Study will look at models of integration

A  University of Vermont-led team of researchers has received an $18.5 million grant to examine models for integrating behavioral care into the primary care setting.

“There is a broad push from multiple sectors to integrate behavioral care into primary medical care,” said co-principle investigator Rodger Kessler, Ph.D., associate professor of family medicine at the University of Vermont College of Medicine. “There is very little research to guide the elements of models that are most effective when one moves in that direction.”

This five-year project will evaluate and compare two models: the most common model – co-locating a behavioral health clinician in a primary care office to treat behavioral health and substance abuse issues, as well as a fully integrated model – in which a behavioral clinician is integrated into the processes, process flow, and procedures of the primary care office, Kessler said.

The study was  one of four selected from 124 applications for funding from the Washington, D.C.-based Patient-Centered Outcomes Research Institute (PCORI), according to a news release from the University of Vermont. PCORI is an organization that supports patient-centered comparative clinical effectiveness research with the goal of providing reliable information to patients, families and clinicians.

Researchers plan to include 30 practices nationwide and as many as 60 patients at each, for a total of 1,800 cases, according to the release. The group will compare fully integrated practices to those using the co-located model.

The project team also includes three patients who live in Vermont and will serve as funded co-investigators, sitting alongside medical and academic professionals in guiding the study’s progress. Benjamin Littenberg, M.D., professor of nursing and general internal medicine at the University of Vermont is leading the study.

Kessler said it’s important to look at these models because demand for behavioral care is often happening at primary care offices while most providers are outside of the medical center in specialty care. “The model of referring primary care patients from primary care to behavioral specialty care in the community has not been an effective model,” he said. “Data has shown that when physicians discuss behavioral care with patients and refer to care within the office, treatment rates are in the area of 75-90 percent.”

He also noted that medical problems with behavioral co morbidity are 100-200 percent more expensive in terms of overall health costs if behavioral health care is not addressed. “When behavioral care is addressed, there is good reason to believe that when treated together it will lower overall health costs.”

He said most of the field has taken the approach of placing a clinician into a primary care practice and seeing what happens. “We would suggest that may not be the best method. There needs to be a clear, educational and process improvement set of activities that accompanies the idea of developing and implementing an integration plan,” Kessler said.

The team is hypothesizing that some thinking and planning for integration will provide better outcomes for patients and clinicians. “Does an organization want to generate higher level outcomes? Do they need to go through the time and effort and focus of developing a fully integrated practice or is just grabbing somebody and putting them in a practice good enough? The data will hopefully give us some answers about that.”

Collaborators and co-investigators on the project include the University of Colorado Denver, University of Minnesota, University at Buffalo, University of Washington, and other organizations, Kessler said. A training component of the project includes colleagues at the University of Massachusetts Medical School Center for Integrated Primary Care and the Arizona State University Doctor of Behavioral Health Program.

A Web site on the project is being developed. Research should begin this month.