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Table 4 Convergence and divergence in referral procedures for Site Yankee

From: Between and within-site variation in qualitative implementation research

Redundant concept Convergence or divergence Supporting data
Mental health providers are co-located in the primary care setting Convergence MHL: Co-location promotes communication and shared understanding, but lack of space limited the implementation.
Convergence PCMH: Only three primary care teams have co-located PCMH due to space restrictions.
Divergence PCP: Some primary care providers forced to give up space for PC/MHI—created conflicts; implementation planning was conducted unilaterally by MH.
PC/MHI team leader triages consults and assigns them to a PC/MHI provider Convergence PCMH: PC referrals to PCMH have increased, particularly for medical conditions such as diabetes management.
Convergence PCP: Implementation increased patient compliance with referrals.
Divergence PCP: PCMH helps refer appropriately, but some providers may not refer to PCMH at all.
Divergence PCP: Conflict between PCMH and ER regarding responsibility for urgent patients.
  1. Note: Supporting data are presented as either convergent or divergent with the redundant concept. MHL refers to the mental health leader at the site; PCMH refers to the Primary Care/Mental Health Integration (PC/MHI) informants at the site; PCP refers to the primary care physician informants at the site. ER = emergency room.