Classifying substance use disorder treatment facilities with co-located mental health services: A latent class analysis approach.

BACKGROUND: The Affordable Care Act calls for increased integration and coordination of behavioral health services, as people with co-occurring disorders (CODs), meeting criteria for both substance use and psychiatric disorders, are overrepresented in treatment samples. Nationwide estimates of mental health (MH) service co-location in substance use disorder (SUD) treatment facilities are needed. We empirically derived a multiple-indicator categorization of services for CODs in SUD treatment facilities. METHODS: We used latent class analysis to categorize 14,037 SUD treatment facilities in the United States and territories included in the 2012 National Survey of Substance Abuse Treatment Services. Latent class indicators included MH screening and diagnosis, MH support services, psychiatric medications, groups for CODs, and psychosocial approaches. Multinomial logistic regression compared facility-identified primary focus (i.e., SUD, MH, mix of SUD-MH, and general/other) and other facility characteristics across classes. RESULTS: A four-class solution was chosen with the following classes: Comprehensive MH/COD Services (25%), MH without COD Services (25%), MH Screening Services (21%), and Limited MH Services (29%). The former two classes with co-located MH services were less likely to report a SUD-primary focus than the latter classes reporting only MH screening or Limited MH Services. Only the Comprehensive MH/COD Services class also had a high probability of providing special groups for CODs. CONCLUSIONS: Approximately half of SUD treatment facilities were in classes with co-located mental health services, but only a quarter provided comprehensive COD services. Future studies should assess differences in patient experiences and treatment outcomes across facilities with and without COD services.

Nursing classifications: Home Health Care Classification System (HHCC): an overview.

This paper provides an overview of the Home Health Care Classification (HHCC) System focusing on its two interrelated taxonomies: HHCC of Nursing Diagnoses and HHCC of Nursing Interventions both of which are classified by 20 Care Components. It highlights the major events that influenced its development, current status, and future uses. The two HHCC taxonomies and their 20 Care Components are used as a standardized framework to code, index, and classify home health clinical nursing practice. Further, they are used to document, electronically track, evaluate outcomes and analyze home health care over time, across settings, population groups, and geographic locations.

Un nuevo modelo integral y de gestión en los Servicios de Psiquiatría / A new integral management model into Psychiatric Services

La acreditación del Servicio de Psiquiatría, la evaluación cuantitativa de la plantilla médica y la implantación de dos ediciones revisadas de guias de la práctica clínica psiquiátrica han producido unos resultados excelentes: una mejora continua de la Calidad y de la relación Coste/ Efectividad (AU)

Personal doctoring. Its impact on continuity of care as measured by the comprehensiveness of care score.

OBJECTIVE: To determine the impact of personal provider continuity on continuity of care as measured by the comprehensiveness of care score. DESIGN: Retrospective cross sectional analysis of medical records. SETTING: The setting was a four doctor practice on the New South Wales Central Coast of Australia. METHOD: The subjects were 131 male and 123 female patients with a mean age of 42.7 years (SD 25.9) median age of 42 years and an age range of 1-95 years. The main outcome measures were a comprehensiveness score for each patient in the personal provider continuity and discontinuity of care group over a two year period. RESULTS: The overall comprehensiveness scores in the personal provider continuity group was 7.38 (95% CI: 7.04-7.71) compared to 6.03 (95% CI: 5.7-6.35) for those in the discontinuity group (p < 0.000). A linear regression model revealed that 15.8% of the total variance of the comprehensiveness score is explained by the two independent variables 'modified continuity index' (13.6%) and 'age' (2.2%). Nonrelated independent variables are gender, number of visits and number of years attending the practice. CONCLUSION: Personal doctoring significantly improves continuity of care as measured by the comprehensiveness of care score, and this observation is essentially age independent. These findings clearly suggest that patients should be encouraged to find and stay with one doctor, and that practices should develop systems to enable patients access to their usual provider. Both strategies, combined with the awareness of potential gaps in our service provision, will increase the likelihood of achieving increased continuity of care.

Strategic planning. From the ground up: planting the seeds of network development.

It is critical to understand and accept the intense effort and planning needed for successful network development. No model exists that can be immediately implemented successfully. Every organization involved in network development will have to become familiar with the issues, benefits and risks, as well as involve the key stakeholders, which include administration, board and health professional providers from physicians through allied professionals. The outcome of this development can be a very successful, efficient new delivery model that will benefit the users, the payers and the providers. Although difficult and sometimes boring, the methodical and thorough movement through the process of developing a regional community network can greatly enhance outcome. The shared vision of the network should be exciting, and should make participants search for the clear image of what will be developed. All should work jointly as partners to accomplish that vision. Although there may be facilitation and assistance, it will be the providers and stakeholders who will be most affected by the network. It is their commitment, effort, energy and experience that will lead to success.