Department of Family Medicine, University of Washington, Seattle, WA, USA.
Psychiatry and Behavioral Sciences, University of Washington, Burlington, VT, USA.
Transl Behav Med. 2020 Aug 7;10(3):527-538. doi: 10.1093/tbm/ibz163.
A movement towards integrated behavioral health (IBH) in primary care continues to grow, among an accumulating evidence base for its effectiveness for improving care. However, healthcare organizations struggle to navigate where to target their limited resources for improving integration. We evaluated a cross-model framework of IBH core processes and structures. We used a mixed-methods approach for evaluation of the framework, which included (a) an evaluation survey of national experts and stakeholders, (b) crosswalks with common IBH measures, and (c) a real-world usability test. Five core IBH principles, mapping to 25 processes, and nine clinic structures were defined. Survey responses from 29 IBH domain and policy experts and stakeholders resulted in uniformly high ratings of importance and variable levels of feasibility for measurement, particularly with respect to electronic health record (EHR) systems. A real-world usability test resulted in good uptake and use of the framework across a state-wide effort. An IBH Cross-Model Framework of core principles, processes, and structures generated good acceptability and showed good real-world utility in a state-wide effort to improve IBH across disparate levels of integration in diverse primary care settings. Findings identify feasible areas of measurement, particularly with EHR systems. Next steps include testing the relationship between the individual framework components and patient outcomes to help guide clinics towards prioritizing efforts focused on improving integration.
综合性基础保健（IBH）在初级保健中的发展趋势持续增长，其有效性的证据基础也在不断积累，以改善医疗服务。然而，医疗保健组织在确定将有限资源用于何处以提高整合度方面存在困难。我们评估了 IBH 核心流程和结构的跨模型框架。我们采用了混合方法来评估该框架，包括（a）对国家专家和利益相关者的评估调查，（b）与常见 IBH 措施的交叉对照，以及（c）真实世界的可用性测试。确定了五个 IBH 核心原则，映射到 25 个流程和九个诊所结构。对 29 名 IBH 领域和政策专家和利益相关者的调查回复得出了一致的高重要性评分和不同程度的可衡量性评分，尤其是在电子健康记录（EHR）系统方面。真实世界的可用性测试在全州范围内的努力中产生了良好的接受度和框架的使用。IBH 跨模型框架的核心原则、流程和结构在全州范围内提高 IBH 的努力中具有良好的可接受性和实际效用，适用于不同整合程度和不同初级保健环境。研究结果确定了可行的测量领域，特别是在 EHR 系统方面。下一步包括测试框架各个组成部分与患者结果之间的关系，以帮助指导诊所优先考虑旨在提高整合度的努力。
