TY - JOUR
AU - K. A. Stephens
AU - C. van Eeghen
AU - Z. Zheng
AU - T. Anastas
AU - K. P. K. Ma
AU - M. G. Prado
AU - J. Clifton
AU - G. Rose
AU - D. Mullin
AU - K. C. G. Chan
AU - R. Kessler
A1 - 
AB - 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 the 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 2,426 patients with multiple chronic medical and behavioral health conditions completed surveys at baseline, midpoint and two year follow-up. Effects of the intervention on patient health and primary care integration outcomes were examined using multilevel mixed-effects models, while controlling for baseline outcome measurements. RESULTS: No differences were found associated with the number of intervention stages completed in patient health outcomes were found for depression, anxiety, fatigue, sleep disturbance, pain, pain interference, social function, patient satisfaction with care or medication adherence. 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. 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.
AD - Department of Family Medicine, University of Washington, Seattle, WA 98195, USA.; Department of Medicine, University of Vermont, Burlington, VT 05405, USA.; Parhelia Wellness, Santa Rosa, CA 95409, USA.; Department of Psychiatry, University of Vermont, Burlington, VT 05405, USA.; Department of Family Medicine and Community Health, UMass Chan Medical School, Worcester, MA 01655, USA.; Department of Biostatistics, University of Washington, Seattle, WA 98195, USA.; Department of Family Medicine, University of Colorado, Denver, CO 80217, USA.
AN - 38370852
BT - medRxiv
C5 - Healthcare Disparities
DA - Feb 8
DO - 10.1101/2024.02.07.24302481
DP - NLM
ET - 20240208
JF - medRxiv
LA - eng
N2 - 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 the 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 2,426 patients with multiple chronic medical and behavioral health conditions completed surveys at baseline, midpoint and two year follow-up. Effects of the intervention on patient health and primary care integration outcomes were examined using multilevel mixed-effects models, while controlling for baseline outcome measurements. RESULTS: No differences were found associated with the number of intervention stages completed in patient health outcomes were found for depression, anxiety, fatigue, sleep disturbance, pain, pain interference, social function, patient satisfaction with care or medication adherence. 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. 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.
PY - 2024
ST - Effects of intervention stage completion in an integrated behavioral health and primary care randomized pragmatic intervention trial
T1 - Effects of intervention stage completion in an integrated behavioral health and primary care randomized pragmatic intervention trial
T2 - medRxiv
TI - Effects of intervention stage completion in an integrated behavioral health and primary care randomized pragmatic intervention trial
U1 - Healthcare Disparities
U3 - 10.1101/2024.02.07.24302481
Y1 - 2024
ER -