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. 2022 Dec;25(6):721-728.
doi: 10.1089/pop.2022.0160.

Measuring Behavioral Health Integration in Primary Care

Nadereh Pourat  1   2 , Lina Tieu  1   2 , Ana E Martinez  1
Affiliations

Measuring Behavioral Health Integration in Primary Care

Nadereh Pourat et al. Popul Health Manag. 2022 Dec.

Abstract

Behavioral health integration (BHI) within primary care settings is shown to improve outcomes. However, achieving BHI requires identifying best practices and a reliable tool that can be used to measure existing levels and progress toward BHI. The objective of this study was to develop and apply a conceptual framework to measure BHI, test the approach, and examine challenges to achieving BHI. Surveys and interviews were conducted with key informants within 17 designated public hospitals in California at the midpoint of participating in a 5-year project to establish BHI. A framework and coding methodology were developed to assess BHI best practices at each hospital. BHI status was assessed in the domains of infrastructure and process. Each domain included 5 themes such as electronic health record integration and functionality (infrastructure) and interprovider communication (process). Themes were assessed using a 6-point scale for various activities under a theme and associated weights. Theme-specific values were standardized from 0% to 100% to compare BHI scores between hospitals. Overall progress toward BHI ranged from scores of 52% to 83% (mean 63%) and indicated greater contribution of infrastructure versus process implementation. Within the infrastructure domain, scores were higher for having institutional and provider support, but lagged in establishing provider proximity. Within the process domain, scores were highest for implementation of behavioral health screening, but were frequently lower for other themes such as use of care coordination and referral processes. Further research is needed to test the robustness of this approach in other settings.

Keywords: behavioral health care; integrated health care; primary care; public hospitals.

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Conflict of interest statement

The authors have no potential conflicts of interest to disclose.

Figures

FIG. 1.
FIG. 1.
Conceptual framework for measuring BHI. BHI, behavioral health integration.
FIG. 2.
FIG. 2.
Ranking of public hospitals by the overall BHI score and relative contribution of infrastructure and process scores. BHI, behavioral health integration.
FIG. 3.
FIG. 3.
Contribution of infrastructure themes to the overall infrastructure score, ranked by the hospitals' overall BHI score. BHI, behavioral health integration; PCP, primary care provider.
FIG. 4.
FIG. 4.
Contribution of process themes to the overall process score, ranked by the hospitals' overall BHI score. BHI, behavioral health integration.
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