The Use of Group Concept Mapping to Improve Transitions of Care Between a Mental Health Center and a Family Medicine Clinic

Purpose:
The purpose of this project is to effectively engage stakeholders from separate primary care and mental health organizations to develop an ideal cross-organization communication system to improve metabolic monitoring for their co-managed patients prescribed second generation antipsychotics using the mixed-method approach of group concept mapping.

Methods:
An interprofessional group of key stakeholders from the Human Development Center and the Duluth Family Medicine Clinic participated in group concept mapping meetings in April and May of 2018. The group concept mapping method is useful for understanding how to bridge the gap between community mental health and primary care, because it allows for stakeholders to come together and contribute their perspectives towards planning and developing an optimal communication system between the two clinics. By using this method, we can incorporate diverse perspectives in the planning process, which will optimize buy-in by stakeholders.

Results:
The 14 participants brainstormed 99 items to improve cross-organization care, which were sorted into a point map with six clusters: standardization of process and protocols; electronic health record (EHR) optimization; effective inter-clinic communication strategies; care team member roles and responsibilities, workflow, and care coordination; patient advocacy and access to behavioral health care; and patient-centered care and education. Stakeholders prioritized items for initial quality improvement efforts and came to consensus on the following: to have agreement on expectations for monitoring, have a standard protocol for release of information, have a way to easily see in the electronic health record which patients are co-managed, a specific “point person” to be responsible for ensuring that checklists and protocols are followed, ensure that the patient’s updated/reconciled medication list is generated prior to clinic visit, to know which clinic/provider is following up on behavioral health medications, and education surrounding monitoring for all involved in patient care.

Conclusions:
Care coordination across health systems is critical to optimize patient care for chronic medical and psychiatric conditions. Group concept mapping provides a strategic process to create buy-in and consensus among stakeholders to take steps towards solving more complex systematic problems such as poor EHR interoperability across health systems.

Funding:
Minnesota Department of Health Rural Family Residency Grant