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Total Results: 98 records

Showing results for "clinical condition or care plan".

21. Success Stories | The Academy
    integrationacademy.ahrq.gov/expert-insight/success-stories
    February 01, 2024 - Community Health Plan of Washington Community Health Plan of Washington 's website The … ’s EMR or in print form to the primary care physician. … The registry promotes a patient centered care plan in which care coordinators and patients work together … The data is then coded into the electronic medical record and a care plan is developed through provider … behavioral health condition is able to do so through the integrated physician’s notes and any documents

22. Track Patients and Monitor Their Outcomes | The Academy
    integrationacademy.ahrq.gov/products/playbooks/behavioral-health-and-primary-care/implementing-plan/track-patients-and-monitor-their-outcomes
    January 01, 2025 - or care plans need adjusting. … Although scores on these scales need to be correlated with clinical observations to confirm depression … adjust the care plan. … for patients who could benefit from a change in their care (treatment) plan. … The patient is not engaged in his or her own care plan.

23. Identifying Patients Who Benefit from IBH | The Academy
    integrationacademy.ahrq.gov/products/playbooks/behavioral-health-and-primary-care/implementing-plan/establish-protocols-identify-patients-who-could-benefit-integrated-care
    February 01, 2025 - records or patient portals. … Minute Count: Tools to Improve Office Efficiency Clinical Workflow Plan (PDF 79 KB) … Workflow Plan This template can be used to map how collaborative care tasks will be accomplished … the Plan menu. … Team Develop a Shared Care Plan Build Patient Understanding of Setbacks

24. Behavioral Health Apps in Primary Care | The Academy
    integrationacademy.ahrq.gov/products/topic-briefs/behavioral-health-apps
    July 01, 2024 - This expanded capacity can be especially beneficial in rural areas or at any primary care setting affected … Randomized clinical trials (RCTs) and meta-analyses or systematic reviews can provide that information … Is there an evidence based app that can provide treatment for the patient's condition? … How will the app fit into the patient's overall comprehensive treatment plan? … For Researchers Conduct more clinical research to determine if behavioral health apps in primary care

25. Develop Your Game Plan | The Academy
    integrationacademy.ahrq.gov/products/playbooks/behavioral-health-and-primary-care/planning-for-integration/develop-your-game-plan
    July 01, 2025 - Define triage processes for the identified sub-population (e.g., screening, use of registry, claims, clinical … You may start at the beginning of Implementing the Plan and follow the steps sequentially or customize … Set a timeline that is appropriate for your setting—it may be 6 months or several years depending on … and GANTT templates) that can help your organization plan the transition to integrated care. … Develop a Shared Care Plan Track Patients and Monitor Outcomes Track Patients

26. General Operations | The Academy
    integrationacademy.ahrq.gov/products/playbooks/opioid-use-disorder/implement-mat-for-oud/general-operations
    August 01, 2024 - Information sharing can be key to care coordination both within a practice or organization and with external … Expiration date or condition of consent. Date of signature. Patient signature. … East Providence, RI: Providers Clinical Support System; 2014. … Online Self-Assessment Plan To Integrate MAT for OUD in Your Ambulatory Care Setting … Expand Plan To Integrate MAT for OUD in Your Ambulatory Care Setting menu.

27. Executive Summary - Lexicon for Behavioral Health and Primary Care Integration Concepts and Definitions Developed by Expert Consensus (pdf file)
    integrationacademy.ahrq.gov/sites/default/files/2020-06/Lexicon_ExecSummary.pdf
    January 01, 2020 - Using an explicit, unified, and shared care plan E. … Having had formal or on-the-job training for the clinical roles and relationships of integrated behavioral … (See full lexicon for specific markers of such follow-up and care plan adjustment.) … plan, making joint follow-up appointments or other collaborative care functions. … starter ”test of change” with limited number of patients or clinical scope Project scale Significant

