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Research ArticleOriginal ResearchA

A Cluster Randomized Trial of Primary Care Practice Redesign to Integrate Behavioral Health for Those Who Need It Most: Patients With Multiple Chronic Conditions

Benjamin Littenberg, Jessica Clifton, Abigail M. Crocker, Laura-Mae Baldwin, Levi N. Bonnell, Ryan E. Breshears, Peter Callas, Prama Chakravarti, Kelly Clark/Keefe, Deborah J. Cohen, Frank V. deGruy, Lauren Eidt-Pearson, William Elder, Chester Fox, Sylvie Frisbie, Katie Hekman, Juvena Hitt, Jennifer Jewiss, David C. Kaelber, Kairn Stetler Kelley, Rodger Kessler, Jennifer B. O’Rourke-Lavoie, George S. Leibowitz, C. R. Macchi, Matthew P. Martin, Mark McGovern, Brenda Mollis, Daniel Mullin, Zsolt Nagykaldi, Lisa W. Natkin, Wilson Pace, Richard G. Pinckney, Douglas Pomeroy, Paula Reynolds, Gail L. Rose, Sarah Hudson Scholle, William J. Sieber, Jeni Soucie, Terry Stancin, Kurt C. Stange, Kari A. Stephens, Kathryn Teng, Elizabeth Needham Waddell and Constance van Eeghen
The Annals of Family Medicine November 2023, 21 (6) 483-495; DOI: https://doi.org/10.1370/afm.3027
Benjamin Littenberg
University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.);
MD
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  • For correspondence: benjamin.littenberg@uvm.edu
Jessica Clifton
University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.);
Parhelia Wellness, Santa Rosa, California (J.C.);
PhD
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Abigail M. Crocker
University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.);
PhD
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Laura-Mae Baldwin
University of Washington, Seattle, Washington (L-M.B., B.M., K.A.S.);
MD, MPH
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Levi N. Bonnell
University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.);
PhD
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Ryan E. Breshears
Wellstar Health System, Marietta, Georgia (R.E.B.);
PhD
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Peter Callas
University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.);
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Prama Chakravarti
Prama Psychology, PLLC, Richland, Washington (P.C.);
PhD
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Kelly Clark/Keefe
University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.);
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Deborah J. Cohen
Oregon Health & Science University, Portland, Oregon (D.J.C., E.N.W.);
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Frank V. deGruy
University of Colorado School of Medicine, Aurora, Colorado (F.V.D., R.K.);
MD
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Lauren Eidt-Pearson
UMass Chan Medical School, Worcester, Massachusetts (L.E-P., D.M.);
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William Elder
University of Houston, Houston, Texas (W.E.);
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Chester Fox
University at Buffalo, Buffalo, New York (C.F.);
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Sylvie Frisbie
University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.);
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Katie Hekman
University of California San Diego, San Diego, California (K.H., W.J.S.);
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Juvena Hitt
University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.);
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Jennifer Jewiss
University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.);
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David C. Kaelber
The MetroHealth System, Cleveland, Ohio (D.C.K., T.S., K.T.);
Case Western Reserve University, Cleveland, Ohio (D.C.K., K.C.S.);
MD, PhD, MPH
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Kairn Stetler Kelley
University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.);
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Rodger Kessler
University of Colorado School of Medicine, Aurora, Colorado (F.V.D., R.K.);
PhD
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Jennifer B. O’Rourke-Lavoie
University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.);
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George S. Leibowitz
Stony Brook University, Stony Brook, New York (G.S.L.);
PhD
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C. R. Macchi
Arizona State University, Tempe, Arizona (C.R.M., M.P.M.);
PhD
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Matthew P. Martin
Arizona State University, Tempe, Arizona (C.R.M., M.P.M.);
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Mark McGovern
Stanford University School of Medicine, Stanford, California (M.M.);
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Brenda Mollis
University of Washington, Seattle, Washington (L-M.B., B.M., K.A.S.);
MPH, MPA, MA
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Daniel Mullin
UMass Chan Medical School, Worcester, Massachusetts (L.E-P., D.M.);
PsyD, MPH
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Zsolt Nagykaldi
University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma (Z.N.);
PhD
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Lisa W. Natkin
University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.);
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Wilson Pace
DARTNet Institute, Aurora, Colorado (W.P.);
MD
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Richard G. Pinckney
University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.);
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Douglas Pomeroy
University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.);
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Paula Reynolds
University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.);
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Gail L. Rose
University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.);
PhD
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Sarah Hudson Scholle
National Committee for Quality Assurance, Washington, DC (S.H.S., J.S.)
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William J. Sieber
University of California San Diego, San Diego, California (K.H., W.J.S.);
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Jeni Soucie
National Committee for Quality Assurance, Washington, DC (S.H.S., J.S.)
MS
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Terry Stancin
The MetroHealth System, Cleveland, Ohio (D.C.K., T.S., K.T.);
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Kurt C. Stange
Case Western Reserve University, Cleveland, Ohio (D.C.K., K.C.S.);
MD, PhD
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Kari A. Stephens
University of Washington, Seattle, Washington (L-M.B., B.M., K.A.S.);
PhD
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Kathryn Teng
The MetroHealth System, Cleveland, Ohio (D.C.K., T.S., K.T.);
MD
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Elizabeth Needham Waddell
Oregon Health & Science University, Portland, Oregon (D.J.C., E.N.W.);
PhD
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Constance van Eeghen
University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.);
DrPH, MHSA, MBA
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Article Information

