TY - JOUR
KW - Adult
KW - Health Care Costs
KW - Humans
KW - Outcome Assessment, Health Care
KW - Patient-Centered Care
KW - Primary Health Care
KW - Randomized Controlled Trials as Topic
KW - Surveys and Questionnaires
KW - behavioral health
KW - Multiple chronic conditions
KW - Pragmatic trials
KW - primary care
KW - Randomized control trial
AU - A. M. Crocker
AU - R. Kessler
AU - C. van Eeghen
AU - L. N. Bonnell
AU - R. E. Breshears
AU - P. Callas
AU - J. Clifton
AU - W. Elder
AU - C. Fox
AU - S. Frisbie
AU - J. Hitt
AU - J. Jewiss
AU - R. Kathol
AU - K. Clark/Keefe
AU - J. O'Rourke-Lavoie
AU - G. S. Leibowitz
AU - C. R. Macchi
AU - M. McGovern
AU - B. Mollis
AU - D. J. Mullin
AU - Z. Nagykaldi
AU - L. W. Natkin
AU - W. Pace
AU - R. G. Pinckney
AU - D. Pomeroy
AU - A. Pond
AU - R. Postupack
AU - P. Reynolds
AU - G. L. Rose
AU - S. H. Scholle
AU - W. J. Sieber
AU - T. Stancin
AU - K. C. Stange
AU - K. A. Stephens
AU - K. Teng
AU - E. N. Waddell
AU - B. Littenberg
A1 - 
AB - 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: Forty-five primary care practices, with existing onsite behavioral health care, will be recruited for this study. Forty-three practices will be randomized to the intervention or usual care arm, while 2 practices will be considered "Vanguard" (pilot) practices for developing the intervention. 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. TRIAL REGISTRATION: ClinicalTrials.gov NCT02868983 . Registered on August 16, 2016.
AD - University of Vermont, Burlington, VT, USA. abigail.crocker@uvm.edu.; Arizona State University, Tempe, AZ, USA.; School of Medicine, University of Colorado, Aurora, CO, USA.; University of Vermont, Burlington, VT, USA.; University of Vermont, Burlington, VT, USA.; Wellstar Health System, Marietta, GA, USA.; University of Vermont, Burlington, VT, USA.; University of Vermont, Burlington, VT, USA.; University of Houston College of Medicine, Houston, TX, USA.; University at Buffalo, Buffalo, NY, USA.; University of Vermont, Burlington, VT, USA.; University of Vermont, Burlington, VT, USA.; University of Vermont, Burlington, VT, USA.; University of Minnesota, Minneapolis, MN, USA.; University of Vermont, Burlington, VT, USA.; University of Vermont, Burlington, VT, USA.; Stony Brook University, Stony Brook, NY, USA.; Arizona State University, Tempe, AZ, USA.; School of Medicine, Stanford University, Palo Alto, CA, USA.; University of Washington, Seattle, WA, USA.; School of Medicine, University of Massachusetts, Worcester, MA, USA.; Health Sciences Center, University of Oklahoma, Oklahoma City, OK, USA.; University of Vermont, Burlington, VT, USA.; DARTNet Institute, Aurora, CO, USA.; University of Vermont, Burlington, VT, USA.; University of Vermont, Burlington, VT, USA.; University of Vermont, Burlington, VT, USA.; CHE Behavioral Health Services, New York City, NY, USA.; University of Vermont, Burlington, VT, USA.; University of Vermont, Burlington, VT, USA.; National Committee for Quality Assurance, Washington, DC, USA.; University of California San Diego, San Diego, CA, USA.; MetroHealth System, Cleveland, OH, USA.; Case Western Reserve University, Cleveland, OH, USA.; University of Washington, Seattle, WA, USA.; MetroHealth System, Cleveland, OH, USA.; Oregon Health & Science University, Portland, OR, USA.; University of Vermont, Burlington, VT, USA.
BT - Trials
C5 - Financing & Sustainability; Healthcare Disparities; Measures; Opioids & Substance Use
CP - 1
DO - 10.1186/s13063-021-05133-8
IS - 1
JF - Trials
LA - eng
M1 - Journal Article
N2 - 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: Forty-five primary care practices, with existing onsite behavioral health care, will be recruited for this study. Forty-three practices will be randomized to the intervention or usual care arm, while 2 practices will be considered "Vanguard" (pilot) practices for developing the intervention. 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. TRIAL REGISTRATION: ClinicalTrials.gov NCT02868983 . Registered on August 16, 2016.
PY - 2021
SN - 1745-6215; 1745-6215
SP - 200
T1 - 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
T2 - Trials
TI - 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
U1 - Financing & Sustainability; Healthcare Disparities; Measures; Opioids & Substance Use
U2 - 33691772
U3 - 10.1186/s13063-021-05133-8
VL - 22
VO - 1745-6215; 1745-6215
Y1 - 2021
Y2 - Mar 10
ER -