Congratulations to Kari Stephens and her co-authors on the latest paper from IBH-PC:
Stephens, K. A., van Eeghen, C., Zheng, Z., Anastas, T., Ma, K. P. K., Prado, M. G., Clifton, J., Rose, G., Mullin, D., Chan, K. C. G., & Kessler, R. (in press). Associations of intervention stage completion on practice level of integrated behavioral health and behavioral health outcomes in an integrated behavioral health and primary care randomized pragmatic intervention trial. Annals of Family Medicine. PMCID: in progress.
Purpose
A
pragmatic, cluster-randomized controlled trial of a comprehensive
practice-level, multi-staged practice transformation intervention aimed
to increase behavioral health integration in primary care practices and
improve patient outcomes. We examined association between completion of
intervention stages and patient outcomes across a heterogenous national
sample of primary care practices.
Methods
Forty-two
primary care practices across the U.S. with co-located behavioral
health and 2,945 patients with multiple chronic medical and behavioral
health conditions completed surveys at baseline, midpoint and two year
follow-up. Effects of intervention on patient health and primary care
integration outcomes were examined using multilevel mixed-effects
models, controlling for baseline outcome measurements.
Results
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. The completion of each intervention
stage was associated with increases in Practice Integration Profile
(PIP) domain scores and were confirmed with modeling using multiple
imputation for: Workflow 3.5 (95% CI: 0.9-6.1), Integration Methods 4.6
(95% CI: 1.5-7.6), Patient Identification 2.9 (95% CI: 0.9-5.0), and
Total Integration 2.7 (95% CI: 0.7-4.7).
Conclusion
A
practice-centric flexible practice transformation intervention
improved integration of behavioral health in primary care across
heterogenous 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 potential to help complex patient populations. Future research is
needed to determine how to best target patient health outcomes at a
population level.
