How well integrated are the participating practices?

Now that we have enrolled the sites, it's time to think about how well they are integrated. One way to look at that is the Practice Integration Profile. The PIP is a 30-item self-report measure that can be completed by providers, managers and staff at a primary care practice. It yields a score from 0 to 100 to indicate how well Behavioral Health is integrated into the practice in each of six domains: Workflow, Clinical Services, Provider Integration, Case Identification, Patient Engagement, and Workspace. There is also an overall or Total PIP score that is the average of the six domain scores. You can read more about the PIP and even try it out yourself at the PIP homepage.

To be eligible for the IBH-PC study, a practice needed to have a Total PIP score of no more than 75. This was to avoid recruiting practices that are already so well integrated that the IBH-PC redesign intervention just doesn't make sense. Why spend a lot of time and effort to integrate when you are already well-integrated?

Of the 118 practices we considered for the study, 70 provided at least 4 PIP surveys by various clinic staff. The Total PIP scores averaged 50 and ranged from 10 to 78. The 43 randomized clinics averaged 49 and ranged from 10 to 73. (The four practices with scores above 75 were ineligible.)

Happily, the stratified randomization worked as planned: the Active and Control groups are very similar in terms of both mean (48 vs. 49) and median (50 vs. 52), with P>0.9 by both Student's t and Wilcoxon rank-sum tests.

N.B.: Some of these PIPs were collected many months before the study actually began at the sites, so all randomized sites submit another wave of PIPs to be used as the baseline in the study analysis.

-Ben Littenberg