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Figure 5. Parameters of collaborative care practice

A National Agenda for Research in Collaborative Care

ParameterSourcePossible values for that parameter
A team...
1. Team composition

All include patients / families on team

From teams in published work, e.g., IMPACT, Primary BehH modelPCP
+ Nurse/MA
+ Care coord.
PCP
+  Nurse/MA
+  Care mgr
+  Consulting BehH
PCP
+ Nurse/MA
+ Care mgr
+ Integ BehH
PCP
+ Nurse/MA
+ Care mgr
+ Integr BehH
+ Other (suited to practice pop.)
2. Level of collaboration or integrationAdapted
From
Doherty,
McDaniel, and Baird;
Blount
Coordinated—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 routines
With a shared population and mission...
3. Target populationA. Locus of CarePrimary Medical CareSpecialty Medical CareSpecialty Care
B. 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 life
D. Kessler and Miller; Peek and BairdMH conditions:
Pts with one or more MH conditions, or family, partner and relationship problems affecting health
Psychophys sx:
Pts with psycho-physiological / stress symptoms sx, e.g., headache, fatigue, insomnia, other
Medical condition:
Pts with one or more medical diseases or conditions, e.g., diabetes, asthma, CHF, COPD
Complex cases:
Complex cases or persons regardless of disease
Using a clinical system...
4. Method of population identification Patient or clinician:
Nonsystematic patient or clinician identification
System indicators:
Epidemiological data, claims, other system data
Universal screening:
All or most patients screened for being part of target pop
5. 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 mainstream
Mainstream:
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 provider
Limited:
Some effort to systematically do shared decision-making, but without a concerted system
By protocol:
Build into clinical system for specific applications involving pt / family / clinician decisions
Supported by an office practice and financial system...
7. Level of office practice design and reliabilityReliability
science
and lean
concepts
Informal:
Referral, communication, and charting are non-standard processes that vary with clinician and clinical situation
Partially routinized:
Some standards set for some processes but variability and clinician preference still operate
Standard work:
Whole team operates each part of the system in a standard expected way that quickly reveals lapses and system errors
8. 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 MH
And 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 effectiveness

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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