Notice2022-22843
Supplemental Evidence and Data Request on Strategies for Integrating Behavioral Health and Primary Care
Primary source
Metadata and text below are from the Federal Register, a public-domain U.S. government work. Always verify the official published version before relying on it for any legal matter.
Published
October 21, 2022
Issuing agencies
Health and Human Services DepartmentAgency for Healthcare Research and Quality
Abstract
The Agency for Healthcare Research and Quality (AHRQ) is seeking scientific information submissions from the public. Scientific information is being solicited to inform our review on Strategies for Integrating Behavioral Health and Primary Care, which is currently being conducted by the AHRQ's Evidence-based Practice Centers (EPC) Program. Access to published and unpublished pertinent scientific information will improve the quality of this review.
Full Text
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<title>Federal Register, Volume 87 Issue 203 (Friday, October 21, 2022)</title>
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[Federal Register Volume 87, Number 203 (Friday, October 21, 2022)]
[Notices]
[Pages 64043-64046]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2022-22843]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Agency for Healthcare Research and Quality
Supplemental Evidence and Data Request on Strategies for
Integrating Behavioral Health and Primary Care
AGENCY: Agency for Healthcare Research and Quality (AHRQ), HHS.
ACTION: Request for supplemental evidence and data submissions.
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SUMMARY: The Agency for Healthcare Research and Quality (AHRQ) is
seeking scientific information submissions from the public. Scientific
information is being solicited to inform our review on Strategies for
Integrating Behavioral Health and Primary Care, which is currently
being conducted by the AHRQ's Evidence-based Practice Centers (EPC)
Program. Access to published and unpublished pertinent scientific
information will improve the quality of this review.
DATES: Submission Deadline on or before November 21, 2022.
ADDRESSES:
Email submissions: <a href="/cdn-cgi/l/email-protection#c8adb8ab88a9a0bab9e6a0a0bbe6afa7be"><span class="__cf_email__" data-cfemail="eb8e9b88ab8a83999ac5838398c58c849d">[email protected]</span></a>.
Print submissions:
Mailing Address: Center for Evidence and Practice Improvement,
Agency for Healthcare Research and Quality, Attn: EPC SEADs
Coordinator, 5600 Fishers Lane, Mail Stop 06E53A, Rockville, MD 20857.
Shipping Address (FedEx, UPS, etc.): Center for Evidence and
Practice Improvement, Agency for Healthcare Research and Quality, Attn:
EPC SEADs Coordinator, 5600 Fishers Lane, Mail Stop 06E77D, Rockville,
MD 20857.
FOR FURTHER INFORMATION CONTACT: Jenae Benns, Telephone: 301-427-1496
or email: <a href="/cdn-cgi/l/email-protection#0c697c6f4c6d647e7d2264647f226b637a"><span class="__cf_email__" data-cfemail="d1b4a1b291b0b9a3a0ffb9b9a2ffb6bea7">[email protected]</span></a>.
SUPPLEMENTARY INFORMATION: The Agency for Healthcare Research and
Quality has commissioned the Evidence-based Practice Center (EPC)
Program to complete a review of the evidence for Strategies for
Integrating Behavioral Health and Primary Care. AHRQ is conducting this
systematic review pursuant to Section 902 of the Public Health Service
Act, 42 U.S.C. 299a. The EPC Program is dedicated to identifying as
many studies as possible that are relevant to the questions for each of
its reviews. In order to do so, we are supplementing the usual manual
and electronic database searches of the literature by requesting
information from the public (e.g., details of studies conducted). We
are looking for studies that report on Strategies for Integrating
Behavioral Health and Primary Care, including those that describe
adverse events. The entire research protocol is available online at:
<a href="https://effectivehealthcare.ahrq.gov/products/strategies-integrating-behavioral-health/protocol">https://effectivehealthcare.ahrq.gov/products/strategies-integrating-behavioral-health/protocol</a>. This is to notify the public that the EPC
Program would find the following information on Strategies for
Integrating Behavioral Health and Primary Care helpful:
[ssquf] A list of completed studies that your organization has
sponsored for this indication. In the list, please indicate whether
results are available on <a href="http://ClinicalTrials.gov">ClinicalTrials.gov</a> along with the
<a href="http://ClinicalTrials.gov">ClinicalTrials.gov</a> trial number.
