Approaches to Behavioral Health Integration at High Performing Primary Care Practices

Abstract Although evidence-based behavioral health integration models have been demonstrated to work well when implemented properly, primary care practices need practical guidance on the steps they can take to build behavioral health integration capacities. This is especially true for practice settings with fewer resources. This study is a pilot field test of a framework continuum composed of core components of behavioral health integration that can be used to translate the implementation of behavioral health into diverse clinical settings guided by a practice's priorities and available resources. This framework, in combination with technical assistance by the study team, was piloted in 11 small primary care sites (defined as ≤5 primary care providers) throughout New York State. Surveys were collected at baseline, 6 months, and 12 months. Informal check-in calls and site visits using qualitative semistructured individual and group interviews were conducted with 10 of the 11 sites. A mixed-methods approach was used to incorporate the survey data and qualitative thematic analysis. All practices advanced at least one level of behavioral health integration along various components of the framework. These advances included implementing depression screening, standardizing workflows for positive screens, integrating patient tracking tools for follow-up behavioral health visits, incorporating warm hand-offs to on-site or off-site behavioral health providers, and formalized external referrals using collaborative agreements. Practices reported they had overall positive experiences using the framework and offered feedback for how to improve future iterations. The framework continuum, in combination with technical assistance, was shown to be useful for primary care practices to advance integrated behavioral health care based on their priorities and resource availability. The results combined with feedback from the practices have yielded a revised “Framework 2.0” that includes a new organization as well as the addition of a “Sustainability” domain.

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Integrating Behavioral Health and Primary Care (IBH-PC) to improve patient-centered outcomes in adults with multiple chronic medical and behavioral health conditions: study protocol for a pragmatic cluster-randomized control trial

Trials ◽

10.1186/s13063-021-05133-8 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Abigail M. Crocker ◽

Rodger Kessler ◽

Constance van Eeghen ◽

Levi N. Bonnell ◽

Ryan E. Breshears ◽

...

Keyword(s):

Primary Care ◽

Health Care ◽

Behavioral Health ◽

Behavioral Health Care ◽

Health Conditions ◽

Patient Centered ◽

Practice Level ◽

Behavioral Health Integration ◽

Care Practices ◽

Primary Care Practices

Abstract Background Chronic diseases that drive morbidity, mortality, and health care costs are largely influenced by human behavior. Behavioral health conditions such as anxiety, depression, and substance use disorders can often be effectively managed. The majority of patients in need of behavioral health care are seen in primary care, which often has difficulty responding. Some primary care practices are providing integrated behavioral health care (IBH), where primary care and behavioral health providers work together, in one location, using a team-based approach. Research suggests there may be an association between IBH and improved patient outcomes. However, it is often difficult for practices to achieve high levels of integration. The Integrating Behavioral Health and Primary Care study responds to this need by testing the effectiveness of a comprehensive practice-level intervention designed to improve outcomes in patients with multiple chronic medical and behavioral health conditions by increasing the practice’s degree of behavioral health integration. Methods Forty-five primary care practices, with existing onsite behavioral health care, will be recruited for this study. Forty-three practices will be randomized to the intervention or usual care arm, while 2 practices will be considered “Vanguard” (pilot) practices for developing the intervention. The intervention is a 24-month supported practice change process including an online curriculum, a practice redesign and implementation workbook, remote quality improvement coaching services, and an online learning community. Each practice’s degree of behavioral health integration will be measured using the Practice Integration Profile. Approximately 75 patients with both chronic medical and behavioral health conditions from each practice will be asked to complete a series of surveys to measure patient-centered outcomes. Change in practice degree of behavioral health integration and patient-centered outcomes will be compared between the two groups. Practice-level case studies will be conducted to better understand the contextual factors influencing integration. Discussion As primary care practices are encouraged to provide IBH services, evidence-based interventions to increase practice integration will be needed. This study will demonstrate the effectiveness of one such intervention in a pragmatic, real-world setting. Trial registration ClinicalTrials.gov NCT02868983. Registered on August 16, 2016.

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Integrating Behavioral Health and Primary Care (IBH-PC) to improve patient-centered outcomes in adults with multiple chronic medical and behavioral health conditions: study protocol for a pragmatic cluster-randomized control trial

10.21203/rs.3.rs-54202/v1 ◽

2020 ◽

Author(s):

Abigail M Crocker ◽

Rodger Kessler ◽

Constance van Eeghen ◽

Levi N Bonnell ◽

Ryan E Breshears ◽

...

Keyword(s):

