TY - JOUR
T1 - Integrating behavioral health & primary care for multiple chronic diseases
T2 - Clinical trial of a practice redesign toolkit
AU - Littenberg, Benjamin
AU - Reynolds, Paula
AU - Natkin, Lisa
AU - van Eeghen, Constance
AU - Callas, Peter
AU - Pace, Wilson
AU - Rose, Gail
AU - Hitt, Juvena
AU - Crocker, Abigail
AU - Mullin, Daniel
AU - Baldwin, Laura Mae
AU - Bonnell, Levi
AU - Waddell, Elizabeth
AU - Pinckney, Richard
AU - Frisbie, Sylvie
AU - Mollis, Brenda
AU - Macchi, C. R.
AU - Nagykaldi, Zsolt
AU - Teng, Kathryn
AU - Stange, Kurt
AU - O'Rourke-Lavoie, Jennifer
AU - Stephens, Kari
AU - Sieber, William
AU - Jewiss, Jennifer
AU - Scholle, Sarah
AU - Pearson, Lauren Eidt
AU - Leibowitz, George
AU - Breshears, Ryan
AU - Clifton, Jessica
AU - Kathol, Roger
AU - Stancin, Terry
AU - McGovern, Mark
AU - Hekman, Mary
AU - Pomeroy, Douglas
N1 - Publisher Copyright:
© 2021 Annals of Family Medicine, Inc.
PY - 2022/4/1
Y1 - 2022/4/1
N2 - Context: Most patients in need of behavioral health (BH) care are seen in primary care, which often has difficulty responding. Some practices integrate behavioral health care (IBH), with medical and BH providers at the same location, working as a team. However, it is difficult to achieve high levels of integration. Objective: Test the effectiveness of a practice intervention designed to increase BH integration. Study Design: Pragmatic, cluster-randomized controlled trial. Setting: 43 primary care practices with on-site BH services in 13 states. Population: 2,460 adults with multiple chronic medical and behavioral conditions. Intervention: 24-month practice change process including an online curriculum, a practice redesign and implementation workbook, remote quality improvement coaching services, and an online learning community. Outcomes: Primary outcomes were changes in the 8 Patient-Reported Outcomes Measurement Information System (PROMIS-29) domain scores. Secondary outcomes were changes in medication adherence, self-reported healthcare utilization, time lost due to disability, cardiovascular capacity, patient centeredness, provider empathy, and several condition-specific measures. A sample of practice staff completed the Practice Integration Profile at each time point to estimate the degree of BH integration in that site. Practice-level case studies estimated the typical costs of implementing the intervention. Results: The intervention had no significant effect on any of the primary or secondary outcomes. Subgroup analyses showed no convincing patterns of effect in any populations. COVID-19 was apparently not a moderating influence of the effect of the intervention on outcomes. The intervention had a modest effect on the degree of practice integration, reaching statistical significance in the Workflow domain. The median cost of the intervention was $18,204 per practice. In post-hoc analysis, level of BH integration was associated with improved patient outcomes independent of the intervention, both at baseline and longitudinally. Conclusions: The specific intervention tested in this study was inexpensive, but had only a small impact on the degree of BH integration, and none on patient outcomes. However, practices that had more integration at baseline had better patient outcomes, independent of the intervention. Although this particular intervention was ineffective, IBH remains an attractive strategy for improving patient outcomes.
AB - Context: Most patients in need of behavioral health (BH) care are seen in primary care, which often has difficulty responding. Some practices integrate behavioral health care (IBH), with medical and BH providers at the same location, working as a team. However, it is difficult to achieve high levels of integration. Objective: Test the effectiveness of a practice intervention designed to increase BH integration. Study Design: Pragmatic, cluster-randomized controlled trial. Setting: 43 primary care practices with on-site BH services in 13 states. Population: 2,460 adults with multiple chronic medical and behavioral conditions. Intervention: 24-month practice change process including an online curriculum, a practice redesign and implementation workbook, remote quality improvement coaching services, and an online learning community. Outcomes: Primary outcomes were changes in the 8 Patient-Reported Outcomes Measurement Information System (PROMIS-29) domain scores. Secondary outcomes were changes in medication adherence, self-reported healthcare utilization, time lost due to disability, cardiovascular capacity, patient centeredness, provider empathy, and several condition-specific measures. A sample of practice staff completed the Practice Integration Profile at each time point to estimate the degree of BH integration in that site. Practice-level case studies estimated the typical costs of implementing the intervention. Results: The intervention had no significant effect on any of the primary or secondary outcomes. Subgroup analyses showed no convincing patterns of effect in any populations. COVID-19 was apparently not a moderating influence of the effect of the intervention on outcomes. The intervention had a modest effect on the degree of practice integration, reaching statistical significance in the Workflow domain. The median cost of the intervention was $18,204 per practice. In post-hoc analysis, level of BH integration was associated with improved patient outcomes independent of the intervention, both at baseline and longitudinally. Conclusions: The specific intervention tested in this study was inexpensive, but had only a small impact on the degree of BH integration, and none on patient outcomes. However, practices that had more integration at baseline had better patient outcomes, independent of the intervention. Although this particular intervention was ineffective, IBH remains an attractive strategy for improving patient outcomes.
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U2 - 10.1370/afm.20.s1.2679
DO - 10.1370/afm.20.s1.2679
M3 - Article
C2 - 36693208
AN - SCOPUS:85147048064
SN - 1544-1709
JO - Annals of family medicine
JF - Annals of family medicine
IS - 20
ER -