Friday, February 14, 2014

#HCLDR Healthcare Leaders Tweet Chat on Behavioral Health Integration and Hospital Readmissions - Feb 18, 2014

Twitter has been a great medium for having discussions, or chats, about various healthcare topics. The original "tweet chat" is #HCSM or HealthCare & Social Media, which is still on Sunday evenings at 9pm ET.

One of the increasingly influential healthcare tweet chats is #HCLDR, Tuesday nights at 8:30 ET, which typically has a hundred or so participants, many of them being patients, hospital executives, physicians, nurses, and others involved in various aspects of quality standards, business, compliance, and related aspects of today's healthcare industry. #HCLDR is passionately and expertly organized by Lisa Fields (@practicalwisdom) and Colin Hung (@colin_hung). Each chat starts with introductions, then three topic questions are asked, each followed by about 15 minutes of discussion. Everyone gets a last word at the end. Each chat must have the #HCLDR hashtag in it to show up in the discussion, which people either use the native Twitter site or app for, or other tools. I tend to prefer, which will automatically refresh the screen to see new tweets, and it ensures you don't forget to add the hashtag.

Each week's tweet chat is documented on their Wordpress blog. Last week's chat was a very current topic regarding the increasing complex trade-offs between privacy and access to healthcare.

Lisa and Colin have asked me to be the guest host for next week's chat on Tue, Feb 18, 8:30-9:30pm ET. The topic will be about Behavioral Health Integration, and will touch on the impact of comorbid mental health and substance use disorders (referred to in the collective as behavioral health) on hospital readmissions.

To whet people's appetite and guide the focus, I've included an image below that shows the relative risk of hospitalization for several medical conditions for four groups of patients (this is 2011 Maryland Medicaid data):
  • patients without any comorbid behavioral health condition
  • patients with a comorbid mental health condition
  • patients with a comorbid substance abuse condition (drug and/or alcohol abuse or dependence)
  • patients who are comorbid for both a mental health AND a substance use disorder

(CELL-SEPT refers to cellulitis and septicemia; CHF is congestive heart failure; RESP//// refers to four respiratory conditions: asthma, COPD, bronchitis, pneumonia; and DM refers to diabetes)

I initially began with the following Topic questions:
  • T1: How can #BehavioralHealth (BH) be better integrated within primary health care? 
  • T2: What are the barriers to addressing the impact of #BehavioralHealth on chronic health conditions?
  • T3: How can primary care improve screening for BH conditions that impact chronic conditions?
But after talking with Lisa on a Google Hangout yesterday, we thought it might be useful to have people suggest their own topic questions before we finalize them.

So, please send a tweet over the weekend about what you want to ask. Include my name (@hitshrink) and also the #hcldr hashtag. I will update this post over the weekend and finalize it on Monday.

***UPDATE 2/16/2014 17:38 ET***
Great discussion on Twitter #HCLDR...
@StorkBrian: Access to Behavioral Health Services is Sorely Lacking in Most Communities
@TeamMDrs: most primary care visits have their basis in a bh issue
  >> @MeganRanneytrue for ER visits too
  >> @PracticalWisdomWe must change ~ some w/Beh/Health housed in ER ~ #noroomintheinn Not enough $ for Rehab
@TeamMDrs: the impact of depression on physical well being is profound and well studied
@StorkBrian: Behavioral Health is a Demanding Specialty Providers Need Support & Appropriate Compensation
@ProfAmyE: Integration of MH svcs in is key.  Paradigm shift for how this works required!
@PracticalWisdomHow many re-Admits every day b/c We left out Behavior Health.Huge #'s I say!
  >> @PerronServices: Why? How?
  >> @HITshrinkIf pt too depr to take care of diabetes -> more admits
@ProfAmyEHealth promotion is about healthy behavior. This is what BH does best!
@StuartMarcusMDR we seeing more violent pts in ED's & med/surg admits? Feels like it. Best practices needed
@TomVargheseJrStandards for good surveillance & feedback systems? What are consensus best practices?
@MeganRanneyHow to integrate #behavioralhealth into day-to-day clinical practice (constraints of time & access)
@MeganRanneyAnd many w/behav health issues have no other source of care  #emergencymedicine

***UPDATE 2/17/2014 09:22 ET***
After fine-tuning the Topic questions, based on above tweets over the weekend, here are the final questions for Tuesday night's #HCLDR tweet chat (using the shorter #bhealth for #behavioralhealth):

  • T1: With shortage of #BHealth resources, what impacts do you see in your settings? #HCLDR
  • T2: What can help PCPs better integrate #BHealth into their practice? #HCLDR
  • T3: What can help to address impact of #BHealth on chronic health conditions? #HCLDR

***UPDATE 2/17/2014 12:50 ET***
Below are some resources that are relevant to the discussion, including links and slides (slide images are linked to underlying source when possible, so click on them to go to Pubmed or wherever).

WSJ 2014 Jan 16 - Shortage of mental health professional blamed on Obamacare

University of Washington's AIMS Center (Advancing Integrated Mental Health Solutions) offers free training for their collaborative care model.

M3 Clinician is an NCQA-recognized screening and clinical decision support tool that helps PCPs identify and manage patients with depression, bipolar, PTSD, anxiety, and substance use disorders. Patient version is  [Disclaimer: Dr Daviss is CMIO for M3 Information.]

Shameless plug for our book [Kindle], from the Shrink Rap docs.


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