Improving Fidelity to PCBH through Measuring GATHER

Improving fidelity to PCBH through measuring GATHER: G is for Diagnostic Variability

Primary Care has served as the first line of care within the US Healthcare system. This means that regardless of symptom or condition severity patients often come to primary care first. While primary care can treat a wide array of conditions, referral to specialty care providers are common. In the last few decades behavioral health has become more adapted to primary care and several models aim to mimic the medical primary care system to become the front line of behavioral health as well as reducing the known barriers to the specialty behavioral health system. Primary Care Behavioral Health (PCBH) is one of these integration models and by definition the PCBH model of integration sees a large variety of patient presentations. This often ranges from mild stress, adjustment, and health changes, but can also include more chronic and severe conditions such as cancer, psychosis, PTSD, and Eating disorders. In many behavioral health models patient diagnoses or symptoms presentation create barriers to access care. Exclusion criteria, insurance acceptance, and lack of rigorously studied treatment protocols can leave some of the most vulnerable patients without needed behavioral health services. The PCBH model at the Yakima Valley Farms Workers Clinic (YVFWC) sees patients as they are: Complex. BHCs within this system conduct visits within the PCBH model of behavioral health integration and ongoing efforts are made to track and ensure fidelity to this approach. The GATHER acronym provides clear guidelines about what PCBH is, but how to measure these goals remains unclear. While some aspects of GATHER are objective such as seeing 10 patients per day, other aspects of PCBH are more nebulous. The presenter will discuss how YVFWC is striving to measure all aspects of GATHER and how the presenter took additional steps to improving reporting, tracking, and advocacy for the PCBH model through the development of a Diagnostic Variability statistic to more objectively measure and define the G (Generalist) of GATHER. This measure has helped determine a range of what G should be and when a BHC may need coaching due to falling short in regards to being a Generalist. Conversely this measure allows us to recognize and learn from those BHCs with the highest G performance. The presenter will show reports, tables, and charts which help calculate these numbers and how aggregate data has allowed us to give empirical meaning to G. Additionally the presentation will also provide several examples of the variety of conditions, diagnoses, and symptoms that present in primary care. These case examples will provide a real world look at how BHCs within the PCBH model can provide meaningful care to complex patients. By exploring these presentations the presenter hopes to validate and normalize the difficulty faced by working in primary care and also to instill hope and confidence that the skills utilized by BHCs can be effective to many conditions deemed “too difficult” for PCBH work

Author(s): Phillip Hawley Keywords: PCBH, Complex Patients Continuing Education: NA Objective 1:: Presenter will explore the PCBH model an... Objective 2:: Presenter will highlight difficulties in... Objective 3:: Presenter will teach audience members a ... Level of Evidence: Yellow

  • Webcast 12_Hawley_Recording
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