Peterson Mary, Turgesen Jeri, Fisk Laura, McCarthy Seamus
Graduate Department of Clinical Psychology, George Fox University.
Yamhill Community Care Organization.
Fam Syst Health. 2017 Jun;35(2):167-173. doi: 10.1037/fsh0000267.
The increased awareness of the financial impact associated with social determinants of health coincides with expectations of the Affordable Care Act (HR 3590) to improve care while reducing costs. The integration of behavioral health providers (BHPs) into primary care has demonstrated improved clinical outcomes. This study was designed with 2 aims, including the evaluation of the financial viability of an integrated care model in a rural setting and the demonstration of incorporating practice-based research into clinical work.
A rural health plan caring for 22,000 members funded a pilot project placing BHPs in 3 clinics to provide integrated care. Patient utilization of medical services for 6 months following BHP services was compared with baseline utilization.
The BHPs treated 256 unique patients, with a total of 459 consultations. The percentage of patients receiving BHP services varied between clinics (Clinic A = 1.4%, Clinic B = 2.7%, and Clinic C = 3.9%). A between-clinic analysis showed differences in medical claims data between baseline and post-BH services. The overall effect sizes for reduced medical utilization for patients at clinics B and C were very large, Hedge's g = -2.31 and -4.79, respectively. Utilization of 4 of the services (emergency, lab, outpatient, and primary care) showed the large reductions in their costs. In contrast, the data for Clinic A showed no change.
Patients receiving behavioral health services within the integrated care model may decrease utilization of medical services following treatment, resulting in cost offset. Potential reasons for variability between clinics are discussed. (PsycINFO Database Record
人们对健康的社会决定因素所带来的经济影响的认识不断提高，这与《平价医疗法案》（HR 3590）在改善医疗服务的同时降低成本的期望相契合。将行为健康服务提供者（BHP）纳入初级保健已显示出临床效果的改善。本研究旨在实现两个目标，包括评估农村地区综合护理模式的财务可行性，以及证明将基于实践的研究纳入临床工作。
一项为22,000名成员提供服务的农村健康计划资助了一个试点项目，在3家诊所安排BHP提供综合护理。将BHP服务后6个月患者的医疗服务利用率与基线利用率进行比较。
BHP共治疗了256名不同患者，总计进行了459次会诊。接受BHP服务的患者百分比在各诊所之间有所不同（诊所A = 1.4%，诊所B = 2.7%，诊所C = 3.9%）。诊所间分析显示基线和BHP服务后医疗索赔数据存在差异。诊所B和C患者医疗利用率降低的总体效应量非常大，Hedge's g分别为-2.31和-4.79。4种服务（急诊、实验室、门诊和初级保健）的利用率显示其成本大幅降低。相比之下，诊所A的数据没有变化。
在综合护理模式下接受行为健康服务的患者在治疗后可能会降低医疗服务利用率，从而实现成本抵消。讨论了诊所之间存在差异的潜在原因。（PsycINFO数据库记录）
