Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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4070 — VA Primary Care-Mental Health Integration Same-Day Access: How do Program Characteristics Relate to Performance?

Lead/Presenter: Brittany Cornwell
All Authors: Cornwell BL (Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC) – VA Office of Mental Health Operations) Brockmann LM (SMITREC) Kearney LK (SMITREC) McCarthy JF (SMITREC)

Objectives:
The My VA Access Initiative prioritizes same-day access to Primary Care-Mental Health Integration (PC-MHI). Little is known regarding how PC-MHI characteristics inform same-day access. We assess associations between PC-MHI elements using 2016 PACT PC-MHI survey data and same-day access from the PC-MHI Same-Day Access Dashboard and describe trends in Dashboard measures.

Methods:
Data from the 2016 PACT PC-MHI survey describe services as of 12/31/2016 for all 392 PC-MHI mandated sites (VA Medical Center divisions; Community Based Outpatient Clinics serving 5000+ patients). The PC-MHI Same-Day Access Dashboard measures the percentage of individuals with a new in-person PC-MHI encounter having same-day primary care. We compared FY2016 to FY2017Q1-Q2 Dashboard trends. Using ANOVA, we assessed correlations between FY2017Q1-Q2 scores and survey reports regarding PC-MHI components and same-day access approaches.

Results:
Among the 392 sites, 356 (90.8%) indicated having PC-MHI, with 271 (69.1%) reporting both co-located collaborative care (CCC) and care management (CM). From FY2016 to FY2017Q1-Q2, national same-day access increased from 35.2% to 42.7%. FY2017Q1-Q2 same-day access was greater at sites reporting CCC and CM (p < 0.001) and sites reporting clinical staff in the same suite as primary care providers (p < 0.001). Same-day access was greater at sites providing brief assessments for new patients (p < 0.001); sites with briefer wait times for same-day PC-MHI with prescribers (p < 0.01) and behavioral health providers (p < 0.001); and sites conducting more frequent warm hand-offs (p < 0.001). Sites reporting a full open access model (some PC-MHI providers having no scheduled appointments) had greater same-day access than those only using other models (alternating scheduled/unscheduled 30-minute appointments; clinic flow based access; open access pager/phone/Lync; CM access; other) (p < 0.001).

Implications:
Same-day access scores were greater at sites with greater PC-MHI fidelity: Having both CCC and CM, staff co-location, brief assessments and wait times, frequent warm hand-offs, and use of full open access. Findings support Dashboard validation and document the importance of PC-MHI implementation with focus on same-day access.

Impacts:
Enhancing PC-MHI implementation is critical for same-day access. The PC-MHI Same-Day Access Dashboard provides an important resource for program monitoring. Findings may help sites improve services and realize the My VA Access Initiative goals.