• Melinda Davis, Bijal A Balasubramanian, Elaine Waller, Benjamin F Miller, Larry A Green, and Deborah J Cohen.
• Department of Family Medicine, Oregon Health & Science University, Portland, OR 97239, USA. davismel@ohsu.edu
• J Am Board Fam Med. 2013 Sep 1; 26 (5): 588-602.

BackgroundMore than 20 years ago the Institute of Medicine advocated for integration of physical and behavioral health care. Today, practices are integrating care in response to recent policy initiatives. However, few studies describe how integration is accomplished in real-world practices without the financial or research support available for most randomized controlled trials.MethodsTo study how practices integrate care, we are conducting a cross-case comparative, mixed-methods study of 11 practices participating in Advancing Care Together (ACT). Using a grounded theory approach, we analyzed multiple sources of data (eg, documents, practice surveys, field notes from observation visits, semistructured interviews, online diaries) collected from each ACT innovator.ResultsIntegration requires making changes in organization and interpersonal relationships. During early integration efforts, challenges related to workflow and access, leadership and culture change, and tracking and using data to evaluate patient- and practice-level improvement emerged for ACT innovators. We describe the strategies innovators are developing to address these challenges.ConclusionIntegrating care is a fundamental and difficult change for practices and health care professionals. Research identifying common challenges that manifest in early efforts can help others attempting integration and inform state, local, and federal policies aimed at achieving wide-spread implementation.

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