Joining Forces to Develop a National Model

Between October 2010 and September 2013, NRHI members formed an AHRQ-funded and PRHI-led consortium called Partners in Integrated Care (PIC) to develop and test a multi-state strategy for disseminating and implementing a primary care delivery model for depression and unhealthy alcohol and drug use based on comparative effectiveness research (CER). By leveraging the NRHI network, the PIC partners assembled and merged their lessons learned, best practices, curriculum, and implementation tools to deploy the evidence-based model. Across four states (Pennsylvania, Massachusetts, Wisconsin and Minnesota) 57 primary care offices implemented the model. PIC was the first initiative in which multiple RHICs collaborated on a single, national project.

PIC partners are:

Core Components of the PIC Primary Care Model include:
• Screening adults in primary care offices for depression and unhealthy alcohol and other drug use
• Adding a dedicated role in primary care for patient engagement, brief interventions, longitudinal monitoring, and facilitation of team-based collaboration (a care manager)
• Providing brief interventions, using motivational interviewing and behavior activation
• Systematically tracking and following-up with patients
• Conducting weekly caseload reviews with a consulting psychiatrist to elicit treatment recommendations for the primary care provider
• Utilizing a stepped-care approach for depression treatment
• Developing a maintenance plan once the patient’s goals are reached

Many NRHI members are prepared to continue this work across additional communities building on the lessons learned.

Some Results
In three of the four states, 54 primary care practice offices implemented the PIC model. These practices administered 69,216 depression and alcohol screenings and 66,837 ‘other drug’ screens. Among patients with documented eligibility, 3,186 received depression services and 429 received substance misuse services. In the fourth state, the PIC model was disseminated to three offices.