28. Payment and Reimbursement | The Academy
    integrationacademy.ahrq.gov/products/playbooks/moud-playbook/implementing-treatment/payment-and-reimbursement
    January 01, 2025 - Plan How to Bill for Services The pre-implementation planning team should identify all diagnostic … Depending on the health plan, payment may be structured as fee-for-service, bundled payments, or case … also receive care for chronic medical conditions at the same practice or organization. … Some payers may condition prior authorization approval on a patient's participation in counseling or … While intended to control costs, these restrictions may conflict with clinical best practices and limit

29. Define Your Vision | The Academy
    integrationacademy.ahrq.gov/products/playbooks/behavioral-health-and-primary-care/planning-for-integration/define-your-vision
    January 01, 2024 - A Systematic Clinical Approach : Care teams use an explicit and systematic clinical approach to identify … Team members engage in shared decision-making with patients to create a unified care plan in a shared … The BHC and PCP may meet formally after each patient's first visit to discuss the shared care plan. … Define Your Vision Develop Your Game Plan Implementing the Plan Expand Implementing … the Plan menu.

30. Ischemic Vascular Disease (IVD): Blood Pressure Control (pdf file)
    integrationacademy.ahrq.gov/sites/default/files/2020-07/Ischemic_Vascular_Disease_Blood_Pressure_Control.pdf
    January 01, 2020 - were discharged alive with acute myocardial infarction (AMI), coronary artery bypass graft (CABG) or … Cardiovascular Disease Use in Federal Program: Physician Quality Reporting System (PQRS) Actual/Planned Use: Care … Setting: Ambulatory Care: Clinician Office/Clinic Condition: Cardiovascular, Cardiovascular: Ischemic … Disease, Coronary Artery Disease Cross-Cutting Area: Data Source: Administrative claims, Electronic Clinical … , Clinician: Individual Measure Type: Outcome Target Population: Populations at Risk, Senior Care

31. Atlas of Integrated Behavioral Health Care Quality Measures: Framework and Core Measures (pdf file)
    integrationacademy.ahrq.gov/sites/default/files/2021-09/ibhc_atlas_framework_and_measures.pdf
    January 01, 2021 - plan that builds a team - with necessary members and functions - to care for a given patient … Structure • Clinical protocols and workflows are clearly documented. … Structure • Protocols or workflows for patient and family engagement are documented for care teams … plan, percentage of patients with follow-up monitoring and treatment adjustment or outcomes of care … Clinical Outcomes • Individual patient clinical improvements due to integrated behavioral health care

32. Strategies To Support Staff | The Academy
    integrationacademy.ahrq.gov/products/playbooks/opioid-use-disorder/obtain-training-and-support-providers-and-staff/strategies-support-staff
    January 01, 2019 - monitor their work, ensure high-quality care is delivered, and address challenging clinical situations … The following models may help: Team meetings or “huddles” —members of the clinical care team can hold … worker or nurse care manager) on the clinical care team to coordinate care for each patient and intensively … Online Self-Assessment Plan To Integrate MAT for OUD in Your Ambulatory Care Setting … Expand Plan To Integrate MAT for OUD in Your Ambulatory Care Setting menu.

33. Why Define Integrated Behavioral Health (IBH)? | The Academy
    integrationacademy.ahrq.gov/products/ibh-lexicon
    February 01, 2025 - "What should I require clinical systems to provide to health plan members and what will I look at to … to implement or facilitate greater integration of primary care and behavioral health care. … to integration with specialty medical care or “bi-directional” integration where primary care is brought … We are implicitly "scored" on behavioral health contributors to good primary care via clinical outcomes … Journal of Clinical Psychology in Medical Settings. 2022;29(2):274-84.

