Behavioral Health Integration Complex Care Initiative

BHICCI MEDICAL AND BEHAVIORAL HEALTH MEASURES DATA PLAN FOR MBC:

http://bhintegration.com/about/bhicci-data-plan/

What is MBC

2

• A standardized, evidenced based measure such as a rating scale, physical exam measure or lab value used to diagnosis a health condition and track response to an intervention.

• Does the health condition have:• a measure that can be easily measured and tracked?• a significant impact on quality of life or mortality?• an effective treatment(s)?

3

Examples of health conditions amenable to MBC

• Hemoglobin A1c (HgA1c)Type 2 Diabetes Mellitus:

• Blood PressureHypertension:

• PHQ9Major Depression:

• GAD7Generalized

Anxiety Disorder:

• Substance Use Assessment Tool (SUA)

Substance Use Disorders:

What would care be like without MBC?

4

• A patient with Type 2 DM shows up for f/u meds on metformin. He has noticed some increased urination and thirst and some numbness in his feet. He doesn’t check his sugars and the clinic lost its contract with laboratory services.• How does the doctor decide whether to adjust medications?

What would care be like without MBC?

• A 35 y/o man presents after starting fluoxetine for depression six weeks ago, he continues to feel depressed but “it’s a little better.” He is sleeping 5 hours per night but his energy is low and still not socializing with friends or family.• How does the doctor decide whether to adjust

medications?

5

It’s like…

6

Goals

•Discuss example measurements• Justify time frames for measurements•Give teams time to “test out” your measurements

sense

7

Diabetes: Hemoglobin A1c (HgA1c)

8

Home run = Glucose of 120 Strike out = Glucose of 400

% saturation of red blood cells with sugar

Best metric to know how good or bad a player (diabetes) is?

9

• A single at bat• Office Blood Glucose level

• Watching some of the home games • Home Glucose Log

• Batting average over a 3 month period• HgA1c

HgA1c to Mean Blood Glucose Conversion (batting average)

10

it take a number of “at bats” (time) to see if a change in batting technique affects batting average

Medications and lifestyle changes (diet) takes 3 months to notice stable change in HgA1c

Goal being < 7% for most patients

So…

Hypertension: Blood Pressure (BP)

The pressure exerted by blood on the walls arteries

11

Systolic (top #) Maximum pressure-------------------------------

Diastolic (bottom #) baseline pressure

Simplified BP Goals

Age: 18-59 Less than 140/90

Age: ≥ 60 Less than 150/90

BP Monitoring

• A BP reading is an “at bat”• No “Batting Average”

equivalent but can attend some home games!• If there are discrepancies b/w

home and office readings, have patients bring in cuffs and compare

13

BP interventions: onset of action

• BP medications have onset of action < 1 day, so… response to BP changes can be detected as early as the next day

14

• Lifestyle changes (e.g. lower salt intake, weight loss) takes weeks to months to affect BP

Major Depression Disorders

• Caused by a combination of biological, psychological, and social factors.• Depression can be complicated making treatment

less straightforward• Lifestyle choices, relationships, and coping skills

matter just as much—if not more so—than genetics.• While not straightforward, we have good evidence

of what works

15

Anxiety Disorders

• Related conditions rather than a single disorder• Share one major symptom: persistent or severe

fear or worry in situations where most people wouldn’t feel threatened.• Effective treatment include talk therapies,

particularly those with behavioral components which emphasize client self-management/self -care strategies, medication, or some combination of the two.

16

Major Depression: PHQ9Anxiety Disorders: GAD7

• Self report scale rather a lab draw or physical measurement• PHQ9 and GAD7 based on DSM criteria for Major

Depression and Generalized Anxiety Disorder• Can be done in person or telephonically

17

GAD-7 Screening Tool

10 + Somewhat Difficult is cutoff for further evaluation and management

Interventions: onset of action• Antidepressants and Therapy do not work

“instantly” for depression and anxiety• Recheck PHQ-9/GAD7 monthly until

remission•Goal is < 5 on the PHQ9 and GAD7

19

BHICCI Medical and Behavioral Health Measures Data Plan for MBC:

http://bhintegration.com/about/bhicci-data-plan/

20