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