Date of Award

Spring 4-18-2024

Embargo Period

12-14-2024

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD) in Health & Rehabilitation Science

Department

Health Sciences and Research

College

College of Health Professions

First Advisor

Jillian Harvey

Second Advisor

Emily Johnson

Third Advisor

Constance Guille

Abstract

Behavioral health (BH) disorders are highly prevalent in the United States and especially concerning in rural communities which disproportionately lack access to BH services. While models for integrating BH into primary care, such as psychiatric collaborative care management (CoCM), have shown promise in mitigating the BH crisis, implementation in rural communities has proved challenging.
This dissertation examines implementation of CoCM nationally and in rural settings through three distinct aims. First, a claims-based retrospective cohort study was used to determine whether commercially insured patients receiving CoCM had lower acute BH care utilization and cost as compared to similar patients not receiving CoCM. Second, a mixed-methods systematic review was conducted to describe barriers and facilitators to rural implementation of CoCM. Finally, implementation science evaluation was applied to a telehealth-enabled CoCM pilot conducted at four rural primary care sites to determine optimal adaptations to the model and characterize barriers and facilitators to implementation.
While each aim was distinct in terms of methods and results, the challenge of implementing CoCM was common across study findings. However, results also showed that successful implementation of CoCM in rural communities is feasible, especially when tailored to these contexts and aided by external supports.

Rights

Copyright is held by the author. All rights reserved.

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