Evaluation of a Collaborative Behavioral Health Program Implementation in Primary Care

Overview

This study will give researchers the opportunity to evaluate implementation of the Collaborative Behavioral Health Program (CBHP), based on the collaborative care model for depression, which aims to improve practice for physicians and staff; improve care for patients; and improve clinic operations through a model that allows for more efficient identification and referral for care for depression.

Study Type

  • Study Type: Observational [Patient Registry]
  • Study Design
    • Time Perspective: Prospective
  • Study Primary Completion Date: December 31, 2023

Detailed Description

This study used a hybrid Type 2 effectiveness-implementation design of a randomized roll-out trial of the Collaborative Care Model for depression (CoCM) in 11 primary care practices in a large healthcare system affiliated with an academic medical center. The Collaborative Behavioral Health Program (CBHP) is supported by leaders in the healthcare system and the primary care steering committee as a means of improving access to effective mental health services. Implementation strategies including hiring and training the necessary staff for CoCM, audit and feedback procedures, and health information technologies to assist with billing and the patient registry, will be provided for all practices. Using a sequential mixed methods measurement approach, we will assess key stakeholders' perspectives of CBHP roll-out, focused on barriers and facilitators of implementation and sustainability. The Stages of Implementation tool will be used to measure the speed and quantity of implementation activities completed across the stages of implementation preparation, implementation, and sustainment over a 30-month period for each practice. Effectiveness of CBHP for patient-level outcomes will be conducted on depressive symptoms, graduation rates for CBHP, and spillover effects on chronic health conditions.

With its focus on implementation processes and strategies, this study will elucidate the critical drivers of CoCM implementation that are understudied for a program with such a robust evidence base. This study will also be among the first to conduct economic analyses on a fee-for-service model with the new billing codes for CoCM and can inform ways to improve implementation efficiency with our optimization approach to successive practices in the roll-out design. Changes to the protocol and current status of the study are also discussed.

Interventions

  • Behavioral: Collaborative Behavioral Health Program
    • Collaborative care is the delivery of mental health care through a proactive collaboration of primary care providers, behavioral care managers based in primary care practices, and psychiatrists who provide supervision to the behavioral care managers and consultation to the primary care providers.

Arms, Groups and Cohorts

  • NMG IM 211 E Chicago Ave
  • NMG IM ARKES
  • NMG IM 1460 N Halsted St
  • NMG IM 201 E Huron St
  • NMG Integrative Medicine 150 E Huron St
  • NMG IM 1776 N Milwaukee Ave
  • NMG IM 20 S Clark St
  • NMG IM FM 1704 Maple Ave
  • NMG IM 259 E Erie St
  • NMG IM 1135 S Delano Ct
  • NMG IM 1333 W Belmont Ave

Clinical Trial Outcome Measures

Primary Measures

  • Impact of implementation strategies on the speed of CBHP implementation (time, in days)
    • Time Frame: 2 years
    • Trends in the rate at which CBHP is implemented over successive practices, as assessed by the Universal Stages of Implementation Completion (USIC)
  • Impact of implementation strategies on the quantity of CBHP implementation (number of CBHP participants)
    • Time Frame: 2 years
    • Trends in the number of CBHP participants over successive practices, as assessed by CBHP referrals, engagement, and treatment completion derived from the electronic health record
  • Acceptability of CBHP
    • Time Frame: 2 years
    • Self-report of key stakeholders and CBHP utilization (referral, engagement, completion)
  • Effectiveness of CBHP on depressive symptoms (PHQ-9 scores)
    • Time Frame: 2 years
    • Pre- and post-treatment self-reported depressive symptoms (PHQ-9 scores), anti-depressant medication prescriptions and adherence, treatment engagement, psychiatry referrals
  • Effectiveness of CBHP on behavioral health service utilization (antidepressant medication prescription, CBHP treatment engagement, and external referrals for behavioral health)
    • Time Frame: 2 years
    • Proportion of patients who are eligible for CBHP who receive behavioral health services, including anti-depressant medication prescriptions, CBHP treatment sessions, and/or external referrals for behavioral health (e.g., psychiatry)

Participating in This Clinical Trial

Inclusion Criteria

• PHQ-9 score > 10

Exclusion Criteria

  • Current suicidality
  • Bipolar disorder
  • Substance abuse disorder
  • Psychosis
  • Other severe mental health condition

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: N/A

Investigator Details

  • Lead Sponsor
    • Northwestern University
  • Collaborator
    • Northwestern Medicine
  • Provider of Information About this Clinical Study
    • Principal Investigator: Justin D. Smith, Associate Professor – Northwestern University
  • Overall Contact(s)
    • Allison Carroll, PhD, 3125031631, allison.carroll@northwestern.edu

References

Smith JD, Hasan M. Quantitative approaches for the evaluation of implementation research studies. Psychiatry Res. 2020 Jan;283:112521. doi: 10.1016/j.psychres.2019.112521. Epub 2019 Aug 17.

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