Date of Award


Document Type


Degree Name

Doctor of Nursing Practice (DNP)

Committee Chair

Sharon Starr


The problems caused by the lack of care coordination between primary care and behavioral health are well documented. Patients with uncontrolled mental health issues along with chronic health problems cost two to three times the health care dollars to manage than patients who have the same chronic health problems but without uncontrolled mental health issues. Despite this, in rural North Carolina, the de facto level of care coordination is none. Mental health and primary care are completely separate, distinct systems that do not routinely communicate. One of the identified barriers to care coordination is the lack of reimbursement for the time and resources required to care coordinate. A primary care clinic and behavioral health clinic in central North Carolina agreed to implement care coordination at its most basic level, enhanced communication. An intervention was undertaken to demonstrate that this communication could happen even with the lack of any reimbursement. To facilitate this process, the two agreed to communicate regarding their shared patients via a designed an electronic “game of catch”, whereby primary care would send regular care summaries of the medical plan, and simultaneously request care summaries of the mental health plan. Then SBAR, a multi-disciplinary communication tool was used to transmit clinical concerns and requests along with these clinical summaries. This “game” ensued every two weeks. After regularly scheduled correspondence, the intervention was completed with an unannounced transmission of care summaries from primary care. During the course of the intervention, 17 care summaries were transmitted by primary care and 14 (84%) were returned by behavioral health. SBAR was used effectively to identify inappropriate therapies, requests for lab monitoring, patient deterioration and instability and others. Provider satisfaction surveys showed a positive trend in the pattern of communication over the course of the intervention. While limited in its scale because of difficulties in identify a large pool of shared patients, the intervention was successful in demonstrating that care coordination was possible with the simple recognition of its necessity. Also identified was the need for a dedicated champion to monitor the progression of the clinical information through each step of the cycle. This intervention had a champion at both clinics. Further study is needed. Recommendations for future interventions include the assurance of bi-directional or closed loop communication and larger samples of identified shared patients.

Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.