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2015 HSR&D/QUERI National Conference Abstract

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3130 — Evaluating Associations between Primary Care-Mental Health Integration Program Characteristics and Program Performance

Cornwell BL, Serious Mental Illness Treatments Resource and Evaluation Center, Office of Mental Health Operations; Brockmann LM, Serious Mental Illness Treatments Resource and Evaluation Center, Office of Mental Health Operations; Lasky EC, Serious Mental Illness Treatments Resource and Evaluation Center, Office of Mental Health Operations; Mach J, Serious Mental Illness Treatments Resource and Evaluation Center, Office of Mental Health Operations; McCarthy JF, Serious Mental Illness Treatments Resource and Evaluation Center, Office of Mental Health Operations;

Objectives:
VHA assesses implementation and fidelity of Primary Care-Mental Health Integration (PC-MHI) programs via an annual national Survey. We examine 2013 Survey data, identify program components from Survey responses, and assess associations with performance metrics using administrative data.

Methods:
In Fall 2013, the National PC-MHI Evaluation surveyed all VA medical center divisions with Primary Care clinics and Community Based Outpatient Clinics serving 5000+ patients (N = 349). We used Principal Components Analysis to identify factor structures among 263 Survey variables based on scree plots, eigenvalue output, and review of Cronbach's alphas. We assessed Pearson correlations between the factors and between each factor and 3 performance metrics derived from Fiscal Year 2014 Quarter 1 administrative data (PC-MHI receipt, same-day PC/PC-MHI access, and prolonged receipt of PC-MHI services).

Results:
Seven factors were identified: 1) Core Implementation, 2) Care Management (CM), 3) CM Supervision, 4) Co-located Collaborative Care (CCC) Prescribing Providers, 5) CCC Behavioral Health Providers, 6) Special Population PACT Teams (with PC-MHI staff participation), and 7) Complex Mental Health Conditions Treatment (e.g., schizophrenia). Core Implementation was associated with greater CM (r = 0.125; p = 0.026); greater CM was associated with lower Complex Mental Health Conditions Treatment (r = -0.111; p = 0.040); and greater CM Supervision was associated with lower CCC Prescribing Providers (r = -0.109; p = 0.043). Same-day access was associated with less prolonged receipt of PC-MHI services (r = -0.185; p = 0.001). Core Implementation was associated with greater PC-MHI receipt (r = 0.112; p = 0.047) and same-day access (r = 0.282; p < 0.001). CM was also associated with greater PC-MHI receipt (r = 0.131; p = 0.015) and same-day access (r = 0.178; p = 0.001). CCC Prescribing Providers was associated with greater PC-MHI receipt (r = 0.225; p < 0.001). Special Population PACT Teams was associated with greater same-day access (r = 0.173; p = 0.002).

Implications:
Site-reported PC-MHI program characteristics were associated with performance assessed using administrative data. Greater Core Implementation, CM, and CCC Prescribing Providers were associated with greater PC-MHI receipt; and greater Core Implementation and CM were associated with enhanced same-day access. Sites reporting Complex Mental Health Conditions Treatment were less likely to report Care Management.

Impacts:
PC-MHI programs should work to enhance implementation to increase mental health access. Treatment for Complex Mental Health Conditions may complicate program capacities to provide Care Management.