic Illness Care. [Online]. Available: http://www.improvingchroniccare.org/ACT_Report_May_2002_Curing_The_System_.pdf [accessed July 24, 2005].

OCR for page 210
Improving the Quality of Health Care for Mental and Substance-Use Conditions Tyor WR, Middaugh LD. 1999. Do alcohol and cocaine abuse alter the course of HIV-associated dementia complex? Journal of Leukocyte Biology 65(4):475–481. Unutzer J, Katon W, Williams JW Jr, Callahan CM, Harpole L, Hunkeler EM, Hoffing M, Arean P, Hegel MT, Schoenbaum M, Oishi SM, Langston CA. 2001. Improving primary care for depression in late life. Medical Care 39(8):785–799. Upshur CC. 2005. Crossing the divide: Primary care and mental health integration. Administration and Policy in Mental Health 32(4):341–355. Watkins KE, Burnam A, Kung F-Y, Paddock S. 2001. A national survey of care for persons with co-occurring mental and substance use disorders. Psychiatric Services 52(8):1062–1068. Watkins K, Pincus HA, Tanielian TL, Lloyd J. 2003. Using the chronic care model to improve treatment of alcohol use disorders in primary care settings. Journal of Studies on Alcohol 64(2):209–218. Weisner C, Mertens J, Parthasarathy S, Moore C, Lu Y. 2001. Integrating primary medical care with addiction treatment: A randomized controlled trial. Journal of the American Medical Association 286(14):1715–1723. Weist MD, Paternite CE, Adelsheim S. 2005. School-Based Mental Health Services. Paper commissioned by the Institute of Medicine Committee on Crossing the Quality Chasm: Adaptation to Mental Health and Addictive Disorders. Available from Institute of Medicine. Wierson M, Forehand R, Frame C. 1992. Epidemiology and treatment of mental health problems in juvenile delinquents. Advances in Behavior Research and Therapy 14: 93–120. Williams JW, Pignone M, Ramirez G, Perez SC. 2002. Identifying depression in primary care: A literature synthesis of case-finding instruments. General Hospital Psychiatry 24(4): 225–237. Wolff NP. 2004. Law and Disorder: The Case Against Diminished Responsibility. Paper commissioned by the Institute of Medicine Committee on Crossing the Quality Chasm: Adaptation to Mental Health and Addictive Disorders. Center for Mental Health Services & Criminal Justice Research and Edward J. Bloustein School of Planning and Public Policy, Rutgers, the State University of New Jersey. Available from the author. Zarski JP, Bohn B, Bastie A, Pawlotsky JM, Baud M, Bost-Bezeaux F, Tran van Nhieu J, Seigneurin JM, Buffet C, Dhumeaux D. 1998. Characteristics of patients with dual infection by hepatitis B and C viruses. Journal of Hepatology 28(1):27–33. Ziguras SJ, Stuart GW. 2000. A meta-analysis of the effectiveness of mental health case management over 20 years. Psychiatric Services 51(11):1410–1421. Zwarenstein M, Stephenson B, Johnston L. 2000. Case management: Effects on professional practice and health care outcomes. (Protocol) The Cochrane Database of Systematic Reviews 2000, Issue 4. Art. No.: CD002797. DOI: 10.1002/14651858.CD002797.