Development and validation of a measure of primary care behavioral health integration.

Kessler, Rodger; Auxier, Andrea; Hitt, Juvena R.; Macchi, C. R.; Mullin, Daniel; Eeghen, Constance van; Littenberg, Benjamin

doi:10.1037/fsh0000227

Cited by 24 publications

(44 citation statements)

References 17 publications

(20 reference statements)

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“…The new six‐item Integration and Sharing Methods domain retains a high degree of internal consistency, even after including the two items formally in the Workspace Arrangements and Infrastructure domain. This change also makes intuitive sense as the Integration and Sharing Methods domain, “covers the type and degree of interactions among medical and behavioral providers.” The inclusion of questions assessing physical proximity and shared documentation in this domain is consistent with the domain's focus.…”

Section: Discussionmentioning

confidence: 72%

“…A validated measure of behavioral health integration will help identify integration activities that are associated with improved patient outcomes. Previous studies have demonstrated the reliability and validity of the PIP . Since the initial validation studies were conducted, 1000 additional PIPs have been completed, resulting in a more robust database.…”

Section: Discussionmentioning

confidence: 99%

“…The third part is the scoring criteria (e.g, “Numerator = # of patients in BH registries” and “Denominator = # of patients with BH needs”). Most stems are followed with the response option of “None: 0 percent,” “Never: 0 percent,” “Some: 1‐33 percent,” “About half: 34‐66 percent,” “Most: 67‐99 percent,” and “All: 100 percent.” Further description of stems, examples, and scoring have been published …”

Section: Methodsmentioning

confidence: 99%

“…A separate set of providers completed an evaluation of four hypothetical clinic settings based on degree of integration, resulting in a high level of correlation with degree of integration ( P = 0.0005). Overall, the PIP was found to be reliable and feasible, with good face validity, low response burden, and good discrimination . The PIP is designed to allow for meaningful comparisons between practices and to aide in the identification of integration activities that positively impact health and other meaningful outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…Beginning in 2013, the authors assembled a group of national integration clinicians and researchers to develop an instrument for measuring the integration of behavioral health services into primary care practices, the Practice Integration Profile (PIP) . The PIP was tested for construct validity in a convenience sample of 152 clinics in 35 states and found to accurately distinguish among clinics with varying degrees of integration assessed by other standards . Rater agreement was consistently high, with total integration scores differing by an average of 7.1 points out of 100.…”

Section: Introductionmentioning

confidence: 99%

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Measuring the integration of primary care and behavioral health services

Mullin

Hargreaves

Auxier

et al. 2019

Health Services Research

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Objective To perform a factor analysis of the Practice Integration Profile (PIP), a 30‐item practice‐level measure of primary care and behavioral health integration derived from the Agency for Healthcare Research and Quality's Lexicon for Behavioral Health and Primary Care Integration. Data Sources The PIP was completed by 735 individuals, representing 357 practices across the United States. Study Design The study design was a cross‐sectional survey. An exploratory factor analysis and assessment of internal consistency reliability via Cronbach's alpha were performed. Data Collection Methods Participant responses were collected using REDCap, a secure, web‐based data capture tool. Principal Findings Five of the PIP's six domains had factor loadings for most items related to each factor representing the PIP of 0.50 or greater. However, one factor had items from two PIP domains that had loadings >0.50. A five‐factor model with redistributed items resulted in improved factor loadings for all domains along with greater internal consistency reliability (>0.80). Conclusions Five of the PIP's six domains demonstrated excellent internal consistency for measures of health care resources. Although minor improvements to strengthen the PIP are possible, it is a valid and reliable measure of the integration of primary care and behavioral health.

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Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Measuring the integration of primary care and behavioral health services

Mullin

Hargreaves

Auxier

et al. 2019

Health Services Research

Self Cite

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Key Components of Effective Pediatric Integrated Mental Health Care Models

et al. 2020

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IMPORTANCEEmerging evidence suggests that integrated care models are associated with improved mental health care access and outcomes for youths (children Յ12 years and adolescents 12-21 years) served in pediatric primary care settings. However, the key components of these complex models remain unexamined.OBJECTIVE To identify and describe the key components of effective pediatric integrated mental health care models. EVIDENCE REVIEWThe PubMed, Embase, PsycINFO, and Cochrane Controlled Register of Trials electronic databases were searched for relevant peer-reviewed articles published between January 1, 1985, and April 30, 2019. Articles were restricted to those published in the English language. Eligible articles reported original data on youths 17 years or younger, implemented an integrated mental health care model in a pediatric primary care setting, and assessed the model's association with primary outcomes (eg, mental health symptom severity) and secondary outcomes (eg, functional impairment and patient satisfaction). Articles that specified some degree of systematic coordination or collaboration between primary care and mental health professionals were included in the final review. Two independent reviewers extracted data on study design, model type, model components, level of integration, and outcomes. Study quality was assessed using the Jadad scale. Data were analyzed between January 1, 2018, and May 31, 2019.FINDINGS Eleven randomized clinical trials involving 2190 participants were included. Three studies focused on youths with depression, 3 on youths with attention-deficit/hyperactivity disorder, and 5 on youths with behavioral disorders. Most studies (9 of 11) implemented either the collaborative care model (n = 3), a slightly modified version of the collaborative care model (n = 2), or colocated care (n = 4). The most commonly reported components of effective pediatric integrated mental health care models were population-based care, measurement-based care, and delivery of evidence-based mental health services; all 3 components were present in studies reporting clinical improvement of mental health symptoms. Other model components, such as treatment-to-target or team-based care, were common in studies reporting specific outcomes, such as functional impairment. CONCLUSIONS AND RELEVANCEThis review is the first to date to systematically search and qualitatively synthesize information on the key components of effective pediatric integrated mental health care models. This knowledge may be especially useful for pediatric primary care administrators in the selection of an integrated care model for their setting.

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