Measuring the integration of primary care and behavioral health services

Mullin, Daniel; Hargreaves, Lee; Auxier, Andrea; Brennhofer, Stephanie; Hitt, Juvena R.; Kessler, Rodger; Littenberg, Benjamin; Macchi, C. R.; Martin, Matthew; Rose, Gail L.; Trembath, Felicia; Eeghen, Constance van

doi:10.1111/1475-6773.13117

Cited by 11 publications

(14 citation statements)

References 14 publications

(26 reference statements)

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“…The level of integration does not appear to be driven by organizational characteristics or specialty, but by the delivery of on-site behavioral health services, supporting the idea that the PIP is measuring the construct of "behavioral health integration" rather than that of "primary care." Consistent with findings reported elsewhere (Mullin et al, 2019), each domain also has a high level of internal consistency, suggesting the domain structure represents empirically sound measurement of independent attributes of integration.…”

Section: Discussionsupporting

confidence: 86%

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Further Experience with the Practice Integration Profile: A Measure of Behavioral Health and Primary Care Integration

Hitt

Brennhofer

Martin

et al. 2021

J Clin Psychol Med Settings

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Valid measures of behavioral health integration have the potential to enable comparisons of various models of integration, contribute to the overall development of high-quality care, and evaluate outcomes that are strategically aligned with standard improvement efforts. The Practice Integration Profile has proven to discriminate among clinic types and integration efforts. We continued the validation of the measure's internal consistency, intra-rater consistency, and inter-rater consistency with a separate and larger sample from a broader array of practices. We found that the Practice Integration Profile demonstrated a high level of internal consistency, suggesting empirically sound measurement of independent attributes of integration, and high reliability over time. The Practice Integration Profile provides internally consistent and interpretable results and can serve as both a quality improvement and health services research tool. KeywordsCollaborative care • Integrated behavioral health • Integrated primary care • Primary care behavioral health • Measurement

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Section: Discussionsupporting

confidence: 86%

“…The PIP generates six domain scores and a total score (Kessler et al, 2016;Macchi et al, 2016;Mullin et al, 2019). It is publicly available to respondents via REDCap (Harris et al, 2009), a secure online survey system.…”

Section: Data Collectionmentioning

confidence: 99%

Further Experience with the Practice Integration Profile: A Measure of Behavioral Health and Primary Care Integration

Hitt

Brennhofer

Martin

et al. 2021

J Clin Psychol Med Settings

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“…Our revision process is summarized in Figure 1. We first redistributed the items to reflect the five domains identified by a 2019 factor analysis (Mullin et al, 2019). Notably, the two items in the work space domain were combined with items in the shared care and integration domain (see Figure 2).…”

Section: Methodsmentioning

confidence: 99%

Practice integration profile revised: Improving item readability and completion.

Rose¹,

Weldon²,

McEntee³

et al. 2023

Families, Systems, & Health

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Introduction: The Practice Integration Profile (PIP) is a reliable, valid, and broadly used measure of the integration of behavioral health (BH) into primary care. The PIP assesses operational and procedural elements that are grounded in the AHRQ Lexicon for Behavioral Health and Primary Care Integration. Prior analyses of PIP data and feedback from users suggested the measure was in need of revisions. This article describes the process used to improve readability, clarity, and pragmatic utility of the instrument. Method: Two rounds of structured cognitive interviews were conducted with clinicians in primary care settings. After each round, interview transcripts were coded by an analytic team using an iterative and consensus-driven process. Themes were identified based on codes. Themes and recommendations for revisions were reviewed and modified by committee. Results: Based on feedback and a prior factor analysis of the PIP, revisions were undertaken to: (a) eliminate redundant or overlapping items; (b) clarify the meaning of items; (c) standardize the response categories, and (d) place items in the most appropriate domains. The resulting measure has 28 items in five domains. Discussion: PIP 2.0 will need further examination to confirm its continuing use as a foundational tool for evaluating integrated care.

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“…A thematic analysis was completed where the 22 retained articles were grouped into 12 themes using an inductive approach and mapped to the quality domains for integrated care from the PIP survey (case identification, workflow, clinical services, workspace, shared care, and patient engagement), and the 3 main levels of stakeholders based on WHO’s definition for health systems: the patient/family (service users), the primary care team (service providers), and the national/sub-national health system (government organizations/agencies). 12 , 18…”

Section: Methodsmentioning

confidence: 99%

Achieving Quality Integrated Care for Adolescent Depression: A Scoping Review

Sarakbi

Groll

Tranmer

et al. 2022

J Prim Care Community Health

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Introduction: While primary care is often the first point of contact for adolescents with depression, more than half of depressed adolescents are either untreated or undertreated. A scoping review had been completed to summarize approaches for achieving quality integrated care in primary care focused on adolescent depression. Methods: The scoping review followed the methodological framework for scoping studies from Arksey and O’Malley. Articles were grouped into themes and mapped to 6 quality domains for integrated care from the practice integration profile survey and 3 levels of stakeholders based on WHO’s definition for health systems (patient/family, primary care team, and national/sub-national health system). Results: A total of 868 records were screened resulting in 22 articles at the patient/family-level (5/22), the primary care team-level (18/22), and the national/sub-national health system-level (16/22). The results highlighted multilevel approaches to support the delivery of quality integrated care for adolescent depression in primary care: (1) population-focused using patient registries, routine screening based on standardized algorithms, and patient-centered strategies, (2) team-driven where primary care clinicians collaborate with mental health clinicians as part of a primary care team, (3) evidence-based delivery of mental health services across the integrated care pathway from screening to follow-up visits, and (4) measurement-guided by leveraging the electronic health record infrastructure to learn from patient outcomes. Conclusion: More research is needed on how to provide quality integrated care for adolescent depression, specifically on patient engagement and retention, grounded in the frontline experiences of patients, families, and clinicians and supported by national and/or sub-national guidelines. A learning system could help integrate mental health services in primary care in a way that is consistent across the national and/or sub-national health system.

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Measuring the integration of primary care and behavioral health services

Cited by 11 publications

References 14 publications

Further Experience with the Practice Integration Profile: A Measure of Behavioral Health and Primary Care Integration

Further Experience with the Practice Integration Profile: A Measure of Behavioral Health and Primary Care Integration

Practice integration profile revised: Improving item readability and completion.

Achieving Quality Integrated Care for Adolescent Depression: A Scoping Review

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