IBH-PC Methods Paper Now Available

The first major report from IBH-PC, a detailed presentation of the study methods to be referred to by following papers, is now available in preprint form. The study is under review at the journal Trials which posted it on ResearchSquare.com where the full text, figures and tables are available as HTML or PDF while they finish their review. Many thanks to Abby Crocker for leading this writing effort!

Crocker, AM., Kessler, R., van Eeghen, C. et al. Integrating Behavioral Health and Primary Care (IBH-PC) to improve patient-centered outcomes in adults with multiple chronic medical and behavioral health conditions: study protocol for a pragmatic cluster-randomized control trial. 05 November 2020, PREPRINT (Version 1) available at Research Square https://doi.org/10.21203/rs.3.rs-54202/v1

ABSTRACT

Background

Chronic 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.

Methods

43 primary care practices, with existing onsite behavioral health care, will be randomized to the intervention or usual care arm. 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.

Discussion

As 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.

 

- Ben Littenberg

Clinical Research Oriented Workshop (CROW) Meeting: November 5, 2020

 Present:   Levi Bonnell, Justine Dee, Nancy Gell, Juvena Hitt, Jen Oshita, Adam Sprouse-Blum, Connie van Eeghen, (7)

 1.                   Warm Up: These are interesting times…

2.                   Levi: three co-authors, he will take notes for them and is first author

a.       Title

                                                   i.      Is it cardiovascular capacity, or cardiorespiratory capacity, or functional capacity (O2 uptake)

1.       Should it be in milligrams/kilograms, rather than METs?  What does the audience understand?

2.       Use SDH or list food/housing/finance

b.       Abstract

                                                   i.      Specify population more; reconsider how the diagnoses are grouped (medical vs behavioral), especially IBS

                                                 ii.      Design: cross sectional

                                               iii.      Outcomes: be consistent; connect with DASI

                                               iv.      Use of “insecurities” to describe the environment; consistent use of SDH (plural noun?)

c.       Introduction

                                                   i.      More explanation of the relationship of predictors, outcomes, and co-variates

d.       General: floating negative signs, how to combine graphs well, avoid passive voice, other references, and a great discussion

3.                   Next week:  Levi will figure it out.

Data Security Woes at University of Vermont Medical Center Aren't Affecting IBHPC

Integrating Behavioral Health and Primary Care is managed out of UVM (the University of Vermont and State Agricultural College, to give its' full name). All the study data are stored on UVM data systems behind UVM firewalls and are accessible only by research staff with the appropriate passwords and training. In the five years we have been operating, we have never had a data breach or unintentional release of subject data. Likewise, I have been managing research data at UVM for 16 years before that without an issue.

Unfortunately, the University of Vermont Medical Center (UVMMC, a separate organization with totally separate computer systems) did suffer a breach last week. As far as I know at this time, no patient data were lost, but the Medical Center's computers have been off line, causing no end of confusion and delay for the patients, staff and providers who work in the hospital or UVMMC clinics. This event made national news and may have prompted some IBHPC research subjects to worry about the security of their private data.

Although the two institutions have similar names, the computer woes at UVMMC have not affected our research at UVM. No UVMMC patients are in the study and no UVMMC computers are used. Our data are all safe and secure, just where they should be, with no unauthorized access (we looked!). If you or your colleagues or patients are at all worried, please know that the issues they may have heard about have nothing to do with IBHPC and every thing is running as planned. If you have any questions or concerns, please feel free to reach out to me.

As always, many thanks for your support and good work,

 

 

Ben Littenberg

Principal Investigator

New tools for Social Determinats of Health

This announcement from NIH addresses an issue that was quite a big problem for IBH-PC over the last 6 years - the lack of standardized measures for SDOH. Progress! (I also like their brief definition of SDOH as "the conditions in which people are born, grow, live, work and age").

 

Notice Announcing Availability of Data Harmonization Tools for Social Determinants of Health (SDOH) via the PhenX Toolkit 

Notice Number: NOT-MD-21-003

The purpose of this Notice is to announce a major data-harmonization effort at the National Institute on Minority Health and Health Disparities (NIMHD) and to encourage the minority health and health disparities research community to use new data collection tools emerging from this effort.

The NIMHD is dedicated to advancing science by improving the yield and impact of its research portfolio. One way to accomplish this is to provide investigators with a common set of tools and resources that allow their work to span the diverse areas of the minority health and health disparities. Social determinants of health—the conditions in which people are born, grow, live, work and age—are known to drive health disparities. Recognizing this, the NIMHD, in collaboration with the National Human Genome Research Institute and the broader scientific community, has identified a series of Core and Specialty measures that will promote the collection of comparable data on social determinants of health (SDOH) across studies. The SDOH are categorized into categories of individual and structural factors that have impact on human health.  The list of constructs and measures is not exhaustive and NIMHD will continue to work towards greater harmonization of measures through vetted common data elements in the science of minority health and health disparities.

