Data-driven approaches to care delivery: Actionable informatics in the DoD’s primary care behavioral health program.

Abstract

Introduction: Transforming administrative health care data into meaningful metrics has been critical to the implementation of the Department of Defense's Primary Care Behavioral Health (PCBH) program. Methods: Data from clinical encounters with PCBH providers are used to develop metrics of program performance collaboratively. Metrics focus on describing the PCBH program and patients, provider fidelity to the model, and provider performance. These metrics form two key deliverables: a monitoring dashboard for program managers and a training dashboard for expert trainers conducting site visits. Results: Behavioral health consultants (BHCs) conducted nearly 200,000 encounters with more than 100,000 unique patients in fiscal year 2019 at more than 170 locations in 6 countries and 37 states. Administrative data derived from these encounters were used to create a variety of metrics that describe practice and performance at both the provider and program levels. These metrics are delivered through a variety of analytic products to stakeholders who use that information to make data-driven decisions about program direction and provider training. Discussion: We discuss examples of program management decisions and expert trainer actions based on these dashboards, highlighting the benefits of continued collaboration between analysts and program managers. Specifically, excerpts from several dashboards illustrate how penetration and productivity metrics yield specific, tailored action plans to improve care delivery and provider performance.

What is the recipe for PCBH? Proposed resources, processes, and expected outcomes.

“…Martin and colleagues (2021) recently conducted a Delphi study to identify electronic medical record (EMR) markers of high productivity by a BHC within PCBH due to its relationship with optimizing access to mental health care. Kincaid et al (2021) also utilizes the EMR to describe the agreed upon expected outcomes of PCBH when examining the program's performance metrics for the Department of Defense PCBH program. These efforts demonstrate momentum in the field toward operationalization of PCBH and begin to highlight some of the ingredients, processes, and outcomes that are significant to the comprehensive operational recipe for PCBH.…”

Leveraging the electronic medical record to measure fidelity to the primary care behavioral health model: Implications for clinical and research pursuits.

“…In service of creating a simple, informative, and visually appealing depiction of the monthly fidelity metrics for the BHCs and clinic leadership, we consulted the existing literature. We found a strong model in Kincaid et al (2021), who used data from clinical encounters to develop monitoring and training dashboards to improve implementation of the Department of Defense’s PCBH program. Their dashboards included metrics such as encounters per patient, types of treatment offered, provider productivity, and BHC penetration into the primary care population (Kincaid et al, 2021).…”

“…dashboards included metrics such as encounters per patient, types of treatment offered, provider productivity, and BHC penetration into the primary care population (Kincaid et al, 2021). Using this as a guiding framework, we created visual depictions of our data using Microsoft Excel.…”

Innovative applications of informatics for families, systems, and health: Introduction to the special issue.

“…This article is exemplary of an informatics method for integrating and using data to continuously monitor and improve care. Kincaid, Peters, and Curry (2021) present an example from the Department of Defense's Primary Care Behavioral Health (PCBH) program. This is a large program with breadth across six countries and 37 states with a centralized administrative structure.…”

“…Kincaid, Peters, and Curry (2021) present an example from the Department of Defense’s Primary Care Behavioral Health (PCBH) program. This is a large program with breadth across six countries and 37 states with a centralized administrative structure.…”