1. Striving for Model Fidelity in the PCBH Model: Metrics and Processes
Session # D8
Striving for Model Fidelity in the PCBH Model: Metrics and Processes
Meghan Fondow, PhD
Primary Care Behavioral Health Manager, Access Community Health Centers
Neftali Serrano, PsyD
Director of Clinical Training, Center of Excellence for Integration
Please insert the assigned session number (track letter, period number), i.e., A2a
Please insert the TITLE of your presentation.
List EACH PRESENTER who will ATTEND the CFHA Conference to make this presentation.
You may acknowledge other authors who are not attending the Conference in subsequent slides.
CFHA 18th Annual Conference
October 13-15, 2016  Charlotte, NC U.S.A.
Collaborative Family Healthcare Association 12th Annual Conference

2. Session # D8
Planning to check out poster presentations in between sessions? See below for posters related to this session: 1.) Turning the Tide: Family Medicine Resident Experiences with Behavioral Science Education within the Primary Care Behavioral Health (PCBH) Model (Friday Only) Authors: Jane Chandy, DO; Cristian Fernandez-Falcon, MD; Barbara Kiersz, DO; Stacy Ogbeide, PsyD, MS; Miguel Palacios, MD 2.) Predictors of Adherence to Behavioral Health Visits in Integrated Primary Care (Friday Only) Authors: Meghan Sharp, Marissa Carraway, Chelsey Solar, Alyssa Adams, Krystal Trout, Melissa Decker, Kari Kirian, Dennis Russo, Doyle Cummings
Please insert the assigned session number (track letter, period number), i.e., A2a
Please insert the TITLE of your presentation.
List EACH PRESENTER who will ATTEND the CFHA Conference to make this presentation.
You may acknowledge other authors who are not attending the Conference in subsequent slides.
CFHA 18th Annual Conference
October 13-15, 2016  Charlotte, NC U.S.A.
Collaborative Family Healthcare Association 12th Annual Conference

3. Faculty Disclosure
The presenters of this session have NOT had any relevant financial relationships during the past 12 months.
You must include ONE of the statements above for this session.
CFHA requires that your presentation be FREE FROM COMMERCIAL BIAS. Educational materials that are a part of a continuing education activity such as slides, abstracts and handouts CANNOT contain any advertising or product‐group message.
The content or format of a continuing education activity or its related materials must promote improvements or quality in health care and not a specific propriety business interest of a commercial interest. Presentations must give a balanced view of therapeutic options. Use of generic names will contribute to this impartiality. If the educational material or content includes trade names, where available trade names for products of multiple commercial entities should be used, not just trade names from a single commercial entity. Faculty must be responsible for the scientific integrity of their presentations. Any information regarding commercial products/services must be based on scientific (evidence‐based) methods generally accepted by the medical community.
Collaborative Family Healthcare Association 12th Annual Conference

4. Learning Objectives At the conclusion of this session, the participant will be able to:
Identify basic metrics that can be used for program/implementation evaluation
Describe ways of expanding basic metrics into more complex program evaluation strategies
Discuss the rationale for implementing a robust metrics tracking system for their own program evaluations
Include the behavioral learning objectives you identified for this session
Collaborative Family Healthcare Association 12th Annual Conference

5. Bibliography / Reference
1. Robinson PJ, Reiter JT. (2015). Behavioral Consultation and Primary Care, 2nd Edition. NY: Springer Science.
2. Bryan, Corso, Corso, Morrow, Kanzler & Ray-Sannerud (2012). Severity of mental health impairment and trajectories of improvement in and integrated primary care clinic. Journal of Consulting and Clinical Psychology, 80(3):
3. Angantyr, K., Rimner, A., Norden, T. & Norlander, T. (2015). Primary Care Behavioral Health model: Perspectives of outcome, client satisfaction, and gender. Social Behavior and Personality, 43(2),
4. Ray-Sannerud, Dolan, Morrow, Corso, Kanzler, & Bryan (2012). Longitudinal outcomes after brief behavioral health intervention in an integrated primary care clinic. Families, Systems & Health, 30(1):
5. Miller, Brown Levey, Payne-Murphy, & Kwan (2014). Outlining the scope of behavioral health practice in integrated primary care: dispelling the myth of the one-trick mental health pony. Families, Systems & Health, 32(3):
Continuing education approval now requires that each presentation include five references within the last 5 years.
Please list at least FIVE (5) references for this presentation that are no older than 5 years.
Without these references, your session may NOT be approved for CE credit.
Collaborative Family Healthcare Association 12th Annual Conference