[ssquf] For completed studies that do not have results on
<a href="http://ClinicalTrials.gov">ClinicalTrials.gov</a>, a summary, including the following elements: study
number, study period, design, methodology, indication and diagnosis,
proper use instructions, inclusion and exclusion criteria, primary and
secondary outcomes, baseline characteristics, number of patients
screened/eligible/enrolled/lost to follow-up/withdrawn/analyzed,
effectiveness/efficacy, and safety results.
[ssquf] A list of ongoing studies that your organization has
sponsored for this indication. In the list, please provide the
<a href="http://ClinicalTrials.gov">ClinicalTrials.gov</a> trial number or, if the trial is not registered, the
protocol for the study including a study number, the study period,
design, methodology, indication and diagnosis, proper use instructions,
inclusion and exclusion criteria, and primary and secondary outcomes.
[ssquf] Description of whether the above studies constitute ALL
Phase II and above clinical trials sponsored by your
[[Page 64044]]
organization for this indication and an index outlining the relevant
information in each submitted file.
Your contribution is very beneficial to the Program. Materials
submitted must be publicly available or able to be made public.
Materials that are considered confidential; marketing materials; study
types not included in the review; or information on indications not
included in the review cannot be used by the EPC Program. This is a
voluntary request for information, and all costs for complying with
this request must be borne by the submitter. The draft of this review
will be posted on AHRQ's EPC Program website and available for public
comment for a period of 4 weeks. If you would like to be notified when
the draft is posted, please sign up for the email list at: <a href="https://www.effectivehealthcare.ahrq.gov/email-updates">https://www.effectivehealthcare.ahrq.gov/email-updates</a>.
The systematic review will answer the following questions. This
information is provided as background. AHRQ is not requesting that the
public provide answers to these questions.
Questions for the Systematic Review
Question 1 (Scan). What approaches have been used to integrate
behavioral health and primary care?
a. How do these approaches vary by:
(i) patient characteristics (e.g., clinical focus/conditions/patient
subgroups)
(ii) core components of the approach
(iii) practice/care delivery setting characteristics such as the policy
environment, and geographic location.
(iv) resources and infrastructure required, such as staffing, payment
models, financing, and technology
(v) mechanisms of care integration
Question 2 (Key). How effective are approaches to integrating
behavioral health and primary care?
a. Does effectiveness vary by:
(i) patient characteristics (e.g., clinical focus/conditions/patient
subgroups)
(ii) core components of the approach
(iii) practice/care delivery setting characteristics, such as the
policy environment, and geographic location.
(iv) resources and infrastructure required, such as staffing,
financing, payment models, and technology
(v) mechanisms of care integration
b. How do interactions among the components of integration
approaches impact effectiveness and maintenance of the integration of
behavioral health and primary care?
Question 3 (Contextual). What are the barriers to and facilitators
of implementing and sustaining different approaches to integrating
behavioral health and primary care?
a. How do the barriers, facilitators, and other factors involved in
the implementation of behavioral health and primary care interact to
affect implementation and sustainability?
Question 4 (Contextual). What reliable, valid, clinically
meaningful, and/or patient-centered measures and metrics are available
to monitor and evaluate integration approaches?
a. How is measurement integrated into clinical care and the ongoing
monitoring and evaluation of integration?
b. Are the measures or metrics specific to characteristics; level
of complexity; or the structure, process, or outcomes of care
integration?
c. Are there models or standards for how frequently the
effectiveness of approaches to integration should be reassessed?
d. What are the gaps in measurement and what are the implications
for our current ability to measure and assess integration?
Question 5 (Contextual). How are care team member roles and their
work flows defined in different approaches to integrating behavioral
health and primary care?
a. What training interventions (e.g., mode and content, trainee
credentials, dose and timing of training) are effective in facilitating
integrated care team functioning?
Population, Interventions, Comparators, Outcomes, and Setting (PICOS)
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PICOS Inclusion Exclusion
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Population............................. Children (aged 0-20 years) and adults (aged <bullet> No exclusions
>=21 years) with behavioral health needs. for age or condition.
Clinical focus/conditions including but not
limited to patients with:
<bullet> Mental illness or mental health
conditions
<bullet> Substance use disorders
<bullet> Stress-linked physical symptoms
(e.g., insomnia, fatigue)
<bullet> Complex overlapping medical
conditions and psychosocial risk factors
<bullet> Experiences of trauma, adverse
experiences, or stressful life events
<bullet> Pregnant patients
<bullet> Geriatric patients
Intervention........................... Different approaches to integrating <bullet> Co-location
behavioral health and primary care without collaboration.
services, including program/model <bullet> Referral only
components and strategies to integrate (cold handoff).
care. <bullet> Warm handoff
Examples of eligible programs/models for without plan for
care integration include but are not continued communication
limited to: and coordination of
<bullet> Collaborative Care Model care.
