University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; and
University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; and.
Pediatrics. 2018 Nov;142(5). doi: 10.1542/peds.2017-2417. Epub 2018 Oct 3.
The prevalence of mental health problems among adolescents in the United States is a major public health concern. However, the uptake of mental health treatment is low. Integrating behavioral health into primary care is 1 research-informed strategy to increase engagement in treatment. Facilitators of and barriers to implementation of integrated behavioral health in a pediatric primary care setting are not well delineated.
We examined the effectiveness of 2 mental health quality improvement strategies: an electronic referral and a social work follow-up protocol. We analyzed the following measures: uptake rate of first mental health appointments, overall use of mental health appointments, and first and overall mental health appointment show rate.
Overall use rate improved after implementation of electronic referral, with 13 consecutive points above the median. First appointment show rates improved with a special cause run occurring after adding social work students to the mental health quality improvement team. First appointment show rate improved from a monthly average of 51% (November 2014 to March 2016) to 78% (April 2016 to December 2016). Use rate improved initially with increased efforts in assisting patients with scheduling; show rate improved more slowly after an emphasis on scheduling patients exhibiting treatment readiness.
Findings suggest that a number of facilitators can increase the effective use of mental health services in an integrated adolescent clinical setting. These include an electronic referral through a shared electronic health record, multidisciplinary collaboration, and care management by social workers equipped with a variety of clinical and care coordination skills.
美国青少年心理健康问题的普遍性是一个主要的公共卫生关注点。然而，心理健康治疗的接受程度很低。将行为健康纳入初级保健是增加治疗参与度的一种经过研究证实的策略。在儿科初级保健环境中实施综合行为健康的促进因素和障碍尚不清楚。
我们研究了两种心理健康质量改进策略的效果：电子转诊和社会工作随访协议。我们分析了以下措施：首次心理健康预约的接受率、整体心理健康预约的使用情况，以及首次和整体心理健康预约的显示率。
电子转诊实施后，整体使用率有所提高，连续 13 次高于中位数。在向心理健康质量改进团队中增加社会工作学生后，特别原因运行导致首次预约显示率有所提高。首次预约显示率从 2014 年 11 月至 2016 年 3 月的每月平均 51%提高到 2016 年 4 月至 12 月的 78%。通过增加协助患者安排预约的努力，使用率最初有所提高；在强调安排表现出治疗准备的患者后，显示率的提高速度较慢。
研究结果表明，许多促进因素可以提高综合青少年临床环境中心理健康服务的有效利用。这些因素包括通过共享电子健康记录进行电子转诊、多学科合作以及配备各种临床和护理协调技能的社会工作者进行护理管理。
