Impact of a Mental Health Based Primary Care Program on Quality of Physical Health Care

Published in: Administration and Policy in Mental Health and Mental Health Services Research [Epub September 2017]. doi: 10.1007/s10488-017-0822-

Posted on on September 19, 2017

by Joshua Breslau, Emily Leckman-Westin, Hao Yu, Bing Han, Riti Pritam, Diana Guarasi, Marcela Horvitz-Lennon, Deborah M. Scharf, Harold Alan Pincus, Molly T. Finnerty

Read More

Access further information on this document at Springer US

This article was published outside of RAND. The full text of the article can be found at the link above.

Research Question

  1. How did quality of care change among patients in the Primary Behavioral Health Care Integration (PBHCI) program in New York state, relative to those receiving care at clinics in the study’s control group?

We examine the impact of mental health based primary care on physical health treatment among community mental health center patients in New York State using propensity score adjusted difference in difference models. Outcomes are quality indicators related to outpatient medical visits, diabetes HbA1c monitoring, and metabolic monitoring of antipsychotic treatment. Results suggest the program improved metabolic monitoring for patients on antipsychotics in one of two waves, but did not impact other quality indicators. Ceiling effects may have limited program impacts. More structured clinical programs to may be required to achieve improvements in quality of physical health care for this population.

Key Findings

  • Quality of laboratory monitoring of metabolic side effects of medications improved among clinics in wave 1 of PBHCI implementation, which had a follow-up period of four years.
  • Other effects on extended scope of primary care practices that were targeted by the PBHCI program, such as having an outpatient medical visit and HbA1c monitoring, were not found among wave 1 clinics.
  • Among wave 2 clinics, no targeted effects on quality of care were found.
  • Lack of effect of the PBHCI program may be due to being implemented at clinics that were already providing relatively high quality of care for the targeted population.
  • Integrated programs such as PBHCI may need longer periods of time to be able to show evidence of their effects.

This report is part of the RAND Corporation External publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

Our mission to help improve policy and decisionmaking through research and analysis is enabled through our core values of quality and objectivity and our unwavering commitment to the highest level of integrity and ethical behavior. To help ensure our research and analysis are rigorous, objective, and nonpartisan, we subject our research publications to a robust and exacting quality-assurance process; avoid both the appearance and reality of financial and other conflicts of interest through staff training, project screening, and a policy of mandatory disclosure; and pursue transparency in our research engagements through our commitment to the open publication of our research findings and recommendations, disclosure of the source of funding of published research, and policies to ensure intellectual independence. For more information, visit

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.