vol. 21 no. 6 483-495
DOI 
https://doi.org/10.1370/afm.3027
PubMed 
38012036

Published By 
The Annals of Family Medicine
Print ISSN 
1544-1709
Online ISSN 
1544-1717
History 
  • Received for publication December 21, 2022
  • Revision received May 5, 2023
  • Accepted for publication May 31, 2023
  • Published online November 27, 2023.

Copyright & Usage 
© 2023 Annals of Family Medicine, Inc.

Author Information

  1. Benjamin Littenberg, MD⇑,
  2. Jessica Clifton, PhD,
  3. Abigail M. Crocker, PhD,
  4. Laura-Mae Baldwin, MD, MPH,
  5. Levi N. Bonnell, PhD,
  6. Ryan E. Breshears, PhD,
  7. Peter Callas, PhD,
  8. Prama Chakravarti, PhD,
  9. Kelly Clark/Keefe, EdD,
  10. Deborah J. Cohen, PhD,
  11. Frank V. deGruy, MD,
  12. Lauren Eidt-Pearson, MSW, LICSW,
  13. William Elder, PhD,
  14. Chester Fox, MD,
  15. Sylvie Frisbie,
  16. Katie Hekman, RN,
  17. Juvena Hitt, MPH,
  18. Jennifer Jewiss, EdD,
  19. David C. Kaelber, MD, PhD, MPH,
  20. Kairn Stetler Kelley, PhD,
  21. Rodger Kessler, PhD,
  22. Jennifer B. O’Rourke-Lavoie,
  23. George S. Leibowitz, PhD,
  24. C. R. Macchi, PhD,
  25. Matthew P. Martin, PhD,
  26. Mark McGovern, PhD,
  27. Brenda Mollis, MPH, MPA, MA,
  28. Daniel Mullin, PsyD, MPH,
  29. Zsolt Nagykaldi, PhD,
  30. Lisa W. Natkin, PhD,
  31. Wilson Pace, MD,
  32. Richard G. Pinckney, MD, MPH,
  33. Douglas Pomeroy,
  34. Paula Reynolds,
  35. Gail L. Rose, PhD,
  36. Sarah Hudson Scholle, DrPH, MPH,
  37. William J. Sieber, PhD,
  38. Jeni Soucie, MS,
  39. Terry Stancin, PhD,
  40. Kurt C. Stange, MD, PhD,
  41. Kari A. Stephens, PhD,
  42. Kathryn Teng, MD,
  43. Elizabeth Needham Waddell, PhD and
  44. Constance van Eeghen, DrPH, MHSA, MBA
  1. University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.);
  2. Parhelia Wellness, Santa Rosa, California (J.C.);
  3. University of Washington, Seattle, Washington (L-M.B., B.M., K.A.S.);
  4. Wellstar Health System, Marietta, Georgia (R.E.B.);
  5. Prama Psychology, PLLC, Richland, Washington (P.C.);
  6. Oregon Health & Science University, Portland, Oregon (D.J.C., E.N.W.);
  7. University of Colorado School of Medicine, Aurora, Colorado (F.V.D., R.K.);
  8. UMass Chan Medical School, Worcester, Massachusetts (L.E-P., D.M.);
  9. University of Houston, Houston, Texas (W.E.);
  10. University at Buffalo, Buffalo, New York (C.F.);
  11. University of California San Diego, San Diego, California (K.H., W.J.S.);
  12. The MetroHealth System, Cleveland, Ohio (D.C.K., T.S., K.T.);
  13. Case Western Reserve University, Cleveland, Ohio (D.C.K., K.C.S.);
  14. Stony Brook University, Stony Brook, New York (G.S.L.);
  15. Arizona State University, Tempe, Arizona (C.R.M., M.P.M.);
  16. Stanford University School of Medicine, Stanford, California (M.M.);
  17. University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma (Z.N.);
  18. DARTNet Institute, Aurora, Colorado (W.P.);
  19. National Committee for Quality Assurance, Washington, DC (S.H.S., J.S.)
  1. CORRESPONDING AUTHOR Benjamin Littenberg Division of General Internal Medicine Research Department of Medicine Robert Larner MD College of Medicine at the University of Vermont University of Vermont 89 Beaumont Ave Burlington, VT 05405 benjamin.littenberg{at}uvm.edu

