Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA.
College of Social Work, University of Utah, Salt Lake City, UT.
Med Care. 2021 Jul 1;59(7):632-638. doi: 10.1097/MLR.0000000000001569.
Integrated behavioral health and primary care can improve the health of persons with complex chronic conditions. The Behavioral Health Integration and Complex Care Initiative (BHICCI) implemented integrated care across a large health system. Whether Behavioral Health Organizations (BHOs) and Federally Qualified Health Centers (FQHCs) implemented the BHICCI differently is unclear.
The objective of this study was to evaluate integration under the BHICCI and to understand implementation differences between BHOs and FQHCs.
We used a convergent parallel mixed-method design. Integration was measured quantitatively using the Maine Health Access Site Self-Assessment (SSA), which was completed by clinic teams at baseline and 24 months, and through n=70 qualitative interviews with initiative stakeholders, which were organized using the Consolidated Framework for Implementation Research. Results were compared to understand how qualitative findings explained quantitative results.
Data were collected in 7 clinics (n=2 FQHC; n=5 BHOs). FQHCs reported greatest improvement in the client centered subscale, with a baseline score of 4.6 (SD=0.64) and 7.8 (SD=0.89) at 24 months. BHOs reported greatest improvement in the organizational supports for integration subscale, with a baseline score of 4.8 (SD=1.07) and 7.9 (SD=1.1) at 24 months. Our Consolidated Framework for Implementation Research analysis illustrates contextual factors, such as insurance plan supports and clinic-level challenges, that explain these scores.
All clinical settings received support from the health plan, but differences between BHOs and FQHCs affected integration progress. Study results can help identify organizational practices that advance or undermine the delivery of integrated care across multiple clinical settings.
综合行为健康和初级保健可以改善患有复杂慢性病的人群的健康状况。行为健康整合和复杂护理倡议（BHICCI）在一个大型医疗系统中实施了综合护理。行为健康组织（BHO）和合格的联邦健康中心（FQHC）是否以不同的方式实施 BHICCI 尚不清楚。
本研究的目的是评估 BHICCI 下的整合情况，并了解 BHO 和 FQHC 之间的实施差异。
我们使用了一种收敛平行混合方法设计。整合程度通过缅因州健康准入网站自我评估（SSA）进行定量测量，该评估由诊所团队在基线和 24 个月时完成，并通过对倡议利益相关者进行 n=70 次定性访谈进行测量，访谈组织使用了实施研究的综合框架。比较结果以了解定性发现如何解释定量结果。
在 7 家诊所（n=2 家 FQHC；n=5 家 BHO）中收集了数据。FQHC 报告在以客户为中心的子量表上的改善最大，基线得分 4.6（SD=0.64），24 个月时为 7.8（SD=0.89）。BHO 报告在整合组织支持子量表上的改善最大，基线得分 4.8（SD=1.07），24 个月时为 7.9（SD=1.1）。我们的实施研究综合框架分析说明了一些背景因素，如保险计划支持和诊所层面的挑战，这些因素可以解释这些分数。
所有临床环境都得到了健康计划的支持，但 BHO 和 FQHC 之间的差异影响了整合的进展。研究结果可以帮助确定组织实践，这些实践可以促进或破坏多个临床环境中综合护理的提供。
