Gouge Natasha, Polaha Jodi, Rogers Rachel, Harden Amy
From Mountain States Medical Group, Pediatrics, Kingsport, Tennessee, the Department of Family Medicine, East Tennessee State University, Johnson City, and Mountain View Pediatrics, Marion, Virginia.
South Med J. 2016 Dec;109(12):774-778. doi: 10.14423/SMJ.0000000000000564.
Integrating a behavioral health consultant (BHC) into primary care is associated with improved patient outcomes, fewer medical visits, and increased provider satisfaction; however, few studies have evaluated the feasibility of this model from an operations perspective. Specifically, time and cost have been identified as barriers to implementation. Our study aimed to examine time spent, patient volume, and revenue generated during days when the on-site BHC was available compared with days when the consultant was not.
Data were collected across a 10-day period when a BHC provided services and 10 days when she was not available. Data included time stamps of patient direct care; providers' direct reports of problems raised; and a review of medical and administrative records, including billing codes and reimbursement. This study took place in a rural, stand-alone private pediatric primary care practice. The participants were five pediatric primary care providers (PCPs; two doctors of medicine, 1 doctor of osteopathy, 2 nurse practitioners) and two supervised doctoral students in psychology (BHCs). Pediatric patients (N = 668) and their parents also participated.
On days when a BHC was present, medical providers spent 2 fewer minutes on average for every patient seen, saw 42% more patients, and collected $1142 more revenue than on days when no consultant was present.
The time savings demonstrated on days when the consultant was available point to the efficiency and potential financial viability of this model. These results have important implications for the feasibility of hiring behavioral health professionals in a fee-for-service system. They have equally useful implications for the utility of moving to a bundled system of care in which collaborative practice is valued.
将行为健康顾问（BHC）纳入初级保健可改善患者预后、减少就诊次数并提高提供者满意度；然而，很少有研究从运营角度评估该模式的可行性。具体而言，时间和成本已被确定为实施的障碍。我们的研究旨在比较有现场BHC时与无顾问时的时间花费、患者数量和产生的收入。
收集了BHC提供服务的10天以及其未提供服务的10天的数据。数据包括患者直接护理的时间戳；提供者对提出问题的直接报告；以及对医疗和行政记录的审查，包括计费代码和报销情况。本研究在一家农村独立的私人儿科初级保健诊所进行。参与者包括五位儿科初级保健提供者（PCP；两名医学博士、一名整骨疗法博士、两名执业护士）和两名受监督的心理学博士生（BHC）。儿科患者（N = 668）及其父母也参与其中。
有BHC在场的日子里，医疗提供者为每位就诊患者平均少花费2分钟，就诊患者数量比无顾问在场时多42%，收入比无顾问在场时多1142美元。
顾问在场时节省的时间表明了该模式的效率和潜在的财务可行性。这些结果对于在按服务收费系统中聘用行为健康专业人员的可行性具有重要意义。它们对于转向重视协作实践的捆绑式护理系统的效用也具有同样有用的意义。