The NIMHD and its partners in the scientific community strongly encourages investigators to incorporate the measures from the Core and Specialty collections available in the Social Determinants of Health Collections of the PhenX Toolkit (www.phenxtoolkit.org) whenever possible.

Core collection: The measures in this collection are deemed relevant and essential to all areas of minority health and health disparities. Funded investigators are strongly encouraged to incorporate, at a minimum, the Core-Tier 1 measures in all primary data collection.

Specialty collections: The measures in these collections are organized at the individual and structural levels for more nuanced investigations of how SDOH influence health. The Individual SDOH Specialty collection includes measurement protocols for use in research where information is being collected from and about people answering for themselves or their family. The Structural SDOH Specialty collection includes measurement protocols at the structural or community level. Funded investigators conducting research in the specified areas of science are strongly encouraged to incorporate the Specialty measures related to the specific concepts covered and are discouraged from using alternative measures in lieu of the Specialty measures to collect similar data.

Through the use of these SDOH measures and common data elements, minority health and health disparity researchers will be able to share, compare, and integrate data across studies. By advocating the use of these common measures, the NIMHD and its partners in the scientific community aim to further enhance the science of minority health and health disparities while advancing a culture of scientific collaboration.

Northern Tier Center for Health in Richford, Vermont

  

A shout out to one of our wonderful IBH-PC sites: the Northern Tier Center for Health in Richford, Vermont is a not-for-profit  health center that provides family medicine and behavioral health services, along with pharmacy, lab, and dental facilities.  In a rural setting, the Health Center found a new way to help meet community needs when it stepped in to operate a full-size grocery store in its building when the owner decided to close in June 2020. This example of people-centered care gives patients and others with limited transportation access to fresh fruit and vegetables at an affordable cost.  Clearly, “integration” means learning how to bring together the services needed by each unique community to support health and wellness in many different ways.

To read more, go to:

https://vtdigger.org/2020/10/04/seeing-grocery-store-in-danger-of-extinction-small-town-health-clinic-steps-in/

Kari Stephens on Healio

Our own Kari Stephens, PhD from the University of Washington was interviewed by Healio about Integrating Behavioral health. See their post here: https://www.healio.com/news/primary-care/20200827/qa-framework-helps-primary-care-practices-integrate-behavioral-health

Jevena Hitt, MPH

I'm thrilled to report that Juvena Hitt was awarded the degree of Master of Public Health from the University of Vermont. Juvena earned the degree while working full-time, herding a thousand cats for the IBH-PC study, and raising her son during a pandemic.  Many congratulations!

 

Congratulations to Kari Stephens for leading a team of investigators (including several members of the IBH-PC research team) that just published this work:

Defining and measuring core processes and structures in integrated behavioral health in primary care: a cross-model framework

Kari A Stephens, Constance van Eeghen, Brenda Mollis, Margaret Au, Stephanie A Brennhofer, Matthew Martin, Jessica Clifton, Elizabeth Witwer, Audrey Hansen, Jeyn Monkman, Gretchen Buchanan, Rodger Kessler

Translational Behavioral Medicine, Volume 10, Issue 3, June 2020, Pages 527–538

https://doi.org/10.1093/tbm/ibz163

Published: 07 August 2020

Abstract

A movement towards integrated behavioral health (IBH) in primary care continues to grow, among an accumulating evidence base for its effectiveness for improving care. However, healthcare organizations struggle to navigate where to target their limited resources for improving integration. We evaluated a cross-model framework of IBH core processes and structures. We used a mixed-methods approach for evaluation of the framework, which included (a) an evaluation survey of national experts and stakeholders, (b) crosswalks with common IBH measures, and (c) a real-world usability test. Five core IBH principles, mapping to 25 processes, and nine clinic structures were defined. Survey responses from 29 IBH domain and policy experts and stakeholders resulted in uniformly high ratings of importance and variable levels of feasibility for measurement, particularly with respect to electronic health record (EHR) systems. A real-world usability test resulted in good uptake and use of the framework across a state-wide effort. An IBH Cross-Model Framework of core principles, processes, and structures generated good acceptability and showed good real-world utility in a state-wide effort to improve IBH across disparate levels of integration in diverse primary care settings. Findings identify feasible areas of measurement, particularly with EHR systems. Next steps include testing the relationship between the individual framework components and patient outcomes to help guide clinics towards prioritizing efforts focused on improving integration.