Sunday, January 29, 2017

Families, Systems & Health publishes two articles from IBH-PC investigators

Although strictly speaking, these papers are not part of the PCORI-funded IBH-PC project, they were written by members of our team about a key instrument in the project.

CR Macchi led the team in preparing a manuscript about the the origins of the Practice Integration Profile.

The Practice Integration Profile: Rationale, development, method, and research.
Macchi, C. R.; Kessler, Rodger; Auxier, Andrea; Hitt, Juvena R.; Mullin, Daniel; van Eeghen, Constance; Littenberg, Benjamin
Families, Systems, & Health, Vol 34(4), Dec 2016, 334-341. 

Insufficient knowledge exists regarding how to measure the presence and degree of integrated care. Prior estimates of integration levels are neither grounded in theory nor psychometrically validated. They provide scant guidance to inform improvement activities, compare integration efforts, discriminate among practices by degree of integration, measure the effect of integration on quadruple aim outcomes, or address the needs of clinicians, regulators, and policymakers seeking new models of health care delivery and funding. We describe the development of the Practice Integration Profile (PIP), a novel instrument designed to measure levels of integrated behavioral health care within a primary care clinic. The PIP draws upon the Agency for Health care Research & Quality’s (AHRQ) Lexicon of Collaborative Care which provides theoretic justification for a paradigm case of collaborative care. We used the key clauses of the Lexicon to derive domains of integration and generate measures corresponding to those key clauses. After reviewing currently used methods for identifying collaborative care, or integration, and identifying the need to improve on them, we describe a national collaboration to describe and evaluate the PIP. We also describe its potential use in practice improvement, research, responsiveness to multiple stakeholder needs, and other future directions.

Rodger Kessler led the writing on a paper describing the research validating the PIP.

Development and validation of a measure of primary care behavioral health integration.
Kessler, Rodger S.; Auxier, Andrea; Hitt, Juvena R.; Macchi, C. R.; Mullin, Daniel; van Eeghen, Constance; Littenberg, Benjamin
Families, Systems, & Health, Vol 34(4), Dec 2016, 342-356.

Introduction: We developed the Practice Integration Profile (PIP) to measure the degree of behavioral health integration in clinical practices with a focus on primary care (PC). Its 30 items, completed by providers, managers, and staff, provide an overall score and 6 domain scores derived from the Lexicon of Collaborative Care. We describe its history and psychometric properties. Method: The PIP was tested in a convenience sample of practices. Linear regression compared scores across integration exemplars, PC with behavioral services, PC without behavioral services, and community mental health centers without PC. An additional sample rated 4 scenarios describing practices with varying degrees of integration. Results: One hundred sixty-nine surveys were returned. Mean domain scores ran from 49 to 65. The mean total score was 55 (median 58; range 0–100) with high internal consistency (Cronbach’s alpha = .95). The lowest total scores were for PC without behavioral health (27), followed by community mental health centers (44), PC with behavioral health (60), and the exemplars (86; p < .001). Eleven respondents rerated their practices 37 to 194 days later. The mean change was + 1.5 (standard deviation = 11.1). Scenario scores were highly correlated with the degree of integration each scenario was designed to represent (Spearman’s ρ = −0.71; P = 0.0005). Discussion: These data suggest that the PIP is useful, has face, content, and internal validity, and distinguishes among types of practices with known variations in integration. We discuss how the PIP may support practices and policymakers in their integration efforts and researchers assessing the degree to which integration affects patient health outcomes.

- Ben Littenberg

Friday, January 27, 2017

It is with great sadness that I write this follow up to Connie’s last post of January 16, 2017. 

Our dear friend and colleague Walter Grant passed away on January 19th  after a very short stay in hospice at the Vermont Respite House.
Here is a link to his obituary:

A memorial service is planned for August 13, 2017. More details can be found at :

Donations to the Jimi Grant Scholarship fund at the Vermont Technical College in Randolph can be made in lieu of flowers in honor of Walter’s son who predeceased him.  

If you would like to send a card to his family, please address to Peggy Larson at:
1876 Mountain View Road
Williston, VT 05495

Although my time knowing Walter was short, he wasted no time showing me his wealth of compassion, humor and wisdom.  I will always keep him close to my heart, or “in my pocket” to help me remember what this patient centered project is all about. 

Jen Lavoie

Sunday, January 22, 2017

ED Utilization for Behavioral Health problems is increasing

Thanks to Strategic Advisory Group member Betty Rambur, RN, PhD for sending along this report: Trends in Emergency Department Visits Involving Mental and Substance Use Disorders, 2006-2013

The punchline is this graph:
Abbreviations: ED, emergency department; SUD, substance use disorder
Source: Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project (HCUP), Nationwide Emergency Department Sample (NEDS), 2006-2013Line graph that shows the number of emergency department visits per 100,000 population aged 15 years and older from 2006 to 2013 that involved mental and substance use disorders. Depression, anxiety or stress reactions: increased steadily from 2,537 in 2006 to 3,945 in 2013, for a 55.5% cumulative increase. Substance use disorders: increased steadily from 1,838 in 2006 to 2,519 in 2013, for a 37.0% cumulative increase. Psychoses or bipolar disorders: increased steadily from 911 in 2006 to 1,385 in 2013, for a 52.0% cumulative increase.

More analysis on this report from the National Academy for State Health Policy can be found here.

Overall, this is yet more evidence that better approaches to Behavioral Health are urgently needed.

Monday, January 16, 2017

Walter Grant Retires from SAG

Our patient partner and charter SAG member, Walter Grant, was admitted to the UVM Medical Center on Saturday, Jan 14, for a recurrent problem with his heart.  He is stable and very glad to see friends and acquaintances from the many activities he has participated in the past: patient advisory groups at the Medical Center, students from past courses he has participated in, and, of course, from SAG.  He informed Jen Lavoie that he will not be able to continue his work with any of these groups, much as he has enjoyed doing so.  Walter is planning a discharge to Hospice Care (Colchester VT).  We all wish him our very best.

- Connie van Eeghen