Wisdom in Numbers: Using Stakeholder Feedback To Shape a Research Agenda for Integrating Mental Health and Primary Care. Charlotte Mullican Benjamin F. Miller C.J. Peek Rodger Kessler. First there was the AHRQ EPC Report. Finding the gaps setting and agenda changing healthcare.
Wisdom in Numbers: Using Stakeholder Feedback To Shape a Research Agenda for Integrating Mental Health and Primary Care
Benjamin F. Miller
First there was the AHRQ EPC Report
The Collaborative Care Research Network (CCRN), a sub-network of the AAFP’s National Research Network (NRN), was created so that clinicians from across the country can ask questions and investigate how to make integrating mental health and primary care work more effectively.
The purpose of the Collaborative Care Research Network Research Conference was to respond to the questions raised by the Agency for Healthcare Research and Quality (AHRQ) Evidence Practice Committee (EPC) report: Integration of Mental Health/Substance Abuse and Primary Care.
There were four specific aims for the conference:
Wisdom of Crowds
Language is important
Imagine being on a planning committee conference call……….
Do you think your clarity (or lack of it) is shared by the person next to you?
Shared terms for the essence that unites the many local variations as the “genuine article”
Lesson from history: Emerging fields require conceptual systems adequate to the work
Before 1881: 12 different units of electromotive force, 10 units of current, 15 units of resistance“The International Electrical Congress of 1881 has borne good fruit. . . a rapprochement between electricians of all countries. . . and the adoption of an international system of measurement which will be in universal use”.
Nature 30, 26-27; 8 May 1884.
After 1881: Volt, Ohm, and Ampere all defined as one conceptual system--as in a mature field
(a disciplined process--not a political campaign)
(implementers and users)
(not just principles, values, abstractions)
(not just an elite group coming with a declaration)
A. Describe an incontrovertible case of collaborative care practice
(“if that’s not collaborative care, I don’t know what is!”)
B. List how that indubitable case could be changed and still be collaborative care
(“yes you can change X or delete Y and it’s still genuine collaborative care”)
C. Name the dimensions or parameters along which collaborative care practices can legitimately differ from one another.
(“our vocabulary for describing and evaluating acceptable variations among practice components”)
1. A team
2. With a shared population & mission
E. Same panel of clinic pts, same mission of PC, assessment, tx, F/U
F. With BH clinician working under same mission and boundaries of PC
3. Using a clinical system
G. Employing population level screening to identify who needs this collab
H. Working form an explicit, unified care plan document w goals & roles
I. With care plans that pay attention to family, culture, lang., school etc
J. Contained in shared med record, with ongoing communic & SDM
4. Supported by an office practice & financial system
K. Clinic ops systems & mgmt that supports communic, collab, care mgmt
L. Sustainable package of financing e.g., single pool, bundled + FFS, PPF, etc
5. And continuous QI and effectiveness measurement
M. Routine collection of use of practice data for local decision-making to improve your performance and for research.
Blount; Doherty, McDaniel & Baird
With a shared population and mission
Stage of life
Kessler & Miller; Peek & Baird
Using a clinical system
Supported by an office practice and financial system
Reliability science & Lean concepts
Into the research
“You cannot solve problems by continuing to use the same solutions that created the problem in the first place.” -Albert Einstein
Conceptual Model of the CCRN
Broad implementation of research findings into practice.
Practice guidelines; public health and professional society recommendations.
The Domains of the CCRN
Disease specific interventions within an organized care framework (e.g., Katon & Unutzer, 2006; Unutzer et al., 2002).
What are the critical elements required in general practice to accomplish the desired outcomes?
We Need new RCT’s
Descriptive (Generation A):
Because what you told me is absolutely correct but completely useless
Where am I?
Yes, how did you know?
You must be a researcher
Because you don’t know where you are, you don’t know where you’re going, and now you’re blaming me
Yes. How did you know?
You’re 30 yards above the ground in a balloon
You must be a policy maker