Implementing Patient-Centred Behavioural Health Integration into Primary Care Using Model-Based Systems Engineering

摘要

Psychiatric and substance use disorders, such as depression and/or opioid use disorders, are categorized as behavioural health conditions. In the United States, approximately one in four adults suffers from a behavioural health condition in any given year. These conditions are prevalent and costly. The current delivery of behavioural health services follows a primary to specialty referral practice, which has led to poor treatment initiation outcomes. These poor outcomes stem from a care delivery model that does not fully cater to the needs of patients. Patients prefer to receive both physical and mental health care within a single primary care setting. In response, healthcare delivery systems developed clinical models and approaches for behavioural health integration into primary care. These clinical models portray a sense of integration. However, these clinical models lack the necessary detail to describe the key components of a system and instead focus heavily on describing the system's physical form. By doing so, clinical models lack the ability to incorporate a broader range of patient needs and the details to describe a system to ensure it produces its intended outcomes. These limitations lead to variations in implementation success. Systematic approaches, including the development of system models, have been used to describe and develop complex systems. In this paper, we detail the design considerations for a patient-centred system model and describe its utilization in an implementation of a patient-centered behavioural health integration into primary care.