The impact of behavioral health consultations on medical encounter duration in pediatric primary care: A retrospective match-controlled study.

Abstract

Introduction:The disproportionate time required to effectively manage psychosocial concerns is a key barrier to advancing delivery of behavioral care by primary care providers. Improved time efficiency is one potential benefit of the integration of behavioral health consultants (BHCs) into pediatric care, but few studies have systematically studied this outcome. We examined the impact of embedded BHCs on duration of medical encounters in a pediatric primary care clinic. Method: We conducted a retrospective matched-pairs analysis of encounters involving behavioral consultations versus encounters for similar patients that did not include a consultation (N ϭ 114) using electronic health record timestamp data. We examined both medical duration (i.e., medical provider services) and total duration (i.e., medical services ϩ behavioral consultation). Results: Patient encounters involving behavioral consultation had a significantly longer (ϩ11.23 min) total duration than matched controls, but significantly shorter (Ϫ11.67 min) medical duration. Discussion: The results indicate BHCs may improve primary care provider efficiency for patients with behavioral concerns, a notable finding given the impact of clinical time-constraints on important health care outcomes.

Evaluating time in health care: What are we busy about?

“…In March 2019, this journal published a brief report in which investigators conducted a retrospective chart review of all patient encounters over a 4-month period including electronic timestamps of the total visit duration as well as the portion devoted to medical care and the portion for behavioral care (Riley, Paternostro, Walker, & Wagner, 2019). In this way, they were able to demonstrate that while the total visit length (medical ϩ behavioral) was longer when a behavioral health concern was addressed, the physician-only portion was significantly shorter when a behavioral health consultant was introduced into the visit (e.g., warm hand-off).…”

“…These data suggest that residents spent less time on notes, but it is by inference only. Riley and colleagues (2019) suggest researchers prospectively develop a more rigorous approach by designing time stamps into EHR workflows in ways that allow for ease of extraction and analyses around key visit components (and less inference).…”

The relationship between integrated pediatric psychology and primary care visit length, revenue, content over 24 months.

“…Specifically, we do not know the number of times PCPs attempted a warm handoff but were unsuccessful (e.g., unwilling to disrupt the BHP during a session). This is a crucial factor that has direct implications for PCP productivity because prior work has shown these referrals can shorten the PCP's portion of a visit (Riley, Paternostro, Walker, & Wagner, 2019).…”