ORIGINAL RESEARCH
W. Perry Dickinson, MD; Mark Gritz, PhD; Kyle E. Knierim, MD; Stephanie Kirchner, MSPH, RD; Douglas H. Fernald, MA; Allyson Gottsman; Kimberly Wiggins, MA, MS; L. Miriam Dickinson, PhD
Corresponding Author: W. Perry Dickinson, MD; University of Colorado School of Medicine, Department of Family Medicine
Email: perry.dickinson@cuanschutz.edu
DOI: 10.3122/jabfm.2024.240081R1
Keywords: Behavioral Medicine, Colorado, Evaluation Studies, Family Medicine, Integrated Health Care Systems, Medical Home, Mental Health, Organizational Change, Primary Health Care, Quality Improvement
Dates: Submitted: 02-21-2024; Revised: 05-02-2024; Accepted: 05-13-2024
FINAL PUBLICATION: |HTML| |PDF|
INTRODUCTION: The Colorado State Innovation Model (SIM) initiative aimed to support primary care practices in implementing behavioral health integration and other aspects of advanced primary care. This project evaluated implementation of behavioral health integration and the Building Blocks of High Performing Primary Care in primary care practices.
METHODS: 334 practices participated in SIM in three cohorts for one year (cohort 3) or two years (cohorts 2 and 3). Practice transformation support for implementation of advanced primary care and behavioral health integration was provided. Measures included: 1) Comprehensive Primary Care Practice Monitor, completed at baseline, 12, and 24 months to assess implementation of the building blocks of primary care and behavioral integration, and 2) Behavioral health clinical quality measures, reported quarterly.
RESULTS: Practices improved on implementation of all building blocks, including leadership, data driven improvement, empanelment, team-based care, patient-team partnerships, population management, access to care, and care coordination, resource utilization, behavioral health integration, and general behavioral health improvement (all p<.0001). Onsite behavioral health integration was implemented by 78% of practices by the end of the intervention. Practices improved on depression screening and monitoring (p<.0001) and maternal depression screening (p<.001). Implementation of several building blocks mediated improvement in depression screening and monitoring and maternal depression screening (p<.05).
DISCUSSION: Practices in the SIM initiative successfully implemented behavioral health integration and the building blocks of high performing primary care, yielding improved behavioral clinical quality measures. Implementation of the building blocks mediated improvements in clinical quality measures.