• Benjamin Littenberg, Jessica Clifton, Abigail M Crocker, Laura-Mae Baldwin, Levi N Bonnell, Ryan E Breshears, Peter Callas, Prama Chakravarti, Kelly Clark/Keefe, Deborah J Cohen, Frank V deGruy, Lauren Eidt-Pearson, William Elder, Chester Fox, Sylvie Frisbie, Katie Hekman, Juvena Hitt, Jennifer Jewiss, David C Kaelber, Kairn Stetler Kelley, Rodger Kessler, Jennifer B O'Rourke-Lavoie, George S Leibowitz, C R Macchi, Matthew P Martin, Mark McGovern, Brenda Mollis, Daniel Mullin, Zsolt Nagykaldi, Lisa W Natkin, Wilson Pace, Richard G Pinckney, Douglas Pomeroy, Paula Reynolds, Gail L Rose, Sarah Hudson Scholle, William J Sieber, Jeni Soucie, Terry Stancin, Kurt C Stange, Kari A Stephens, Kathryn Teng, Elizabeth Needham Waddell, and Constance van Eeghen.
• University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.); benjamin.littenberg@uvm.edu.
• Ann Fam Med. 2023 Nov 1; 21 (6): 483495483-495.

PurposePatient outcomes can improve when primary care and behavioral health providers use a collaborative system of care, but integrating these services is difficult. We tested the effectiveness of a practice intervention for improving patient outcomes by enhancing integrated behavioral health (IBH) activities.MethodsWe conducted a pragmatic, cluster randomized controlled trial. The intervention combined practice redesign, quality improvement coaching, provider and staff education, and collaborative learning. At baseline and 2 years, staff at 42 primary care practices completed the Practice Integration Profile (PIP) as a measure of IBH. Adult patients with multiple chronic medical and behavioral conditions completed the Patient-Reported Outcomes Measurement Information System (PROMIS-29) survey. Primary outcomes were the change in 8 PROMIS-29 domain scores. Secondary outcomes included change in level of integration.ResultsIntervention assignment had no effect on change in outcomes reported by 2,426 patients who completed both baseline and 2-year surveys. Practices assigned to the intervention improved PIP workflow scores but not PIP total scores. Baseline PIP total score was significantly associated with patient-reported function, independent of intervention. Active practices that completed intervention workbooks (n = 13) improved patient-reported outcomes and practice integration (P ≤ .05) compared with other active practices (n = 7).ConclusionIntervention assignment had no effect on change in patient outcomes; however, we did observe improved patient outcomes among practices that entered the study with greater IBH. We also observed more improvement of integration and patient outcomes among active practices that completed the intervention compared to active practices that did not. Additional research is needed to understand how implementation efforts to enhance IBH can best reach patients.© 2023 Annals of Family Medicine, Inc.

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