RT Journal Article
SR Electronic
T1 A Cluster Randomized Trial of Primary Care Practice Redesign to Integrate Behavioral Health for Those Who Need It Most: Patients With Multiple Chronic Conditions
JF The Annals of Family Medicine
JO Ann Fam Med
FD American Academy of Family Physicians
SP 483
OP 495
DO 10.1370/afm.3027
VO 21
IS 6
A1 Littenberg, Benjamin
A1 Clifton, Jessica
A1 Crocker, Abigail M.
A1 Baldwin, Laura-Mae
A1 Bonnell, Levi N.
A1 Breshears, Ryan E.
A1 Callas, Peter
A1 Chakravarti, Prama
A1 Clark/Keefe, Kelly
A1 Cohen, Deborah J.
A1 deGruy, Frank V.
A1 Eidt-Pearson, Lauren
A1 Elder, William
A1 Fox, Chester
A1 Frisbie, Sylvie
A1 Hekman, Katie
A1 Hitt, Juvena
A1 Jewiss, Jennifer
A1 Kaelber, David C.
A1 Kelley, Kairn Stetler
A1 Kessler, Rodger
A1 O’Rourke-Lavoie, Jennifer B.
A1 Leibowitz, George S.
A1 Macchi, C. R.
A1 Martin, Matthew P.
A1 McGovern, Mark
A1 Mollis, Brenda
A1 Mullin, Daniel
A1 Nagykaldi, Zsolt
A1 Natkin, Lisa W.
A1 Pace, Wilson
A1 Pinckney, Richard G.
A1 Pomeroy, Douglas
A1 Reynolds, Paula
A1 Rose, Gail L.
A1 Scholle, Sarah Hudson
A1 Sieber, William J.
A1 Soucie, Jeni
A1 Stancin, Terry
A1 Stange, Kurt C.
A1 Stephens, Kari A.
A1 Teng, Kathryn
A1 Waddell, Elizabeth Needham
A1 van Eeghen, Constance
YR 2023
UL http://www.annfammed.org/content/21/6/483.abstract
AB PURPOSE Patient outcomes can improve when primary care and behavioral health providers use a collaborative system of care, but integrating these services is difficult. We tested the effectiveness of a practice intervention for improving patient outcomes by enhancing integrated behavioral health (IBH) activities.METHODS We conducted a pragmatic, cluster randomized controlled trial. The intervention combined practice redesign, quality improvement coaching, provider and staff education, and collaborative learning. At baseline and 2 years, staff at 42 primary care practices completed the Practice Integration Profile (PIP) as a measure of IBH. Adult patients with multiple chronic medical and behavioral conditions completed the Patient-Reported Outcomes Measurement Information System (PROMIS-29) survey. Primary outcomes were the change in 8 PROMIS-29 domain scores. Secondary outcomes included change in level of integration.RESULTS Intervention assignment had no effect on change in outcomes reported by 2,426 patients who completed both baseline and 2-year surveys. Practices assigned to the intervention improved PIP workflow scores but not PIP total scores. Baseline PIP total score was significantly associated with patient-reported function, independent of intervention. Active practices that completed intervention workbooks (n = 13) improved patient-reported outcomes and practice integration (P ≤ .05) compared with other active practices (n = 7).CONCLUSION Intervention assignment had no effect on change in patient outcomes; however, we did observe improved patient outcomes among practices that entered the study with greater IBH. We also observed more improvement of integration and patient outcomes among active practices that completed the intervention compared to active practices that did not. Additional research is needed to understand how implementation efforts to enhance IBH can best reach patients.