Associations of intervention stage completion on practice level of integrated behavioral health and behavioral health outcomes

 

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.