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A Cluster Randomized Trial of Primary Care Practice Redesign to Integrate Behavioral Health for Those Who Need It Most: Patients With Multiple Chronic Conditions.
Littenberg, Benjamin; Clifton, Jessica; Crocker, Abigail M; Baldwin, Laura-Mae; Bonnell, Levi N; Breshears, Ryan E; Callas, Peter; Chakravarti, Prama; Clark/Keefe, Kelly; Cohen, Deborah J; deGruy, Frank V; Eidt-Pearson, Lauren; Elder, William; Fox, Chester; Frisbie, Sylvie; Hekman, Katie; Hitt, Juvena; Jewiss, Jennifer; Kaelber, David C; Kelley, Kairn Stetler; Kessler, Rodger; O'Rourke-Lavoie, Jennifer B; Leibowitz, George S; Macchi, C R; Martin, Matthew P; McGovern, Mark; Mollis, Brenda; Mullin, Daniel; Nagykaldi, Zsolt; Natkin, Lisa W; Pace, Wilson; Pinckney, Richard G; Pomeroy, Douglas; Reynolds, Paula; Rose, Gail L; Scholle, Sarah Hudson; Sieber, William J; Soucie, Jeni; Stancin, Terry; Stange, Kurt C; Stephens, Kari A; Teng, Kathryn; Waddell, Elizabeth Needham; van Eeghen, Constance.
Afiliação
  • Littenberg B; University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.); benjamin.littenberg@uvm.edu.
  • Clifton J; University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.).
  • Crocker AM; Parhelia Wellness, Santa Rosa, California (J.C.).
  • Baldwin LM; University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.).
  • Bonnell LN; University of Washington, Seattle, Washington (L-M.B., B.M., K.A.S.).
  • Breshears RE; University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.).
  • Callas P; Wellstar Health System, Marietta, Georgia (R.E.B.).
  • Chakravarti P; University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.).
  • Clark/Keefe K; Prama Psychology, PLLC, Richland, Washington (P.C.).
  • Cohen DJ; University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.).
  • deGruy FV; Oregon Health & Science University, Portland, Oregon (D.J.C., E.N.W.).
  • Eidt-Pearson L; University of Colorado School of Medicine, Aurora, Colorado (F.V.D., R.K.).
  • Elder W; UMass Chan Medical School, Worcester, Massachusetts (L.E-P., D.M.).
  • Fox C; University of Houston, Houston, Texas (W.E.).
  • Frisbie S; University at Buffalo, Buffalo, New York (C.F.).
  • Hekman K; University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.).
  • Hitt J; University of California San Diego, San Diego, California (K.H., W.J.S.).
  • Jewiss J; University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.).
  • Kaelber DC; University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.).
  • Kelley KS; The MetroHealth System, Cleveland, Ohio (D.C.K., T.S., K.T.).
  • Kessler R; Case Western Reserve University, Cleveland, Ohio (D.C.K., K.C.S.).
  • O'Rourke-Lavoie JB; University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.).
  • Leibowitz GS; University of Colorado School of Medicine, Aurora, Colorado (F.V.D., R.K.).
  • Macchi CR; University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.).
  • Martin MP; Stony Brook University, Stony Brook, New York (G.S.L.).
  • McGovern M; Arizona State University, Tempe, Arizona (C.R.M., M.P.M.).
  • Mollis B; Arizona State University, Tempe, Arizona (C.R.M., M.P.M.).
  • Mullin D; Stanford University School of Medicine, Stanford, California (M.M.).
  • Nagykaldi Z; University of Washington, Seattle, Washington (L-M.B., B.M., K.A.S.).
  • Natkin LW; UMass Chan Medical School, Worcester, Massachusetts (L.E-P., D.M.).
  • Pace W; University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma (Z.N.).
  • Pinckney RG; University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.).
  • Pomeroy D; DARTNet Institute, Aurora, Colorado (W.P.).
  • Reynolds P; University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.).
  • Rose GL; University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.).
  • Scholle SH; University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.).
  • Sieber WJ; University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.).
  • Soucie J; National Committee for Quality Assurance, Washington, DC (S.H.S., J.S.).
  • Stancin T; University of California San Diego, San Diego, California (K.H., W.J.S.).
  • Stange KC; National Committee for Quality Assurance, Washington, DC (S.H.S., J.S.).
  • Stephens KA; The MetroHealth System, Cleveland, Ohio (D.C.K., T.S., K.T.).
  • Teng K; Case Western Reserve University, Cleveland, Ohio (D.C.K., K.C.S.).
  • Waddell EN; University of Washington, Seattle, Washington (L-M.B., B.M., K.A.S.).
  • van Eeghen C; The MetroHealth System, Cleveland, Ohio (D.C.K., T.S., K.T.).
Ann Fam Med ; 21(6): 483-495, 2023.
Article em En | MEDLINE | ID: mdl-38012036
ABSTRACT

PURPOSE:

Patient outcomes can improve when primary care and behavioral health providers use a collaborative system of care, but integrating these services is difficult. We tested the effectiveness of a practice intervention for improving patient outcomes by enhancing integrated behavioral health (IBH) activities.

METHODS:

We conducted a pragmatic, cluster randomized controlled trial. The intervention combined practice redesign, quality improvement coaching, provider and staff education, and collaborative learning. At baseline and 2 years, staff at 42 primary care practices completed the Practice Integration Profile (PIP) as a measure of IBH. Adult patients with multiple chronic medical and behavioral conditions completed the Patient-Reported Outcomes Measurement Information System (PROMIS-29) survey. Primary outcomes were the change in 8 PROMIS-29 domain scores. Secondary outcomes included change in level of integration.

RESULTS:

Intervention assignment had no effect on change in outcomes reported by 2,426 patients who completed both baseline and 2-year surveys. Practices assigned to the intervention improved PIP workflow scores but not PIP total scores. Baseline PIP total score was significantly associated with patient-reported function, independent of intervention. Active practices that completed intervention workbooks (n = 13) improved patient-reported outcomes and practice integration (P ≤ .05) compared with other active practices (n = 7).

CONCLUSION:

Intervention assignment had no effect on change in patient outcomes; however, we did observe improved patient outcomes among practices that entered the study with greater IBH. We also observed more improvement of integration and patient outcomes among active practices that completed the intervention compared to active practices that did not. Additional research is needed to understand how implementation efforts to enhance IBH can best reach patients.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Múltiplas Afecções Crônicas Limite: Adult / Humans Idioma: En Revista: Ann Fam Med Assunto da revista: MEDICINA DE FAMILIA E COMUNIDADE Ano de publicação: 2023 Tipo de documento: Article
Texto completo
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Múltiplas Afecções Crônicas Limite: Adult / Humans Idioma: En Revista: Ann Fam Med Assunto da revista: MEDICINA DE FAMILIA E COMUNIDADE Ano de publicação: 2023 Tipo de documento: Article