TY - JOUR
T1 - Defining and measuring core processes and structures in integrated behavioral health in primary care
T2 - A cross-model framework
AU - Stephens, Kari A.
AU - Van Eeghen, Constance
AU - Mollis, Brenda
AU - Au, Margaret
AU - Brennhofer, Stephanie A.
AU - Martin, Matthew
AU - Clifton, Jessica
AU - Witwer, Elizabeth
AU - Hansen, Audrey
AU - Monkman, Jeyn
AU - Buchanan, Gretchen
AU - Kessler, Rodger
N1 - Funding Information:
This study was funded through a http://dx.doi. org/10.13039/100006093,"Patient-Centered Outcomes Research Institute (PCORI) Award (PCS-1409-24372). The views, statements, and opinions presented in this manuscript are solely the responsibility of the author(s) and do not necessarily represent the views of the PCORI, its Board of Governors or Methodology Committee. The PCORI is an independent, nonprofit organization authorized by Congress in 2010. Its mission is to fund research that will provide patients, their caregivers, and clinicians with the evidence-based information needed to make better-informed healthcare decisions. PCORI is committed to continually seeking input from a broad range of stakeholders to guide its work.
Publisher Copyright:
© 2020 Society of Behavioral Medicine.
PY - 2020/6/1
Y1 - 2020/6/1
N2 - A movement towards integrated behavioral health (IBH) in primary care continues to grow, among an accumulating evidence base for its effectiveness for improving care. However, healthcare organizations struggle to navigate where to target their limited resources for improving integration. We evaluated a cross-model framework of IBH core processes and structures. We used a mixed-methods approach for evaluation of the framework, which included (a) an evaluation survey of national experts and stakeholders, (b) crosswalks with common IBH measures, and (c) a real-world usability test. Five core IBH principles, mapping to 25 processes, and nine clinic structures were defined. Survey responses from 29 IBH domain and policy experts and stakeholders resulted in uniformly high ratings of importance and variable levels of feasibility for measurement, particularly with respect to electronic health record (EHR) systems. A realworld usability test resulted in good uptake and use of the framework across a state-wide effort. An IBH Cross-Model Framework of core principles, processes, and structures generated good acceptability and showed good real-world utility in a state-wide effort to improve IBH across disparate levels of integration in diverse primary care settings. Findings identify feasible areas of measurement, particularly with EHR systems. Next steps include testing the relationship between the individual framework components and patient outcomes to help guide clinics towards prioritizing efforts focused on improving integration.
AB - A movement towards integrated behavioral health (IBH) in primary care continues to grow, among an accumulating evidence base for its effectiveness for improving care. However, healthcare organizations struggle to navigate where to target their limited resources for improving integration. We evaluated a cross-model framework of IBH core processes and structures. We used a mixed-methods approach for evaluation of the framework, which included (a) an evaluation survey of national experts and stakeholders, (b) crosswalks with common IBH measures, and (c) a real-world usability test. Five core IBH principles, mapping to 25 processes, and nine clinic structures were defined. Survey responses from 29 IBH domain and policy experts and stakeholders resulted in uniformly high ratings of importance and variable levels of feasibility for measurement, particularly with respect to electronic health record (EHR) systems. A realworld usability test resulted in good uptake and use of the framework across a state-wide effort. An IBH Cross-Model Framework of core principles, processes, and structures generated good acceptability and showed good real-world utility in a state-wide effort to improve IBH across disparate levels of integration in diverse primary care settings. Findings identify feasible areas of measurement, particularly with EHR systems. Next steps include testing the relationship between the individual framework components and patient outcomes to help guide clinics towards prioritizing efforts focused on improving integration.
KW - Evidence-based care
KW - Integrated behavioral health
KW - Primary care
KW - Quality care
KW - Teamcare
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U2 - 10.1093/tbm/ibz163
DO - 10.1093/tbm/ibz163
M3 - Article
C2 - 32766871
AN - SCOPUS:85089261813
SN - 1869-6716
VL - 10
SP - 527
EP - 538
JO - Translational behavioral medicine
JF - Translational behavioral medicine
IS - 3
ER -