Reliant Medical Group, OptumCare, Worcester, MA, United States.
United Health Group, Minnetonka, MN, United States.
J Med Internet Res. 2024 Oct 30;26:e54528. doi: 10.2196/54528.
In the United States, innovation is needed to address the increasing need for mental health care services and widen the patient-to-provider ratio. Despite the benefits of digital mental health interventions (DMHIs), they have not been effective in addressing patients' behavioral health challenges as stand-alone treatments.
This study evaluates the implementation and effectiveness of precision behavioral health (PBH), a digital-first behavioral health care model embedded within routine primary care that refers patients to an ecosystem of evidence-based DMHIs with strategically placed human support.
Patient demographic information, triage visit outcomes, multidimensional patient-reported outcome measure, enrollment, and engagement with the DMHIs were analyzed using data from the electronic health record and vendor-reported data files. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework was used to evaluate the implementation and clinical effectiveness outcomes of PBH.
PBH had a 47.58% reach rate, defined as patients accepting the PBH referral from their behavioral health integrated clinician. PBH patients had high DMHI registration rates (79.62%), high activation rates (76.54%), and high retention rates at 15 days (57.69%) and 30 days (44.58%) compared to literature benchmarks. In total, 74.01% (n=168) of patients showed clinical improvement, 22.47% (n=51) showed no clinical change, and 3.52% (n=8) showed clinical deterioration in symptoms. PBH had high adoption rates, with behavioral health integrated clinicians referring on average 4.35 (SD 0.46) patients to PBH per month and 90%-100% of clinicians (n=12) consistently referring at least 1 patient to PBH each month. A third (32%, n=1114) of patients were offered PBH as a treatment option during their triage visit.
PBH as a care model with evidence-based DMHIs, human support for patients, and integration within routine settings offers a credible service to support patients with mild to moderate mental health challenges. This type of model has the potential to address real-life access to care problems faced by health care settings.
在美国，需要创新来满足不断增长的精神卫生保健服务需求，并扩大医患比例。尽管数字心理健康干预（DMHI）有其益处，但它们作为单一治疗方法并不能有效解决患者的行为健康挑战。
本研究评估了精准行为健康（PBH）的实施情况和效果，这是一种嵌入常规初级保健中的数字优先行为保健模式，它将患者转介给一个基于证据的 DMHI 生态系统，并提供战略性的人工支持。
使用电子健康记录和供应商报告的数据文件，分析患者的人口统计学信息、分诊就诊结果、多维患者报告结局测量、入组和与 DMHI 的互动情况。使用 RE-AIM（可及性、有效性、采用、实施、维持）框架评估 PBH 的实施和临床效果结果。
PBH 的可及性（即患者接受其行为健康整合临床医生的 PBH 转介）达到了 47.58%。PBH 患者的 DMHI 注册率（79.62%）、激活率（76.54%）和 15 天（57.69%）和 30 天（44.58%）的保留率均高于文献基准。共有 74.01%（n=168）的患者显示出临床改善，22.47%（n=51）显示出无临床变化，3.52%（n=8）的患者症状出现临床恶化。PBH 的采用率很高，行为健康整合临床医生平均每月为 PBH 转介 4.35（SD 0.46）名患者，90%-100%（n=12）的临床医生每月始终为 PBH 转介至少 1 名患者。在分诊就诊时，有三分之一（32%，n=1114）的患者被提供 PBH 作为治疗选择。
作为一种包含基于证据的 DMHI、患者人工支持的护理模式，以及在常规环境中的整合，PBH 为支持有轻度至中度心理健康挑战的患者提供了一种可靠的服务。这种模式有可能解决医疗保健环境中面临的实际获得护理的问题。
