Department of Veterans Affairs, Center for Clinical Management Research, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA.
Department of Psychiatry, University of Michigan Medical School, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA.
BMC Health Serv Res. 2017 Aug 29;17(1):612. doi: 10.1186/s12913-017-2562-z.
Incorporating behavioral health care into patient centered medical homes is critical for improving patient health and care quality while reducing costs. Despite documented effectiveness of behavioral health integration (BHI) in primary care settings, implementation is limited outside of large health systems. We conducted a survey of BHI in primary care practices participating in the Comprehensive Primary Care (CPC) initiative, a four-year multi-payer initiative of the Centers for Medicare and Medicaid Services (CMS). We sought to explore associations between practice characteristics and the extent of BHI to illuminate possible factors influencing successful implementation.
We fielded a survey that addressed six substantive domains (integrated space, training, access, communication and coordination, treatment planning, and available resources) and five behavioral health conditions (depression, anxiety, pain, alcohol use disorder, and cognitive function). Descriptive statistics compared BHI survey respondents to all CPC practices, documented the availability of behavioral health providers, and primary care and behavioral health provider communication. Bivariate relationships compared provider and practice characteristics and domain scores.
One hundred sixty-one of 188 eligible primary care practices completed the survey (86% response rate). Scores indicated basic to good baseline implementation of BHI in all domains, with lowest scores on communication and coordination and highest scores for depression. Higher scores were associated with: having any behavioral health provider, multispecialty practice, patient-centered medical home designation, and having any communication between behavioral health and primary care providers.
This study provides useful data on opportunities and challenges of scaling BHI integration linked to primary care transformation. Payment reform models such as CPC can assist in BHI promotion and development.
将行为健康护理纳入以患者为中心的医疗之家对于改善患者健康和护理质量，同时降低成本至关重要。尽管在初级保健环境中已经证明行为健康整合（BHI）的有效性，但在大型医疗系统之外，其实施受到限制。我们对参与综合初级保健（CPC）计划的初级保健实践中的 BHI 进行了调查，该计划是医疗保险和医疗补助服务中心（CMS）的为期四年的多方计划。我们试图探讨实践特征与 BHI 程度之间的关联，以阐明可能影响成功实施的因素。
我们进行了一项调查，该调查涉及六个实质性领域（整合空间、培训、就诊机会、沟通与协调、治疗计划和可用资源）和五个行为健康状况（抑郁、焦虑、疼痛、酒精使用障碍和认知功能）。描述性统计比较了 BHI 调查受访者与所有 CPC 实践，记录了行为健康提供者的可用性以及初级保健和行为健康提供者之间的沟通情况。对提供者和实践特征以及域评分进行了单变量关系比较。
在 188 家符合条件的初级保健实践中，有 161 家完成了调查（86%的回应率）。评分表明，所有领域的 BHI 基本实施良好，但沟通和协调得分最低，抑郁得分最高。较高的分数与以下因素相关：拥有任何行为健康提供者、多专业实践、以患者为中心的医疗之家指定以及行为健康和初级保健提供者之间存在任何沟通。
这项研究提供了有关与初级保健转型相关的 BHI 整合扩展的机会和挑战的有用数据。CPC 等支付改革模型可以协助促进和发展 BHI。
