576 - Behavioral health integration in an academically-affiliated pediatric primary care practice

Durham Pediatrics is an urban, academically-affiliated primary care practice serving > 14,000 patients from birth to young adulthood. Prior to the COVID-19 pandemic the practice rarely diagnosed or treated behavioral health conditions. Then in 2020, the incidence of depression and anxiety increased four-fold among the practice’s patient population. 


Objective: To address this unprecedented need, Durham Pediatrics launched a quality improvement initiative to better integrate behavioral health services into the medical home.

Design/Methods: Using quality improvement methodology, the practice identified root causes that contributed to the lack of behavioral health services. The practice then formed a physician-led multidisciplinary Behavioral Health Improvement Team (BHIT) to guide the practice transformation. The BHIT partnered with health system behavioral health and population health leaders to implement a strategic A3. Priority countermeasures included a) provider training; b) implementation of the collaborative care model; c) standard work for behavioral health screening.

Results:

100% of providers completed an extended CME course to improve their comfort with identification and treatment of behavioral health needs. The practice added co-located and virtual team members to implement the collaborative care model. Through successive Plan-Do-Study–Act cycles the practice refined the screening and referral process for depression, anxiety, ADHD, and other conditions. The percentage of well visits for patients 12-22 years with a billed CPT code for social-emotional screening increased from 51% in 2019 to 72% thus far in 2022. Since referral tracking was launched in early 2022 more than 400 referrals have been made to the behavioral health team for patients from birth-22 years.


Conclusion(s): In this large pediatric primary care medical home, increased provider competency and confidence in treating behavioral health spurred a profound cultural shift and increased behavioral health integration. Future directions include expanded screening for patients < 12 years, more robust protocols for managing suicidal ideation, and spread of the work to other practices in the primary care network.