6. Learning Assessment A learning assessment is required for CE credit.
A question and answer period will be conducted at the end of this presentation.
Please incorporate audience interaction through a brief Question & Answer period during or at the conclusion of your presentation.
This component MUST be done in lieu of a written pre- or post-test based on your learning objectives to satisfy accreditation requirements.
Collaborative Family Healthcare Association 12th Annual Conference

7. Striving for Model Fidelity in the PCBH Model: Metrics and Processes
Meghan Fondow, PhD
Neftali Serrano, PsyD

8. PCBH Model Integrated care model Population based care
85-90% of patients recommended to be seen 4 times or less each year

9. Access Community Health Centers
Program started 2007
Significant growth since start
Currently 8 BHC team members with various FTEs across 3 sites

10. Quality Improvement Metrics included from the beginning
How do we know we are maintaining model fidelity?
Data!

11. Where to Start?
Check with your EHR, Quality Improvement and/or billing office
What data do they have access to?
Can these resources be mined?

12. Program Outcomes
Population penetration

13. Program Outcomes
Population penetration for specific populations

14. Productivity
By provider, by clinic location, by day of week

15. Productivity
By clinic location (productivity report)

16. Model Adherence Average number of visits by patient per year N MeanN
Mean
Min
Max
2007
678
2.46 1 15
2008
1044
2.60 19
2009
1625
2.61 23
2010
2655
2.50 29
2011
3083
2.55 31
2012
2854
2.39 25
2013
2541
2.42
2014
2714
2.41
2015
2599
2.24

17. Model Adherence Following 4 visits or fewer for 85-90% of patients?
1 Visit
2-4 Visits
5 or More Visits
2007
45%
43% 9%
2008
48%
42%
10%
2009
51%
39%
2010
2011
50%
40%
2012
41% 8%
2013
38%
2014
53%
35%
12%
2015
54%
36%

18. Clinical Outcomes- PHQ-9 (2014)

19. Clinical Outcomes- PHQ-9 (2015)

20. Clinical Outcomes
Clinical outcomes, like PHQ-9 scores, often do not mirror the outcomes in research for a variety of reasons:
Heterogenous population with a variety of confounding characteristics (eg. Language, SES, comorbidites)
Measurement cadence in practice is often far less well developed than in research trials (eg. Measure more, likely to show more progress)
Patient goals do not necessarily align with symptom reduction
We use PHQ-9 scores to trigger a care management process for highly symptomatic patients and to ascertain trends in our care processes
We are still looking for the “perfect” BHC clinical outcome measure

21. Communication Internal to organization External to outside agencies
Quarterly metrics
External to outside agencies
Annual report

22. References
Robinson PJ, Reiter JT. (2015). Behavioral Consultation and Primary Care, 2nd Edition. NY: Springer Science.
Bryan, Corso, Corso, Morrow, Kanzler & Ray-Sannerud (2012). Severity of mental health impairment and trajectories of improvement in and integrated primary care clinic. Journal of Consulting and Clinical Psychology, 80(3):
Angantyr, K., Rimner, A., Norden, T. & Norlander, T. (2015). Primary Care Behavioral Health model: Perspectives of outcome, client satisfaction, and gender. Social Behavior and Personality, 43(2),
Ray-Sannerud, Dolan, Morrow, Corso, Kanzler, & Bryan (2012). Longitudinal outcomes after brief behavioral health intervention in an integrated primary care clinic. Families, Systems & Health, 30(1):
Miller, Brown Levey, Payne-Murphy, & Kwan (2014). Outlining the scope of behavioral health practice in integrated primary care: dispelling the myth of the one-trick mental health pony. Families, Systems & Health, 32(3):

23. Session Evaluation
Please complete and return the evaluation form before leaving this session. Thank you!
This should be the last slide of your presentation
Collaborative Family Healthcare Association 12th Annual Conference