Rose to present at Society of Behavioral Medicine

Gail Rose, PhD, Assistant Professor of Psychiatry, will present the latest work of her research team at the Society of Behavioral Medicine Annual Meeting this April in Bethesda, MD. Congratulations, Gail!

A Measure for Integrated Behavioral Health in Primary Care: Improving Clarity and Utility of a Valid Measure

Gail Rose, Mindy L. McEntee, Tara L. Weldon, Dan Mullin, CR Macchi, Connie van Eeghen, Benjamin Littenberg, Matthew Martin, Juvena Hitt, and Rodger Kessler.

The integration of behavioral health (BH) into primary care is a critical step in delivering care that is efficient, effective, and satisfying to patients and clinicians. As models of integration vary across theory and practice, measurement plays a key role in disseminating standards, encouraging practice transformation, and supporting health services research because it enables comparisons across practices and within practices over time. The Practice Integration Profile (PIP) is a reliable and valid 30-item measure that assesses operational and procedural elements that align with established domains of BH integration in the AH
RQ Lexicon. The PIP measures independent attributes of integration with high reliability over time and can serve as a quality improvement or health services research tool. However, a measurement is limited by its level of clarity and utility. Prior analyses of PIP data and feedback from users suggested the measure, previously validated, could benefit from improvement.

Aims

To improve the clarity, utility, and interpretability of the PIP.

Design

Scale development

Methods

 Two rounds of structured cognitive interviews were conducted with clinicians in primary care settings. After each round, an analytic team coded interview transcripts using an iterative and consensus-driven process to identify recurring themes. Themes and recommendations for revisions were presented to our expert panel for review and modification. Panelists reviewed each item, suggested changes in light of feedback from interviews, and sought team consensus before making final decisions.

Results

Based on the themes, recommendations, and a published factor analysis of the PIP, revisions were undertaken to: 1) Clarify the meaning of items that were ambiguous, confusing, or overly broad. 2) Place items in the most useful and appropriate domains. 3) Standardize the response categories. 4) Eliminate redundant or overlapping items. The resulting measure has 28 items in five domains. Conclusion Healthcare measurement tools are more effective when items and formatting are clear and useful to target audiences. In response to identified clinical need, we undertook this data-driven revision to clarify the purpose of the measure, focus the domains, and refine each item to reflect the diverse integrated care clinic processes and practices. PIP 2.0 will need further examination to confirm it’s continuing use as a foundational tool for evaluating integrated care.