Mental Health, Substance Abuse, and Health Behavior Services in Patient-Centered Medical Homes

Article Figures & Data

Table 1. Practice Demographic Characteristics of the Sample (n = 123)

Characteristics	Practices (%)
<5 Physicians	55
NCQA recognition level
1 or 2	44
3	56
Ownership
Physician owned	50
Other	40
>20% of patients with Medicaid or other public insurance or no insurance	33
Practices with more than one location	37
Specialty
Internal medicine only	22
Family practice only	40
Pediatrics only	6
Combination	25
Other specialty	6

Table 3. Comparison of Referral Processes for Behavioral Health versus Other Medical Subspecialty among Patient-Centered Medical Home practices

Process	Practices Reporting That They Have a Standardized Process (%)
Process	MH/SA	Cardiology	P Value (MH/SA vs Cardiology)	Endocrinology	P Value (MH/SA vs Endocrinology)
Processing referrals	84	91	.006	90	.01
Tracking referrals	75	85	.001	83	.003
Providing patient history and other information to specialists	83	96	.0006	96	.0006
Receiving consultation reports from specialists	77	96	<.0001	96	.0001
Helping patients schedule appointments with specialists outside the practice	78	87	.04	84	.24

Table 4. Results for Mental Health Organization Index

Organizational Items	Practices Reporting Each Organizational Item (%)
Organizational Items	Yes, Works Well	Yes, Needs Improvement	No
Use of formal screening tool for:
Depression and/or other mental health problems	46	34	20
Alcohol problems	39	32	29
Substance use problems	33	32	36
ADHD in children or adults	34	24	42
Standardized process to make referrals to MH/substance use providers	50	33	16
Standardized process to track referrals to MH/substance use providers	33	41	25
Regularly provide patient history and other information to MH/substance use providers	59	25	16
Regularly receive consultation reports from MH/substance use providers	34	43	23
Help patients schedule outside appointments with MH/substance use providers	41	37	22
	Yes (2 points)		No (0 points)
Has at least one mental health clinician at the practice	42		58
Scheduling of appointments with mental health clinicians at the practice in same manner as medical appointments	36		64
Availability of same-day appointments with a mental health clinician	28		72
Mental Health Organizational Index, mean (SD)	12.3 (5.6)

ADHD, attention deficit hyperactivity disorder; MH, mental health; SD, standard deviation.

Table 5. Reporting on Mental Health Organizational Index and Mental Health Clinical Index By Practice Characteristics

	Mental Health Organizational Index		Mental Health Clinical Index
	Mean (SD)	P Value (Difference across Categories	Mean (SD)	P Value (Difference across Categories)
Ownership/affiliation		.07		.75
Physician owned (n = 61,61)	11.4 (5.5)		7.8 (5.0)
Other (n = 49,49)	13.4 (5.9)		7.5 (5.4)
Practice size		.30		.95
<5 Physicians (n = 66,65)	11.9 (5.3)		7.6 (5.3)
≥5 Physicians (n = 53,51)	12.9 (5.7)		7.5 (5.1)
NCQA patient-centered medical home recognition		.86		.11
Level 1 or 2 (n = 53,51)	12.2 (5.6)		6.7 (5.8)
Level 3 (n = 66,65)	12.4 (5.4)		8.2 (4.6)
Insurance mix		<.0001		.003
≤20% of patients with Medicaid or other public insurance or no insurance (n = 63,63)	10.4 (5.4)		6.6 (4.7)
>20% of patients with Medicaid or other public insurance or no insurance (n = 41,41)	14.9 (5.4)		9.7 (5.4)