From Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health in Dallas, Dallas, TX (KKJ, BAB); Department of Family Medicine, Oregon Health & Science University, Portland, OR (TTW, RG, BM, KDC, JED, DJC); OCHIN, Inc., Portland (JED).
J Am Board Fam Med. 2018 Sep-Oct;31(5):712-723. doi: 10.3122/jabfm.2018.05.180041.
Integrating behavioral health into primary care can improve care quality; however, most electronic health records are not designed to meet the needs of integrated teams. We worked with practices and behavioral health (BH) clinicians to design a suite of electronic health record tools to address these needs ("BH e-Suite"). The purpose of this article is to examine whether implementation of the BH e-Suite changes process of care, intermediate clinical outcomes, and patient experiences, and whether its use is acceptable to practice members and BH clinicians.
We conducted a convergent mixed-methods proof-of-concept study, implementing the BH e-Suite across 6 Oregon federally qualified community health centers ("intervention clinics"). We matched intervention clinics to 6 control clinics, based on location and patient panel characteristics, to assess whether process of care (Patient Health Questionnaire-9 [PHQ-9] and Generalized Anxiety Disorder-7 screening) and intermediate outcomes (PHQ-9, Generalized Anxiety Disorder-7 scores) changed postimplementation. Prepost patient surveys were used to assess changes in patient experience. To elucidate factors influencing implementation, we merged quantitative findings with structured observations, surveys, and interviews with practice members.
Implementation improved process of care (PHQ-9 screening). During the course of the study, change in intermediate outcomes was not observed. Degree of BH e-Suite implementation varied: 2 clinics fully implemented, 2 partially implemented, and 2 practices did not implement at all. Initial practice conditions (eg, low resistance to change, higher capacity), process characteristics (eg, thoughtful planning), and individual characteristics (eg, high self-efficacy) were related to degree of implementation.
Health information technology tools designed for behavioral health integration must fit the needs of clinics for the successful uptake and improvement in patient experiences. Research is needed to further assess the effectiveness of this tool in improving patient outcomes and to optimize broader dissemination of this tool among primary care clinics integrating behavioral health.
将行为健康融入初级保健可以提高护理质量；然而，大多数电子健康记录的设计无法满足整合团队的需求。我们与实践和行为健康（BH）临床医生合作，设计了一套电子健康记录工具来满足这些需求（“BH e-Suite”）。本文的目的是检验实施 BH e-Suite 是否会改变护理流程、中间临床结果和患者体验，以及其使用是否被实践成员和 BH 临床医生接受。
我们进行了一项收敛混合方法的概念验证研究，在俄勒冈州的 6 家联邦合格社区卫生中心（“干预诊所”）实施 BH e-Suite。我们根据地理位置和患者群体特征将干预诊所与 6 家对照诊所相匹配，以评估护理流程（PHQ-9 和广泛性焦虑症-7 筛查）和中间结果（PHQ-9、广泛性焦虑症-7 评分）是否在实施后发生变化。使用前后的患者调查评估患者体验的变化。为了阐明影响实施的因素，我们将定量发现与结构观察、实践成员的调查和访谈相结合。
实施改善了护理流程（PHQ-9 筛查）。在研究过程中，未观察到中间结果的变化。BH e-Suite 的实施程度不同：2 家诊所完全实施，2 家诊所部分实施，2 家诊所根本没有实施。初始实践条件（例如，对变革的抵抗力低，能力高）、过程特征（例如，深思熟虑的规划）和个人特征（例如，高自我效能感）与实施程度相关。
为行为健康整合而设计的健康信息技术工具必须符合诊所的需求，以实现成功采用并改善患者体验。需要进一步研究来评估该工具在改善患者结局方面的有效性，并优化该工具在整合行为健康的初级保健诊所中的广泛传播。
