Table 1.

Effect of Clinic PC-MHI Penetration on Mental Health Care Quality, 2013-2016

Quality measure completed within 24 h	Clinic mean	Odds ratio	95% CI, lower limit	95% CI, upper limit	p value
Suicide risk evaluation
Following annual positive depression screen	83%	0.99	0.92	1.07	0.80
Following annual positive PTSD screen	84%	0.96	0.88	1.04	0.33
Following annual positive depression or PTSD	83%	0.98	0.93	1.04	0.54
Clinician follow-up or counseling
Following annual positive depression screen	64%	0.96	0.90	1.03	0.29
Following annual positive PTSD screen	79%	0.95	0.85	1.06	0.36
For alcohol misuse screening result of 5 or greater (within 14 days)	79%	0.97	0.92	1.02	0.20

PC-MHI Primary Care–Mental Health Integration, CI confidence interval, PTSD post-traumatic stress disorder

Key quality metrics examined and thought to be facilitated by primary care and mental health integration are shown. Multilevel logistic regression models controlled for clinic PC-MHI penetration rate, year, VA regional network, clinic characteristics (level of patient-centered medical home implementation, size, rurality, type [i.e., hospital, community-based]), and patient characteristics (age, gender, race-ethnicity, marital status, VA means test, service connectedness, Gagne Comorbidity Score category, homelessness, distance from home to clinic, depression, anxiety, PTSD, substance use disorder, serious mental illness [i.e., schizophrenia, bipolar disorder]). The distribution of clinic PC-MHI penetration was normalized by performing log base 2 transformation. Odds ratios, therefore, are interpreted as percentage changes in odds of a person meeting the quality measure per year, relative to each two-fold increase in clinic PC-MHI penetration (i.e., a change from 2% to 4% of primary care patients seen by a PC-MHI provider annually).