Does the Primary Care Behavioral Health Model Reduce Emergency Department Visits?

OBJECTIVE: To examine the impact of integrating behavioral health services using the primary care behavioral health (PCBH) model on emergency department (ED) utilization.

DATA SOURCES: Utilization data from three Dane County, Wisconsin hospitals and four primary care clinics from 2003 to 2011.

STUDY DESIGN: We used a retrospective, quasi-experimental, controlled, pre-post study design. Starting in 2007, two clinics began integrating behavioral health into their primary care practices with a third starting in 2010. A fourth, nonimplementing, community clinic served as control. Change in emergency department and primary care utilization (number of visits) for patients diagnosed with mood and anxiety disorders was the outcomes of interest.

DATA COLLECTION: Retrospective data were obtained from electronic patient records from the three main area hospitals along with primary care data from participating clinics.

PRINCIPAL FINDINGS: Following the introduction of the PCBH model, one clinic experienced a statistically significant (p < .01, 95 percent CI 6.3-16.3 percent), 11.3 percent decrease in the ratio of ED visits to primary care encounters, relative to a control site, but two other intervention clinics did not.

CONCLUSIONS: The PCBH model may be associated with a reduction in ED utilization, but better-controlled studies are needed to confirm this result.