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The Annals of Family Medicine: 21 (6)
The Annals of Family Medicine: 21 (6)
Vol. 21, Issue 6
November/December 2023
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A Cluster Randomized Trial of Primary Care Practice Redesign to Integrate Behavioral Health for Those Who Need It Most: Patients With Multiple Chronic Conditions
Benjamin Littenberg, Jessica Clifton, Abigail M. Crocker, Laura-Mae Baldwin, Levi N. Bonnell, Ryan E. Breshears, Peter Callas, Prama Chakravarti, Kelly Clark/Keefe, Deborah J. Cohen, Frank V. deGruy, Lauren Eidt-Pearson, William Elder, Chester Fox, Sylvie Frisbie, Katie Hekman, Juvena Hitt, Jennifer Jewiss, David C. Kaelber, Kairn Stetler Kelley, Rodger Kessler, Jennifer B. O’Rourke-Lavoie, George S. Leibowitz, C. R. Macchi, Matthew P. Martin, Mark McGovern, Brenda Mollis, Daniel Mullin, Zsolt Nagykaldi, Lisa W. Natkin, Wilson Pace, Richard G. Pinckney, Douglas Pomeroy, Paula Reynolds, Gail L. Rose, Sarah Hudson Scholle, William J. Sieber, Jeni Soucie, Terry Stancin, Kurt C. Stange, Kari A. Stephens, Kathryn Teng, Elizabeth Needham Waddell, Constance van Eeghen
The Annals of Family Medicine Nov 2023, 21 (6) 483-495; DOI: 10.1370/afm.3027

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A Cluster Randomized Trial of Primary Care Practice Redesign to Integrate Behavioral Health for Those Who Need It Most: Patients With Multiple Chronic Conditions
Benjamin Littenberg, Jessica Clifton, Abigail M. Crocker, Laura-Mae Baldwin, Levi N. Bonnell, Ryan E. Breshears, Peter Callas, Prama Chakravarti, Kelly Clark/Keefe, Deborah J. Cohen, Frank V. deGruy, Lauren Eidt-Pearson, William Elder, Chester Fox, Sylvie Frisbie, Katie Hekman, Juvena Hitt, Jennifer Jewiss, David C. Kaelber, Kairn Stetler Kelley, Rodger Kessler, Jennifer B. O’Rourke-Lavoie, George S. Leibowitz, C. R. Macchi, Matthew P. Martin, Mark McGovern, Brenda Mollis, Daniel Mullin, Zsolt Nagykaldi, Lisa W. Natkin, Wilson Pace, Richard G. Pinckney, Douglas Pomeroy, Paula Reynolds, Gail L. Rose, Sarah Hudson Scholle, William J. Sieber, Jeni Soucie, Terry Stancin, Kurt C. Stange, Kari A. Stephens, Kathryn Teng, Elizabeth Needham Waddell, Constance van Eeghen
The Annals of Family Medicine Nov 2023, 21 (6) 483-495; DOI: 10.1370/afm.3027
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Subjects

  • Domains of illness & health:
    • Chronic illness
    • Mental health
  • Person groups:
    • Older adults
  • Methods:
    • Quantitative methods
  • Other research types:
    • Professional practice
  • Core values of primary care:
    • Comprehensiveness
    • Coordination / integration of care
  • Other topics:
    • Multimorbidity

Keywords

  • behavioral health integration
  • behavioral medicine
  • primary care
  • multiple chronic conditions
  • pragmatic clinical trial
  • randomized controlled trial

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