Degree of Behavioral Health Integration and Patient Outcomes

Primary care practices with greater integration of behavioral health care have better patient-reported outcomes. We sought to identify whether there is a threshold effect in the relationship between the degree of Integrated Behavioral Health (IBH) and patient-reported outcomes.

Secondary analysis of survey results from Integrating Behavioral Health and Primary Care, a multistate longitudinal randomized, controlled study of 3,929 adults with multiple chronic medical and behavioral conditions. Patient outcomes included Patient-Reported Outcomes Measurement Information System-29 (PROMIS-29) functional status (PROMIS-29), depression (PHQ-9), anxiety (GAD-7), the Duke Activity Status Index, Consultation and Relational Empathy (CARE), patient centeredness, and utilization. IBH was measured by the Practice Integration Profile (PIP) version 1.0. The optimal threshold was identified by examining the relationship of PIP to PROMIS-29. The discriminatory power of the threshold was examined using multilevel linear regression with adjustment for potential confounders.

Fifteen of 44 practices with 1,237 patients were highly integrated (PIP ≥ 65). All outcomes tended to be better in patients from practices with high integration. After adjustment for potential confounders, the relationship remained beneficial for all outcomes, with Pain Intensity (-0.51 [95% CI -0.97, 0.04]), patient centeredness (2.52 [0.88, 4.16]), and CARE (1.62 [0.62, 2.61]) statistically significant.

Patients in high integration practices report better outcomes. A measurable target for IBH, such as a PIP total score ≥ 65, provides a focus for practice leadership and guidance on the time and resources needed to achieve integration associated with positive patient outcomes. The results of this analysis provide further evidence of the broad, beneficial impacts of integrating behavioral health and primary care services.