What Matters for Behavioral Health Integrated into Medical Subspecialty Clinics? Lessons from a Program Review

Abstract:
Background/Significance
Integrated care is a proven approach for improving behavioral health outcomes in primary care settings (Reed, 2016). Consultation-liaison (CL) psychiatrists also practice in medical subspecialty clinics, which present unique clinical and administrative challenges compared to primary care settings. Relatively little has been published about key metrics and principles for delivering integrated behavioral health that apply across medical subspecialty settings. Here, we present the preliminary results of a comprehensive program review examining outpatient behavioral health services integrated into 8 subspecialty clinics (gastroenterology, neurology, pain medicine, oncology, HIV, sports medicine, hepatology, and perinatal medicine). Our goal was to assess feasibility, utilization, and stakeholder satisfaction in a uniform way across subspeciality integrated behavioral health programs.


Methods
This retrospective quality improvement study synthesized clinical and operational data over a 1-year period across multiple subspecialty integrated care programs. We utilized clinical analytics tools to extract data on utilization, wait times, show rates, patient satisfaction, and diagnoses managed. We also surveyed integrated CL psychiatrists to assess stakeholder priorities and administrative needs across subspecialty areas.


Results
Beginning with neurology and gastroenterology clinics, preliminary data shows a total of 4,279 outpatient behavioral health visits completed over a 1-year period by 5 CL psychiatrists (1.25 full-time equivalents) and 5 therapists (3 full-time equivalents). Both integrated programs demonstrated high patient access (next available appointment within 6 weeks and >85% utilization rate for all psychiatrists) and patient satisfaction (Press Ganey top box rates >85%). While both integrated programs primarily treated patients with anxiety, depressive, and trauma-related disorders, high rates of functional neurological disorder in the neurology clinic (6% of visits) and ADHD in the gastroenterology clinic (12% of visits) were noted. Survey results showed variation in administrative support for the behavioral health teams across clinics.



Discussion
Preliminary data from our study demonstrate high levels of patient access, utilization, and patient satisfaction in integrated subspecialty behavioral health models in neurology and gastroenterology, highlighting the feasibility and strengths of this model. Stakeholders noted variability in administrative support across clinics, which may be an opportunity for standardization. We are in the process of incorporating key operational metrics (utilization rates, new patient lead-times, billing data) and clinical data into a standardized analytics dashboard to be used by 8 outpatient integrated subspecialty behavioral health teams across our system. Data from all 8 subspecialty areas will be presented.

Conclusion/Implications
Integrated behavioral health within subspecialty medical clinics may face different clinical challenges, stakeholder priorities, and administrative barriers compared to primary care settings. Since outpatient care is a growth area for CL psychiatry (Bourgeois, 2020), it will be critical to identify clinical and operational metrics and best practices that apply to integrated behavioral health across subspecialty clinics.