Evaluating Fidelity to the Primary Care Behavioral Health Model Among Pediatric Subspecialty Clinics in Rural Appalachia
Location
D.P. Culp Center Ballroom
Start Date
4-5-2024 9:00 AM
End Date
4-5-2024 11:30 AM
Poster Number
107
Name of Project's Faculty Sponsor
Morgan Treaster
Faculty Sponsor's Department
Pediatrics
Competition Type
Competitive
Type
Poster Presentation
Presentation Category
Health
Abstract or Artist's Statement
Pediatric patients in rural areas face unique challenges in managing chronic illness. Furthermore, unmet mental health needs or lifestyle factors impact health. Primary Care Behavioral Health (PCBH) is an integrated team-based care approach that places behavioral health providers in medical settings to see patients same-day for identified needs and follow up for short-term care. The principles of this model are summarized by the GATHER acronym: Generalist, Accessible, Team-based, High productivity, Educator, and Routine. PCBH acknowledges the psychosocial aspects of chronic illnesses and overcomes barriers to care for rural communities. We evaluated fidelity to the PCBH model by examining trends in utilization of services that may have implications for accessibility and productivity of an integrated behavioral health provider in pediatric subspecialty clinics in rural northeast Tennessee. De-identified data was collected over the first year of the integrated behavioral health program. Among other variables, the number of warm handoffs (WHO), scheduled visits, monthly totals by subspecialty, medical diagnoses, and visit duration were collected. Descriptive statistics were calculated utilizing Excel. Over a one-year period, behavioral health saw 518 patients, of which 35.6% required subsequent visits. Within this subset of patients, the average number of visits with behavioral health was 2.8. Of these, 67.7% of patients saw behavioral health first as a WHO as opposed to 32.3% having an initial scheduled visit on a different day than their medical appointment. Differences were identified across subspecialties of endocrinology (endo), gastroenterology (GI), and neurology (neuro) for how patients initially connected with behavioral health; 64%, 78%, and 56% had a WHO first and 36%, 22% and 44% had a scheduled visit respectively. Average duration of WHOs were consistent across subspecialities; visits were an average of 29.7, 27.1, and 26.1 minutes, respectively. The average times for scheduled visits were 35.1, 32.7, and 34.3 minutes respectively. Findings yield preliminary results for fidelity to the PCBH model, while also highlighting areas for growth. There were high rates of provider use of same-day service accessibility (WHOs). Subspecialty differences with WHOs versus scheduled initial visits may reflect needing additional behavioral health providers to fulfill the same day demand for services or disparities across disciplines regarding desire for PCBH (warm handoffs) versus a co-located model of integration (referral for consultation). Despite novelty of the program, average visit duration was close to the recommended 15-30 minute consults by the PCBH model. Longer visits may be due to the complex patient population or need for additional training to enhance efficiency and potential productivity. Addressing these factors may enhance fidelity and have positive implications for the health of medically complex pediatric patients in rural areas.
Evaluating Fidelity to the Primary Care Behavioral Health Model Among Pediatric Subspecialty Clinics in Rural Appalachia
D.P. Culp Center Ballroom
Pediatric patients in rural areas face unique challenges in managing chronic illness. Furthermore, unmet mental health needs or lifestyle factors impact health. Primary Care Behavioral Health (PCBH) is an integrated team-based care approach that places behavioral health providers in medical settings to see patients same-day for identified needs and follow up for short-term care. The principles of this model are summarized by the GATHER acronym: Generalist, Accessible, Team-based, High productivity, Educator, and Routine. PCBH acknowledges the psychosocial aspects of chronic illnesses and overcomes barriers to care for rural communities. We evaluated fidelity to the PCBH model by examining trends in utilization of services that may have implications for accessibility and productivity of an integrated behavioral health provider in pediatric subspecialty clinics in rural northeast Tennessee. De-identified data was collected over the first year of the integrated behavioral health program. Among other variables, the number of warm handoffs (WHO), scheduled visits, monthly totals by subspecialty, medical diagnoses, and visit duration were collected. Descriptive statistics were calculated utilizing Excel. Over a one-year period, behavioral health saw 518 patients, of which 35.6% required subsequent visits. Within this subset of patients, the average number of visits with behavioral health was 2.8. Of these, 67.7% of patients saw behavioral health first as a WHO as opposed to 32.3% having an initial scheduled visit on a different day than their medical appointment. Differences were identified across subspecialties of endocrinology (endo), gastroenterology (GI), and neurology (neuro) for how patients initially connected with behavioral health; 64%, 78%, and 56% had a WHO first and 36%, 22% and 44% had a scheduled visit respectively. Average duration of WHOs were consistent across subspecialities; visits were an average of 29.7, 27.1, and 26.1 minutes, respectively. The average times for scheduled visits were 35.1, 32.7, and 34.3 minutes respectively. Findings yield preliminary results for fidelity to the PCBH model, while also highlighting areas for growth. There were high rates of provider use of same-day service accessibility (WHOs). Subspecialty differences with WHOs versus scheduled initial visits may reflect needing additional behavioral health providers to fulfill the same day demand for services or disparities across disciplines regarding desire for PCBH (warm handoffs) versus a co-located model of integration (referral for consultation). Despite novelty of the program, average visit duration was close to the recommended 15-30 minute consults by the PCBH model. Longer visits may be due to the complex patient population or need for additional training to enhance efficiency and potential productivity. Addressing these factors may enhance fidelity and have positive implications for the health of medically complex pediatric patients in rural areas.