PCORI has identified the need for large studies that look at real-life questions faced by diverse patients, caregivers, and clinicians. To address this need, PCORI launched the Pragmatic Clinical Studies initiative in 2014. Pragmatic clinical studies allow for larger-scale studies with longer timelines to compare the benefits and harms of two or more approaches known to be effective for preventing, diagnosing, treating, or managing a disease or symptom. They focus on everyday care for a wide range of patients. This research project is one of the studies PCORI awarded as part of this program.

This research project is in progress. PCORI will post the research findings on this page within 90 days after the results are final.

What is the research about?

Adults who have long-term health problems, such as heart disease or diabetes, often also have behavioral health problems, such as depression or use of alcohol or drugs. Patients with behavioral health problems may find it hard to take care of their physical health. Behavioral health problems can also increase the chance of having poor health outcomes. Patients need treatment for both physical and behavioral health problems.

Patients with behavioral health problems may see their primary care doctors first and then get a referral to specialist trained to treat behavioral health issues. These specialists include psychologists or social workers. But finding a behavioral-health specialist, making an appointment, and getting to the visits can make it hard to get care. This study is comparing two ways of delivering health care to see which is better at improving health and functioning in adults with both physical and behavioral health problems:

• One way puts behavioral-health providers and primary care doctors in the same place or nearby. This is called colocation.
• The second way puts behavioral-health providers and primary care doctors together, but it also adds training for behavioral-health providers, medical providers, nurses, and office staff to work together as a team. This is called integrated behavioral health.

Who can this research help?

This research can help healthcare administrators plan how to deliver behavioral health care. It can also help healthcare providers deliver better care to patients.

What is the research team doing?

The research team is working with 40 healthcare practices in the United States. These practices include family medicine clinics, internal medicine clinics, and community health centers. All of the practices are offering basic behavioral-health services at the clinic or nearby (colocation). Half of the practices also get an intensive program to help them add integrated behavioral health services. Each clinic adding integrated behavioral health gets:

• Online training about integrated behavioral health for behavioral health providers, doctors, nurses, and staff
• A tool kit to help make integrated behavioral health work at their practice
• A workbook to support the practice staff in changing their current processes to help integrated behavioral health run smoothly

The team is selecting 75 patients who have both medical and behavioral health problems from each practice, by chance. The research team is following these 3,000 patients for five years. The research team wants to find out if increasing the integration of behavioral-health services improves patients’ overall health when compared with colocation alone. Researchers also want to know how patients feel about their care.

The research team is using a survey to ask doctors and staff at each practice how well integrated behavioral health works at the practice. Finally, the research team is holding interviews and focus groups with patients, doctors, and staff to understand what does and doesn’t work well.

The research team includes health care experts, doctors, nurses, psychologists, and patients. Patients had input into the study design. Their input included what questions are important to patients and families.

Research methods at a glance