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<h1>Figure 5. Parameters of collaborative care practice</h1>
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<h2>A National Agenda for Research in Collaborative Care</h2> <div id="basic-modal"><!-- start: Basic Modal -->
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<table border="1" cellpadding="2" cellspacing="0" width="90%"><tbody><tr valign="top"><th scope="col">Parameter</th><th scope="col">Source</th><th colspan="6" scope="col">Possible values for that parameter</th></tr><tr valign="top"><td colspan="8" scope="row"><em>A team...</em></td></tr><tr valign="top"><td width="20%"><strong>1. Team composition</strong> <p><strong>All include patients / families on team</strong></p></td><td width="15%">From teams in published work, e.g., IMPACT, Primary BehH model</td><td colspan="2">PCP<br />+ Nurse/MA<br />+ Care coord.</td><td width="16%">PCP<br />+  Nurse/MA<br />+  Care mgr<br />+  Consulting BehH</td><td colspan="2">PCP<br />+ Nurse/MA<br />+ Care mgr<br />+ Integ BehH</td><td width="18%">PCP<br />+ Nurse/MA<br />+ Care mgr<br />+ Integr BehH<br />+ Other (suited to practice pop.)</td></tr><tr valign="top"><td scope="row"><strong>2. Level of collaboration or integration</strong></td><td>Adapted<br />From<br />Doherty,<br />McDaniel, and Baird;<br />Blount</td><td colspan="3">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 culture</td><td colspan="2">Co-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 culture</td><td>Integrated—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</td></tr><tr valign="top"><td colspan="8" scope="row"><em>With a shared population and mission...</em></td></tr><tr valign="top"><td rowspan="4" scope="row"><strong>3. Target population</strong></td><td>A. Locus of Care</td><td colspan="3">Primary Medical Care</td><td colspan="2">Specialty Medical Care</td><td>Specialty Care</td></tr><tr valign="top"><td>B. Blount</td><td colspan="4">Targeted:<br />For specific populations such as disease, age, or other focus—"vertically integrated"</td><td colspan="2">Non-targeted:<br />For any patient deemed to need collaborative care—"all comers"—"horizontally integrated"</td></tr><tr valign="top"><td>C. Life stage</td><td colspan="2">Children</td><td colspan="2">Adults/young adults</td><td>Geriatrics</td><td>End of life</td></tr><tr valign="top"><td>D. Kessler and Miller; Peek and Baird</td><td colspan="2">MH conditions:<br />Pts with one or more MH conditions, or family, partner and relationship problems affecting health</td><td colspan="2">Psychophys sx:<br />Pts with psycho-physiological / stress symptoms sx, e.g., headache, fatigue, insomnia, other</td><td>Medical condition:<br />Pts with one or more medical diseases or conditions, e.g., diabetes, asthma, CHF, COPD</td><td>Complex cases:<br />Complex cases or persons regardless of disease</td></tr><tr valign="top"><td colspan="8" scope="row"><em>Using a clinical system...</em></td></tr><tr valign="top"><td scope="row"><strong>4. Method of population identification</strong></td><td> </td><td colspan="3">Patient or clinician:<br />Nonsystematic patient or clinician identification</td><td colspan="2">System indicators:<br />Epidemiological data, claims, other system data</td><td>Universal screening:<br />All or most patients screened for being part of target pop</td></tr><tr valign="top"><td scope="row"><strong>5. Program scale or maturity</strong></td><td>Davis: From pilot to project to mainstream</td><td colspan="3">Pilot:<br />A demonstration of feasibility or starter "test of change"</td><td colspan="2">Project:<br />Multiple promising pilots gathered together and led visibly as a project aiming toward the mainstream</td><td>Mainstream:<br />Full scale way of life in the organization—the way things are done, no longer a project attached to the mainstream.</td></tr><tr valign="top"><td scope="row"><strong>6. Level of pt centeredness / engagement</strong></td><td>Level of shared decision- making</td><td colspan="3">Little or none:<br />Chance, random; up to individual provider</td><td colspan="2">Limited:<br />Some effort to systematically do shared decision-making, but without a concerted system</td><td>By protocol:<br />Build into clinical system for specific applications involving pt / family / clinician decisions</td></tr><tr valign="top"><td colspan="7"><em>Supported by an office practice and financial system...</em></td></tr><tr valign="top"><td scope="row"><strong>7. Level of office practice design and reliability</strong></td><td>Reliability<br />science<br />and lean<br />concepts</td><td colspan="3">Informal:<br />Referral, communication, and charting are non-standard processes that vary with clinician and clinical situation</td><td colspan="2">Partially routinized:<br />Some standards set for some processes but variability and clinician preference still operate</td><td>Standard work:<br />Whole team operates each part of the system in a standard expected way that quickly reveals lapses and system errors</td></tr><tr valign="top"><td scope="row"><strong>8. Business model / financing</strong></td><td> </td><td>FFS only</td><td colspan="2">FFS + small bundled care mgmt fee</td><td>Large bundled care management fee + small FFS</td><td>Separate medical and MH capitations</td><td>One pool of funds for all care—medical or MH</td></tr><tr valign="top"><td colspan="8" scope="row"><em>And continuous quality improvement and effectiveness measurement...</em></td></tr><tr valign="top"><td scope="row"><strong>9.  Ability to collect and use practice data</strong></td><td> </td><td colspan="3">Little or no routine data collected and used</td><td>Commitment to building system for collecting and using practice data</td><td colspan="2">Mature data collection and use in decision- making for quality and effectiveness</td></tr></tbody></table><p class="size2"><a href="/research/findings/final-reports/collaborativecare/collab3.html#fig5">Return to Document</a></p> </div><!-- end: Basic Modal -->
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<div class="current-as-of">Page last reviewed June 2011</div>
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<span>Internet Citation: Figure 5. Parameters of collaborative care practice: A National Agenda for Research in Collaborative Care.
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June 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://archive.ahrq.gov/research/findings/final-reports/collaborativecare/collab3fig5.html</span>
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