Primary Care ◽

Health Care ◽

Behavioral Health ◽

Behavioral Health Care ◽

Health Conditions ◽

Patient Centered ◽

Practice Level ◽

Behavioral Health Integration ◽

Care Practices ◽

Primary Care Practices

Abstract BackgroundChronic diseases that drive morbidity, mortality, and health care costs are largely influenced by human behavior. Behavioral health conditions such as anxiety, depression, and substance use disorders can often be effectively managed. The majority of patients in need of behavioral health care are seen in primary care, which often has difficulty responding. Some primary care practices are providing integrated behavioral health care (IBH), where primary care and behavioral health providers work together, in one location, using a team-based approach. Research suggests there may be an association between IBH and improved patient outcomes. However, it is often difficult for practices to achieve high levels of integration. The Integrating Behavioral Health and Primary Care study responds to this need by testing the effectiveness of a comprehensive practice-level intervention designed to improve outcomes in patients with multiple chronic medical and behavioral health conditions by increasing the practice’s degree of behavioral health integration.Methods43 primary care practices, with existing onsite behavioral health care, will be randomized to the intervention or usual care arm. The intervention is a 24-month supported practice change process including an online curriculum, a practice redesign and implementation workbook, remote quality improvement coaching services, and an online learning community. Each practice’s degree of behavioral health integration will be measured using the Practice Integration Profile. Approximately 75 patients with both chronic medical and behavioral health conditions from each practice will be asked to complete a series of surveys to measure patient-centered outcomes. Change in practice degree of behavioral health integration and patient-centered outcomes will be compared between the two groups. Practice-level case studies will be conducted to better understand the contextual factors influencing integration.DiscussionAs primary care practices are encouraged to provide IBH services, evidence-based interventions to increase practice integration will be needed. This study will demonstrate the effectiveness of one such intervention in a pragmatic, real-world setting.Trial registrationClinicalTrials.gov NCT02868983. Registered August 16, 2016. https://clinicaltrials.gov/ct2/show/NCT02868983

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A qualitative study of high-performing primary care practices during the COVID-19 pandemic

BMC Family Practice ◽

10.1186/s12875-021-01589-4 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Stephanie L. Albert ◽

Margaret M. Paul ◽

Ann M. Nguyen ◽

Donna R. Shelley ◽

Carolyn A. Berry

Keyword(s):

Primary Care ◽

Chronic Disease ◽

Disease Management ◽

Service Delivery ◽

Preventive Care ◽

Chronic Disease Management ◽

High Performing ◽

Care Processes ◽

Care Practices ◽

Primary Care Practices

Abstract Background Primary care practices have remained on the frontline of health care service delivery throughout the COVID-19 pandemic. The purpose of our study was to understand the early pandemic experience of primary care practices, how they adapted care processes for chronic disease management and preventive care, and the future potential of these practices’ service delivery adaptations. Methods We interviewed 44 providers and staff at 22 high-performing primary care practices located throughout the United States between March and May 2020. Interviews were transcribed and coded using a modified rapid assessment process due to the time-sensitive nature of the study. Results Practices reported employing a variety of adaptations to care during the COVID-19 pandemic including maintaining safe and socially distanced access through increased use of telehealth visits, using disease registries to identify and proactively outreach to patients, providing remote patient education, and incorporating more home-based monitoring into care. Routine screening and testing slowed considerably, resulting in concerns about delayed detection. Patients with fewer resources, lower health literacy, and older adults were the most difficult to reach and manage during this time. Conclusion Our findings indicate that primary care structures and processes developed for remote chronic disease management and preventive care are evolving rapidly. Emerging adapted care processes, most notably remote provision of care, are promising and may endure beyond the pandemic, but issues of equity must be addressed (e.g., through payment reform) to ensure vulnerable populations receive the same benefit.

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Primary-Care Practices Appreciate Having Integrated Behavioral Health Consultants

PsycEXTRA Dataset ◽

10.1037/e510052018-001 ◽

2017 ◽

Author(s):

Rebecca A. Clay ◽

Keyword(s):

Primary Care ◽

Behavioral Health ◽

Integrated Behavioral Health ◽

Care Practices ◽

Primary Care Practices

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Have Rates of Behavioral Health Assessment and Treatment Increased for Massachusetts Children Since the Rosie D. Decision? A Report From Two Primary Care Practices

Clinical Pediatrics ◽

10.1177/0009922813507993 ◽

2013 ◽

Vol 53 (3) ◽

pp. 243-249 ◽

Cited By ~ 7

Author(s):

Giusy Romano-Clarke ◽

Michael H. Tang ◽

Dean C. Xerras ◽

Harwood S. Egan ◽

Roger C. Pasinski ◽

...

Keyword(s):

Primary Care ◽

Behavioral Health ◽

Health Assessment ◽

Assessment And Treatment ◽

Care Practices ◽

Primary Care Practices

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A Behavioral Health Survey of Primary Care Integration in Rhode Island

PRiMER ◽

10.22454/primer.2018.467362 ◽

2018 ◽

Vol 2 ◽

Author(s):

Shayla N. M. Durfey ◽

Theodore Long ◽

Tracy L. Jackson ◽

Margaret I. Gradie ◽

Sandra Powell ◽

...

Keyword(s):

Primary Care ◽

Behavioral Health ◽

Rhode Island ◽

Health Survey ◽

Communication Systems ◽

Health Clinics ◽

Department Of Health ◽

Baseline Evaluation ◽

Care Practices ◽

Primary Care Practices

Background: Integrating behavioral and primary care practices improves quality of care, but limited data exists regarding the extent or attributes of such integration. We conducted a baseline evaluation of the level and characteristics of integrated practices in Rhode Island. Methods: The Rhode Island Department of Health 2015 Statewide Health Inventory Behavioral Health Survey was sent to behavioral health clinics and outpatient psychiatry and psychology practices. Survey questions assessed indicators of integration, including colocation, shared electronic medical records (EMRs), and shared communication systems. Results: Only 19%, 9%, and 17% of behavioral health clinics, psychiatrists, and psychologists, respectively reported any integration with primary care practices. Compared to psychology (3.5%) and psychiatry (0.0%) practices, behavioral health clinics reported the highest level of practice colocation (10.4%, P<0.05). Compared to non-colocated practices, colocated behavioral health clinics reported higher levels of integration by other indicators, including shared EMRs (33.0% vs 0.0%, P=0.01). Conclusion: This statewide survey demonstrated that limited integration exists between behavioral health and primary care practices in Rhode Island, and that such integration has a range of characteristics and levels. More practice integration is needed to ensure the delivery of high-quality, evidence-based care to the millions of individuals living with cooccurring behavioral and physical health needs.

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