Key DFM Personnel

Richard Brown, MD, MPH – Principal Investigator

Funding

Pittsburg Regional Health Initiative

Summary

The research initiative, which is being organized by three CVEs and the Network for Regional Healthcare Improvement, targets depression and substance use, which affects 17.6 million and 22 million Americans, respectively. The goal is to identify unhealthy substance use and depression in the primary care setting before these chronic diseases become debilitating by removing barriers and introducing strategies, training, and tools to widely disseminate and implement comparative effectiveness research-based models that integrate behavioral health services into primary care-Screening, Brief Intervention, and Referral to Treatment (SBIRT) and Improvement Mood-Promoting Access to Collaborative Treatment (IMPACT). Identifying and managing these behavioral health conditions is critical for increasing physical and social role function, for improving the ability to manage co-morbid physical diseases, for reducing the economic costs of untreated behavior health problems, and for reducing the current and large treatment gap for people with substance use disorders.

Methodology

In the first 6 months of the initiative, the partners-drawing on their own experiences and successful training approaches, tools and materials (see Facilities and Resources and Equipment)-will develop a dissemination and implementation strategy that addresses the significant barriers to implementing SBIRT and IMPACT. The strategy will have the following components, each of which will be described in greater detail below:

(1) A Marketing Plan will explicitly address major system’s barriers to implementation (including system-level reimbursement barriers and lack of community awareness about the prevalence and impact of behavioral health problems). It will further include stakeholder-specific strategies, information and messages describing the case for implementation and be designed to help major stakeholder groups understand the value of integrating IMPACT and SBIRT screening and intervention techniques into primary care and the key steps needed to support success.

(2) A Practice Support Plan will address practice-level implementation barriers, including reimbursement challenges and billing at the practice level, workforce issues and organizational change (including the need to develop collaborative care approaches), and health information technology and billing.

The initiative’s first goal will be to increase the number of practices that implement IMPACT and/or SBIRT. As seen in Figure 1, indicators 1-4 will be used to measure this goal. The second goal is to increase the number of patients screened for depression and/or unhealthy substance use through IMPACT and SBIRT. This goal will be measured by collecting data for indicator 5. This data will enable the measurement of the NQF measure, ?Percentage of patients with depression or bipolar disorder with evidence of an initial assessment that includes an appraisal for alcohol or chemical substance use. Our third goal is to engage the patients who screen positive for depression/unhealthy substance use into IMPACT or SBIRT. This goal will be measured by collecting data for indicators 6 and 7. The data for these measures will also enable the calculation of the NQF measure, ?Percentage of patients aged 18 years and older screened for clinical depression using a standardized tool and a follow up plan documented.? Our fourth goal is to improve the clinical outcomes of the patients who receive IMPACT services. This goal will be measured by collecting data to calculate indicator 8, which is aligned with the HRSA Health Disparities Collaboratives55 and Minnesota Community Measurement measures. In addition, Indicator 8 is valid, since 50% reduction in the symptoms of depression is an accepted measurement of clinical improvement in randomized trials. Our fifth goal is to reduce high-risk drinking days and drug-use days. This goal will be measured by data collected for indicators 9 and 10.