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Regional Adoption of Primary CareMental Health Integration in Veterans Health Administration Patient-Centered Medical Homes

Leung, Lucinda B.; Rose, Danielle; Stockdale, Susan; McGowan, Michael; Yano, Elizabeth M.; Graaff, A. Laurie; Dresselhaus, Timothy R.; Rubenstein, Lisa V.

The Journal for Healthcare Quality (JHQ): September/October 2019 - Volume 41 - Issue 5 - p 297–305
doi: 10.1097/JHQ.0000000000000206
Original Article

Introduction: Behavioral health integration is important, yet difficult to implement, in patient-centered medical homes. The Veterans Health Administration (VA) mandated evidence-based collaborative care models through Primary CareMental Health Integration (PC-MHI) in large PC clinics. This study characterized PC-MHI programs among all PC clinics, including small sites exempt from program implementation, in one VA region.

Methods: Researchers administered a cross-sectional key informant organizational survey on PC-MHI among VA PC clinics in Southern California, Arizona, and New Mexico (n = 69 distinct sites) from February to May 2018. Researchers analyzed PC clinic leaders' responses to five items about organizational structure and practice management.

Results: Researchers received surveys from 65 clinics (94% response rate). Although only 38% were required to implement on-site PC-MHI programs, 95% of participating clinics reported providing access to such services. The majority reported having integrated, colocated, or tele-MH providers (94%) and care management (77%). Most stated same-day services (59%) and “warm” handoffs (56%) were always available, the former varying significantly based on clinic size and distance from affiliated VA hospitals.

Conclusions: Regional adoption of PC-MHI was high, including telemedicine, among VA patient-centered medical homes, regardless of whether implementation was required. Small, remote PC clinics that voluntarily provide PC-MHI services may need more support.

For more information on this article, contact Lucinda B. Leung at

Funders: Drs. L. B. Leung, D. Rose, and S. Stockdale and Mr. M. McGowan were funded by the Veterans Assessment and Improvement Laboratory for Patient-Centered Care (XVA 65-018). Dr. E. M. Yano was funded by a VA HSRD Service Senior Research Scientist Award (project RCS-05-195).

The authors declare no conflicts of interest.

These views represent the opinions of the authors and not necessarily those of the VA or the U.S. government.

© 2019 National Association for Healthcare Quality
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