Regional Adoption of Primary Care-Mental Health Integration in Veterans Health Administration Patient-Centered Medical Homes.

Leung LB, Rose D, Stockdale S, McGowan M, Yano EM, Graaff AL, Dresselhaus TR, Rubenstein LV. Regional Adoption of Primary Care-Mental Health Integration in Veterans Health Administration Patient-Centered Medical Homes. Journal for healthcare quality : official publication of the National Association for Healthcare Quality. 2019 Sep 1; 41(5):297-305.

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Abstract:

INTRODUCTION: Behavioral health integration is important, yet difficult to implement, in patient-centered medical homes. The Veterans Health Administration (VA) mandated evidence-based collaborative care models through Primary Care-Mental Health Integration (PC-MHI) in large PC clinics. This study characterized PC-MHI programs among all PC clinics, including small sites exempt from program implementation, in one VA region. METHODS: Researchers administered a cross-sectional key informant organizational survey on PC-MHI among VA PC clinics in Southern California, Arizona, and New Mexico (n = 69 distinct sites) from February to May 2018. Researchers analyzed PC clinic leaders' responses to five items about organizational structure and practice management. RESULTS: Researchers received surveys from 65 clinics (94% response rate). Although only 38% were required to implement on-site PC-MHI programs, 95% of participating clinics reported providing access to such services. The majority reported having integrated, colocated, or tele-MH providers (94%) and care management (77%). Most stated same-day services (59%) and "warm" handoffs (56%) were always available, the former varying significantly based on clinic size and distance from affiliated VA hospitals. CONCLUSIONS: Regional adoption of PC-MHI was high, including telemedicine, among VA patient-centered medical homes, regardless of whether implementation was required. Small, remote PC clinics that voluntarily provide PC-MHI services may need more support.