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BackgroundIntegrating behavioural health care into primary care practices may increase patients’ access to behavioural health services and improve health outcomes. However, few studies have explored factors that influence integration processes.ObjectiveWe sought to better understand contextual factors that support or impede behavioural health integration in primary care practices.MethodsWe conducted 71 semi-structured interviews with providers, staff, and leaders from eight primary care practices in the United States with integrated behavioural health services, which were participating in a randomized control, pragmatic trial: Integrating Behavioural Health and Primary Care. Practices were selected for diversity on geographic location, size, ownership, and experience with integration. We conducted a thematic analysis of the qualitative data derived from the interviews.ResultsWe identified four categories of contextual factors influencing behavioural health integration: leadership commitment to integration, financial considerations, workflow and communication systems, and providers’ perspectives on integration and team-based healthcare. Supportive factors included leaders’ commitment to integration, adequate staffing, customized communication and workflow systems, collaborative practice culture, and healthy working relationships amongst providers. Impediments included staffing issues and payment models that do not reimburse for activities required to support integrated care.ConclusionInterviewees described various benefits of integration, including providers feeling better equipped to address patients’ needs due to collaboration between medical and behavioural providers and resulting interdisciplinary learning. Given concerns about provider burnout, this finding warrants further study.

To describe the development of the Patient Centeredness Index (PCI), evaluate its psychometric characteristics and evaluate the relationships between scores on the PCI and an established measure of empathy.Patient centeredness helps patients manage multiple chronic conditions with their providers, nurses and other team members. However, no instrument exists for evaluating patient centeredness within primary care practices treating this population.Multi-site instrument development and validation. STROBE reporting guidelines were followed.To identify themes, we consulted literature on patient centeredness and engaged stakeholders who had or were caring for people with multiple chronic conditions (n = 7). We composed and refined items to represent those themes with input from clinicians and researchers. To evaluate reliability and convergent validity, we administered surveys to participants (n = 3622) with chronic conditions recruited from 44 primary care practices for a large-scale cluster randomised clinical trial of the effects of a practice-level intervention on patient and practice-level outcomes. Participants chose to complete the 16-item survey online, on paper or by phone. Surveys assessed demographics, number of chronic conditions and ratings of provider empathy. We conducted exploratory factor analysis to model the interrelationships among items.A single factor explained 93% of total variance. Factor loadings ranged from 0.55-0.85, and item-test correlations were ≥.67. Cronbach's alpha was .93. A moderate, linear correlation with ratings of provider's empathy (r = .65) supports convergent validity.The PCI is a new tool for obtaining patient perceptions of the patient centeredness of their primary care practice. The PCI shows acceptable reliability and evidence of convergent validity among patients managing chronic conditions.The PCI rapidly identifies patients' perspectives on patient centeredness of their practice, making it ideal for administration in busy primary care settings that aim to efficiently address patient-identified needs.Clinicaltrials.org Protocol ID: WLPS-1409-24372.Integrating Behavioural Health and Primary Care for Comorbid Behavioural and Medical Problems (IBHPC).

Background: The purpose of this study was to explore the contextual factors influencing how individual Community Health Teams make decisions about what services to offer and how to allocate their resources. Methods: We conducted thirteen semi-structured interviews with Community Health Team (CHTs) leaders between January to March, 2021. We analyzed interviewees descriptions of their service offerings, resources allocation, and decision-making process to identify themes. Results: Four major themes emerged from the interview data as contextual factors influencing community health team program managers’ decision-making process: commitment to offering high quality care coordination, Blueprint’s stable and flexible structure, use of data in priority setting, and leveraging community partnerships and local resources. Conclusions: Community based CHTs with flexible funding allowed programs to tailor service offerings in response to community needs. It is important for teams to have access to community level data. Teams are cultivating and leveraging community partners to increase their care coordination capacity, which is focus of their work. CHTs are a model for leveraging community partnerships to increase service capacity and pubic engagement in health services for other states to replicate.

Background To avoid statistical errors, researchers who recruit patients from selected medical practices and analyze them at the individual level need to account for the clustered nature of their sample. This is most often done using the intraclass correlation coefficients (ICCs), a measure of how strongly subjects recruited from the same cluster (in this case patients from a clinic) resemble each other. Aims The aim is to support the design of cluster-randomized studies by supplying estimates of variance and ICC of various measures using a population of patients from multiple primary care clinics. Materials and methods ICCs were extracted from a large cluster-randomized pragmatic clinical trial of adult primary care patients managing multiple chronic conditions, the Integrating Behavioral Health and Primary Care study (IBH-PC). IBH-PC collected demographics and patient-reported health outcomes on over 3,000 adults from 44 primary care practices in 13 states across the US. We present estimates of the standard deviation and ICC for gender, race, ethnicity, marital status, employment, income, education, social determinants of health, PROMIS-29 functional status, Duke Activity Status Index (DASI), nine-item Patient Health Questionnaire (PHQ-9) depression score, Generalized Anxiety Disorder (GAD-7) anxiety score, Asthma Symptom Utility Index, restricted activity days, medication adherence, health care visits in the past month, emergency room visits in the past year, hospital days in the past year, perception of quality and patient-centeredness of care, alcoholic drinks per month, and the GAIN substance use disorder screener. Results ICCs varied broadly with the highest values found for race and income and the lowest for short-term estimates of the GAIN. Conclusions These values can be used to inform the design, especially power estimates and sample size requirements, of future studies.

Purpose Although the number of higher education institutions adopting sustainability-focused faculty learning communities (FLCs) has grown, very few of these programs have published evaluation research. This paper aims to report findings from an evaluation of the University of Vermont’s (UVM’s) sustainability faculty fellows (SFF) program. It discusses how utilization-focused program evaluation is an important tool for developing and improving sustainability-focused FLCs. The SFF program aims to enhance sustainability education by bringing faculty members together to expand their knowledge of sustainability concepts and offer pedagogical support for integrating those concepts in higher education curricula. Design/methodology/approach A utilization-focused evaluation framework guided the evaluation’s design and implementation. Multiple methods were used to collect evaluation data, including in-person interviews and an online survey with SFF program participants. Findings The evaluation’s findings suggest that UVM’s SFF program expanded faculty understanding of sustainability concepts, encouraged curricular and instructional reform and made progress toward developing a community of faculty interested in sustainability education. The evaluation’s utilization focus was instrumental in providing useful information for improving the SFF program. Originality/value Evaluation findings expand what we know about the potential effectiveness of sustainability-focused FLCs, as well as challenges institutions might encounter when adopting such an approach to faculty development. Findings also point to ways in which utilization-focused evaluations can inform program development and improvement efforts.