34. Integrated Behavioral Health & Primary Care: Snapshot of an Integrated Practice (pdf file)
    integrationacademy.ahrq.gov/sites/default/files/2020-06/AHRQ_Lexicon_Collateral_Snapshot.pdf
    January 01, 2020 - If you or your colleagues plan to transform your practice into an integrated behavioral health … practice, here are the key defining features you’ll need to build or develop: ■ A practice team … All team members should get formal or on-the-job training in team building and collaboration. … ■ A systematic clinical approach. … The plan sets goals, outlines treatments (including patient self-management), and documents progress

35. Pharmacotherapy | The Academy
    integrationacademy.ahrq.gov/products/playbooks/opioid-use-disorder/implement-mat-for-oud/pharmacotherapy
    January 01, 2018 - she fails to adhere to the plan (including the intensity of services or referrals to other providers … With this information, the provider can determine any next steps or adjustments to the treatment plan … Guidelines A set of clinical guidelines for providers offering MAT through a nurse care manager … Online Self-Assessment Plan To Integrate MAT for OUD in Your Ambulatory Care Setting … Expand Plan To Integrate MAT for OUD in Your Ambulatory Care Setting menu.

36. Clinicwide Orientation to Treating Patients with OUD | The Academy
    integrationacademy.ahrq.gov/products/playbooks/moud-playbook/obtain-training-and-support/clinicwide-orientation
    January 01, 2021 - intentional efforts to shift organizational culture and promote understanding of OUD as a treatable medical condition … so primary care should plan to provide it. … of use is common and is not a sign of failure but rather the need to adjust the patient's treatment plan … assessments and ongoing medication management visits to develop a treatment plan that meets patients … Accessed April 28, 2025. https://www.asam.org/quality-care/clinical-recommendations/asam-clinical-considerations-for-engagement-and-retention-of-non-abstinent-patients-in-treatment

37. Build Culture of IBH by Obtaining Expertise | The Academy
    integrationacademy.ahrq.gov/products/playbooks/behavioral-health-and-primary-care/implementing-plan/obtain-behavioral-health-expertise-and-build-culture-integration
    August 01, 2025 - The primary diagnoses or clinical needs of your patient population will help inform your decision. … plan with primary care providers and summarizing goals and next steps with patients Leading group sessions … in coordinating care, providing patient education, managing medication adherence, and offering clinical … Define Your Vision Develop Your Game Plan Implementing the Plan Expand Implementing … the Plan menu.

38. Medication-Assisted Treatment for Opioid Use Disorder Self-Assessment Checklist (pdf file)
    integrationacademy.ahrq.gov/sites/default/files/2021-02/self-assessment_508_compliant.pdf
    January 01, 2021 - Plan to Integrate Medication-Assisted Treatment for Opioid Use Disorder in Your Ambulatory Care Setting … We have developed a plan to support staff through continuing education, clinical supervision, and consulting … We emphasize continuity of care during any transition in setting or level of care to minimize the risk … We have developed a financial sustainability plan that identifies practice models or other strategies … We use care registries to track patient progress over time and prompt changes to the treatment plan if

39. Pregnant & Postpartum Behavioral Health Integration | AHRQ
    integrationacademy.ahrq.gov/products/topic-briefs/pregnant-postpartum-women
    December 01, 2024 - encourage them to actively participate in their care and care plan ning . … Developing a shared care plan can ease the exchange of clinical information, medication reconciliation … to locate OBGYN, primary care and behavioral health care team members in the same space or in different … risks and benefits, create an individualized, patient-centered treatment plan, make clinical decisions … Available at: https://www.bccsu.ca/clinical-care-guidance/ . Accessed August 18, 2022. 113.

40. Pregnant & Postpartum Behavioral Health Integration | AHRQ
    integrationacademy.ahrq.gov/products/topic-briefs/pregnant-postpartum-women
    December 01, 2024 - encourage them to actively participate in their care and care plan ning . … Developing a shared care plan can ease the exchange of clinical information, medication reconciliation … to locate OBGYN, primary care and behavioral health care team members in the same space or in different … risks and benefits, create an individualized, patient-centered treatment plan, make clinical decisions … Available at: https://www.bccsu.ca/clinical-care-guidance/ . Accessed August 18, 2022. 113.