Stephens Kari A, van Eeghen Constance, Zheng Zihan, Anastas Tracy, Ma Kris Pui Kwan, Prado Maria G, Clifton Jessica, Rose Gail, Mullin Daniel, Chan Kwun C G, Kessler Rodger
Department of Family Medicine, University of Washington, Seattle, Washington
Department of Medicine, University of Vermont, Burlington, Vermont.
Ann Fam Med. 2025 Jan 27;23(1):35-43. doi: 10.1370/afm.230576.
We performed a pragmatic, cluster randomized controlled trial of a comprehensive practice-level, multistage practice transformation intervention aiming to increase behavioral health integration in primary care practices and improve patient outcomes. We examined associations between completion of intervention stages and patient outcomes across a heterogeneous national sample of primary care practices.
Forty-two primary care practices across the United States with colocated behavioral health and 2,945 patients with multiple chronic medical and behavioral health conditions completed surveys at baseline, midpoint, and 2-year follow-up. We examined effects of intervention on patient health and primary care integration outcomes using multilevel mixed-effects models, controlling for baseline outcome measurements.
No differences were found associated with the number of intervention stages completed and patient health outcomes including depression, anxiety, fatigue, sleep disturbance, pain, pain interference, social participation, and physical function. However, the completion of each intervention stage was associated with increases in Practice Integration Profile domain scores and confirmed with modeling using multiple imputation for the following: workflow 3.5 (95% CI, 0.9 to 6.1), integration methods 4.6 (95% CI, 1.5 to 7.6), patient identification 2.9 (95% CI, 0.9 to 5.0), and total integration 2.7 (95% CI, 0.7 to 4.7).
A practice-centric flexible practice transformation intervention improved integration of behavioral health in primary care across heterogeneous primary care practices treating patients with multiple chronic conditions when accounting for completion of intervention stages. Interventions that allow practices to flexibly improve care have the potential to help complex patient populations. Future research is needed to determine how to best target patient health outcomes at the population level.
我们开展了一项务实的整群随机对照试验，对一项全面的实践层面多阶段实践转型干预措施进行评估，旨在增强初级保健机构中行为健康整合度并改善患者治疗效果。我们在一个异质性的全国初级保健机构样本中，研究了干预阶段的完成情况与患者治疗效果之间的关联。
美国42家设有同址行为健康服务的初级保健机构以及2945名患有多种慢性疾病和行为健康问题的患者在基线、中期和2年随访时完成了调查。我们使用多水平混合效应模型，在控制基线结果测量值的情况下，研究干预措施对患者健康和初级保健整合效果的影响。
未发现完成的干预阶段数量与患者健康结局（包括抑郁、焦虑、疲劳、睡眠障碍、疼痛、疼痛干扰、社会参与和身体功能）之间存在差异。然而，每个干预阶段的完成都与实践整合概况领域得分的增加相关，并且通过多重填补建模得到证实，具体如下：工作流程3.5（95%置信区间，0.9至6.1）、整合方法4.6（95%置信区间，1.5至7.6）、患者识别2.9（95%置信区间，0.9至5.0）以及总体整合2.7（95%置信区间，0.7至4.7）。
以实践为中心的灵活实践转型干预措施，在考虑干预阶段完成情况时，改善了不同类型初级保健机构中为患有多种慢性病患者提供的初级保健中行为健康的整合。允许各机构灵活改善医疗服务的干预措施有潜力帮助复杂的患者群体。未来需要开展研究，以确定如何在人群层面上最佳地针对患者健康结局。
