Figure 5. Parameters of collaborative care practice A National Agenda for Research in Collaborative Care ParameterSourcePossible values for that parameterA team...1. Team composition All include patients/families on teamFrom teams in published work, e.g., IMPACT, Primary BehH modelPCP+ Nurse/MA+ Care coord.PCP+ Nurse/MA+ Care mgr+ Consulting BehHPCP+ Nurse/ MA+ Care mgr+ Integ BehHPCP+ Nurse/MA+ Care mgr+ Integr BehH+ Other (suited to practice pop.)2. Level of collaboration or integrationAdaptedFromDoherty,McDaniel, and Baird;BlountCoordinated—basic collaboration at a distance Referral-triggered periodic exchange of info between clinicians in separate medical and behavioral settings, with minimally shared care plan or clinic cultureCo-located—basic collaboration on-site Behavioral and medical clinicians in same space, with regular communication, usually separate systems, but some shared care plans and clinic cultureIntegrated—in partially or fully integrated system Shared space and systems with regular communications, mostly unified rather than separate care plans, and largely shared culture and collaborative routinesWith a shared population and mission...3. Target populationA. Locus of CarePrimary Medical CareSpecialty Medical CareSpecialty CareB. BlountTargeted:For specific populations such as disease, age, or other focus—"vertically integrated"Non-targeted:For any patient deemed to need collaborative care—"all comers"—"horizontally integrated"C. Life stageChildrenAdults/young adultsGeriatricsEnd of lifeD. Kessler and Miller; Peek and BairdMH conditions:Pts with one or more MH conditions, or family, partner and relationship problems affecting healthPsychophys sx:Pts with psycho-physiological/stress symptoms sx, e.g., headache, fatigue, insomnia, otherMedical condition:Pts with one or more medical diseases or conditions, e.g., diabetes, asthma, CHF, COPDComplex cases:Complex cases or persons regardless of diseaseUsing a clinical system...4. Method of population identification Patient or clinician:Nonsystematic patient or clinician identificationSystem indicators:Epidemiological data, claims, other system dataUniversal screening:All or most patients screened for being part of target pop5. Program scale or maturityDavis: From pilot to project to mainstreamPilot:A demonstration of feasibility or starter "test of change"Project:Multiple promising pilots gathered together and led visibly as a project aiming toward the mainstreamMainstream:Full scale way of life in the organization—the way things are done, no longer a project attached to the mainstream.6. Level of pt centeredness/engagementLevel of shared decision makingLittle or none:Chance, random; up to individual providerLimited:Some effort to systematically do shared decision-making, but without a concerted systemBy protocol:Build into clinical system for specific applications involving pt/family/clinician decisionsSupported by an office practice and financial system...7. Level of office practice design and reliabilityReliabilityscienceand leanconceptsInformal:Referral, communication, and charting are non-standard processes that vary with clinician and clinical situationPartially routinized:Some standards set for some processes but variability and clinician preference still operateStandard work:Whole team operates each part of the system in a standard expected way that quickly reveals lapses and system errors8. Business model/financing FFS onlyFFS + small bundled care mgmt feeLarge bundled care management fee + small FFSSeparate medical and MH capitationsOne pool of funds for all care—medical or MHAnd continuous quality improvement and effectiveness measurement...9. Ability to collect and use practice data Little or no routine data collected and usedCommitment to building system for collecting and using practice dataMature data collection and use in decision making for quality and effectivenessReturn to Document Current as of June 2011 Internet Citation: Figure 5. Parameters of collaborative care practice: A National Agenda for Research in Collaborative Care. June 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/final-reports/collaborativecare/collab3fig5.html
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