TY - JOUR
T1 - A Cluster Randomized Trial of Primary Care Practice Redesign to Integrate Behavioral Health for Those Who Need It Most
T2 - Patients With Multiple Chronic Conditions
AU - Littenberg, Benjamin
AU - Clifton, Jessica
AU - Crocker, Abigail M.
AU - Baldwin, Laura Mae
AU - Bonnell, Levi N.
AU - Breshears, Ryan E.
AU - Callas, Peter
AU - Chakravarti, Prama
AU - Clark/keefe, Kelly
AU - Cohen, Deborah J.
AU - Degruy, Frank V.
AU - Eidt-Pearson, Lauren
AU - Elder, William
AU - Fox, Chester
AU - Frisbie, Sylvie
AU - Hekman, Katie
AU - Hitt, Juvena
AU - Jewiss, Jennifer
AU - Kaelber, David C.
AU - Kelley, Kairn Stetler
AU - Kessler, Rodger
AU - O’rourke-Lavoie, Jennifer B.
AU - Leibowitz, George S.
AU - Macchi, Charles
AU - Martin, Matthew P.
AU - McGovern, Mark
AU - Mollis, Brenda
AU - Mullin, Daniel
AU - Nagykaldi, Zsolt
AU - Natkin, Lisa W.
AU - Pace, Wilson
AU - Pinckney, Richard G.
AU - Pomeroy, Douglas
AU - Reynolds, Paula
AU - Rose, Gail L.
AU - Scholle, Sarah Hudson
AU - Sieber, William J.
AU - Soucie, Jeni
AU - Stancin, Terry
AU - Stange, Kurt C.
AU - Stephens, Kari A.
AU - Teng, Kathryn
AU - Waddell, Elizabeth Needham
AU - van Eeghen, Constance
N1 - Publisher Copyright:
© 2023, Annals of Family Medicine, Inc. All rights reserved.
PY - 2023/11/1
Y1 - 2023/11/1
N2 - 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; how-ever, 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.
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; how-ever, 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.
KW - behavioral health integration
KW - behavioral medicine
KW - multiple chronic condition
KW - primary care
KW - randomized controlled trial
KW - spragmatic clinical trial
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U2 - 10.1370/afm.3027
DO - 10.1370/afm.3027
M3 - Article
C2 - 38012036
AN - SCOPUS:85178350183
SN - 1544-1709
VL - 21
SP - 483
EP - 495
JO - Annals of Family Medicine
JF - Annals of Family Medicine
IS - 6
ER -