Abstract
BackgroundChronic diseases that drive morbidity, mortality, and health care costs are largely influenced by human behavior. Behavioral health conditions such as anxiety, depression, and substance use disorders can often be effectively managed. The majority of patients in need of behavioral health care are seen in primary care, which often has difficulty responding. Some primary care practices are providing integrated behavioral health care (IBH), where primary care and behavioral health providers work together, in one location, using a team-based approach. Research suggests there may be an association between IBH and improved patient outcomes. However, it is often difficult for practices to achieve high levels of integration. The Integrating Behavioral Health and Primary Care study responds to this need by testing the effectiveness of a comprehensive practice-level intervention designed to improve outcomes in patients with multiple chronic medical and behavioral health conditions by increasing the practice’s degree of behavioral health integration.MethodsForty-five primary care practices, with existing onsite behavioral health care, will be recruited for this study. Forty-three practices will be randomized to the intervention or usual care arm, while 2 practices will be considered “Vanguard” (pilot) practices for developing the intervention. The intervention is a 24-month supported practice change process including an online curriculum, a practice redesign and implementation workbook, remote quality improvement coaching services, and an online learning community. Each practice’s degree of behavioral health integration will be measured using the Practice Integration Profile. Approximately 75 patients with both chronic medical and behavioral health conditions from each practice will be asked to complete a series of surveys to measure patient-centered outcomes. Change in practice degree of behavioral health integration and patient-centered outcomes will be compared between the two groups. Practice-level case studies will be conducted to better understand the contextual factors influencing integration.DiscussionAs primary care practices are encouraged to provide IBH services, evidence-based interventions to increase practice integration will be needed. This study will demonstrate the effectiveness of one such intervention in a pragmatic, real-world setting.Trial registrationClinicalTrials.gov NCT02868983. Registered on August 16, 2016.
Highlights
Background and rationale {6a} The chronic diseases that drive the majority of morbidity, mortality, and health care costs in America and around the globe are largely influenced by human behavior
An alternative approach to delivering BH for primary care patients is Integrated Behavioral Health Care (IBH) in which the Behavioral Health Provider (BHP) is a full member of the practice who shares workspace, infrastructure, records and support systems, participates fully in the life of the practice, and collaborates closely with Primary Care Providers (PCP) in patient assessment and management
Research question 2: does using the integrated behavioral health care (IBH)-PC toolkit affect the degree of practice-level behavioral health care integration in primary care practices?
Summary
Study setting {9} The IBH-PC study takes place in 45 primary care practices across the United States (Fig. 1). Study instruments Research question 1: does using the IBH-PC toolkit, a practice-level intervention, affect patient-centered outcomes in adults with multiple chronic medical and behavioral health conditions?. Statistical methods Statistical methods for primary and secondary outcomes {20a} Research question 1: does using the IBH-PC toolkit, a practice-level intervention, affect patient-centered outcomes in adults with multiple chronic medical and behavioral health conditions?. Costs of IBH-PC toolkit implementation will be measured only, while research costs (identifying eligible patients, collecting and analyzing research data, etc.) and changes in operational costs and revenues after completion of the intervention will not be included. Oversight and monitoring Composition of the coordinating center and trial steering committee {5d} The research team includes expertise in behavioral and medical management, research design, multicenter data collection, epidemiology and biostatistics, patient engagement, practice transformation, continuing education, quantitative outcomes assessment, and qualitative analysis of processes and outcomes. It is anticipated that study findings will be reported in numerous formats such as peer-reviewed literature, conference proceedings, blog posts, and policy briefs
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