<bullet> Primary Care Behavioral Health <bullet> Population level
Model health promotion or
<bullet> Co-location models prevention programs that
<bullet> Models that use telehealth for are not individualized,
integration integrated care (e.g.,
The baseline requirement is that the Silver Sneakers).
practice design of the approach facilitates <bullet> Interventions
interaction among primary care and for chronic medical
behavioral health providers in the conditions that do not
provision of care. Ongoing collaboration include a significant,
and coordination of care are required; explicit behavioral
activities may include screening and health component.
diagnosis, acute and long-term
interventions, and follow up and
maintenance.
[[Page 64045]]
Comparator............................. <bullet> Care as usual (e.g., non-integrated <bullet> No comparator
behavioral health and primary care for KQ 2 (descriptive
services) in a different group or time studies; such as case
period studies).
<bullet> Alternative care integration <bullet> Comparators not
strategy or strategies applicable to other
<bullet> No care questions.
Outcomes............................... Outcomes of interest include but not limited Simulated results or
to: responses to
PATIENT LEVEL hypothetical scenarios
Health outcomes: or questions.
<bullet> Morbidity
<bullet> Mortality
<bullet> Improved symptoms
<bullet> Guideline concordant screening and
diagnosis
<bullet> Remission/recovery
<bullet> Adherence to treatment
Patient Reported Outcomes:
<bullet> Health related quality of life
<bullet> Functional status (including social
and adaptive functioning)
<bullet> Satisfaction with care
Measures of care utilization:
<bullet> Avoidable emergency care or
inpatient care for behavioral health crises
<bullet> Total health care utilization
Measures of access to care:
<bullet> Patients receive routine care as
soon as wanted
<bullet> Patients receive acute care when
needed
<bullet> Average wait time for BH
<bullet> Patients experiencing difficulties
or delays in obtaining BH care
<bullet> Patients with mental health
condition received treatment
<bullet> Patients with SUDs received
treatment
CLINICIAN AND PRACTICE LEVEL
Clinician Outcomes:
<bullet> Clinician retention/turnover rates
<bullet> Burnout
<bullet> Professional satisfaction
<bullet> Efficiency of clinician time use
Population/community/clinic panel health
outcomes:
<bullet> BH-related preventive care measures
<bullet> BH screening services
Cost outcomes:
<bullet> Cost per patient per year
<bullet> Cost per service
<bullet> Costs associated with care delays,
fragmentation, poor coordination,
redundancy, requested but not completed
patient referrals
Implementation Outcomes:
<bullet> Adoption of intervention approaches
<bullet> Fidelity
<bullet> Systemic Change/Sustainment
HARMS
<bullet> Missed diagnoses
<bullet> Delays in care
<bullet> Overutilization of resources
<bullet> Redundant or inappropriate care
Setting................................ <bullet> Health systems/hospitals and <bullet> Hospitals.
community-based primary care practices in <bullet> Prehospital/EMS/
the United States (physical or virtual) or crisis care.
in countries with similar healthcare <bullet> Prisons.
systems <bullet> Countries with
<bullet> Non-healthcare settings providing healthcare systems that
outpatient BH/PC (school-based clinics, do not provide
community centers, churches, shelters) information relevant to
<bullet> Nursing homes, group homes and the U.S.
other long-term residential settings
Study Designs.......................... <bullet> Experimental and observational <bullet> Articles that do
studies that describe and evaluate not include any data.
integration approach. <bullet> Proposals for
<bullet> For Scan Question 1 and Contextual approaches that have not
Questions 3 and 5: Survey and Qualitative been implemented.
Studies. <bullet> Descriptions of
<bullet> For Contextual Question 4: approaches that have not
Psychometric Studies been evaluated (for
<bullet> Systematic reviews that directly KQ2).
address one of the review questions <bullet> Articles
reporting simulation or
speculation.
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Abbreviations: BH = behavioral health; EMS = emergency medical services; KQ = key question; PC = primary care.
[[Page 64046]]
Dated: October 17, 2022.
Marquita Cullom,
Associate Director.
[FR Doc. 2022-22843 Filed 10-20-22; 8:45 am]
BILLING CODE 4160-90-P
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