• Hayley D Germack, Lucinda Leung, Xinhua Zhao, Hongwei Zhang, and Grant R Martsolf.
• Department of Acute and Tertiary Care, School of Nursing, University of Pittsburgh, 3500 Victoria Street 336 Victoria Building, Pittsburgh, PA, USA. hdg8@pitt.edu.
• J Gen Intern Med. 2022 Jan 1; 37 (1): 404840-48.

BackgroundIntegrating mental health in primary care settings is associated with improved screening and detection of mental illness. In 2010, the Veterans Health Administration launched a patient-centered medical home (PCMH) model nationally across all clinical sites that integrated mental health into primary care-the Patient Aligned Care Team (PACT) initiative. Team-based delivery of continuous primary and mental health care, as found in effective collaborative care models, is thought to be crucial to managing veterans with mental health disorders. The association between clinic implementation of specific aspects of PACT and clinical outcomes of veterans with mental health disorders remains unknown.ObjectiveTo examine the association between clinic implementation of team-based care and continuity of care and subsequent hospitalizations among veterans with mental health disorders.DesignRetrospective cohort study.PatientsA total of 1,444,942 veterans with comorbid mental health disorders and physical health conditions receiving primary care in 831 VA PACT clinics in fiscal year (FY) 2015.Main MeasuresWe examined the clinic-level implementation of team-based care and continuity of care in the clinic where veterans received their primary care. Our primary outcome was any hospitalization in the VA or fee-based service in FY2016. We examined the impact of clinic-level implementation of team-based care and continuity of care on having a hospitalization, adjusting for patient demographic, clinical characteristics, and facility characteristics.Key ResultsVeterans receiving care in clinics with the greatest versus lowest quartile of implementation of team-based care had lower rates of hospitalization (8.8% vs. 12.3%; adjusted OR = 0.92, 95% CI 0.85-0.99, p < 0.035). There was not a statistically significant association between clinic-level implementation of continuity of care and hospitalization.ConclusionsVeterans receiving care in clinics with greater implementation of team-based care had statistically significant lower rates of hospitalization.© 2021. Society of General Internal Medicine.

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