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

Trials

Rodger Kessler¹  C. R. Macchi¹  Rachel Postupack²  Kurt C. Stange³  Wilson Pace⁴  Zsolt Nagykaldi⁵  Terry Stancin⁶  Kathryn Teng⁶  Sarah Hudson Scholle⁷  Elizabeth Needham Waddell⁸  Mark McGovern⁹  Daniel J. Mullin^1,10  George S. Leibowitz^1,11  Chet Fox^1,12  William J. Sieber^1,13  William Elder^1,14  Roger Kathol^1,15  Abigail M. Crocker^1,16  Douglas Pomeroy^1,16  Richard G. Pinckney^1,16  Paula Reynolds^1,16  Juvena Hitt^1,16  Kelly Clark/Keefe^1,16  Alexander Pond^1,16  Gail L. Rose^1,16  Levi N. Bonnell^1,16  Sylvie Frisbie^1,16  Benjamin Littenberg^1,16  Jennifer O’Rourke-Lavoie^1,16  Peter Callas^1,16  Lisa Watts Natkin^1,16  Jessica Clifton^1,16  Constance van Eeghen^1,16  Jennifer Jewiss^1,16  Brenda Mollis^1,17  Kari A. Stephens^1,17  Ryan E. Breshears^1,18 

[1] Arizona State University;CHE Behavioral Health Services;Case Western Reserve University;DARTNet Institute;Health Sciences Center, University of Oklahoma;MetroHealth System;National Committee for Quality Assurance;Oregon Health & Science University;School of Medicine, Stanford University;School of Medicine, University of Massachusetts;Stony Brook University;University at Buffalo;University of California San Diego;University of Houston College of Medicine;University of Minnesota;University of Vermont;University of Washington;Wellstar Health System;

关键词: Behavioral health;    Primary care;    Multiple chronic conditions;    Pragmatic trials;    Randomized control trial;   

DOI  :  10.1186/s13063-021-05133-8

来源: DOAJ

【 摘 要 】

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 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.

【 授权许可】

Unknown