Source: Integrated Team-Based Care at Intermountain (JAMA, 2016)

Summary

The largest peer-reviewed evaluation of one of Intermountain's own clinical redesigns: a retrospective cohort study comparing primary care delivered in Intermountain's integrated team-based care (TBC) practices — physical and mental health managed by one team — against its traditional practice management (TPM) practices. JAMA 316(8):826–834, published 2016-08-23; DOI 10.1001/jama.2016.11232; PubMed 27552616.

It matters to this wiki for two reasons. It is the primary record behind the claim that Intermountain's integrated behavioral health work produced measurable results, and it is a rare case of a health system publishing a mixed result about itself in a top-five journal — one quality measure moved the wrong way, and the paper reports it.

Useful Claims

• Design and scale: a retrospective, longitudinal cohort study of adults who received primary care at 113 unique Intermountain Healthcare Medical Group primary care practices from 2003 through 2005 and kept yearly encounters through 2013. Over the study period January 2010 – December 2013 it covers 113,452 unique patients (mean age 56.1 years, 58.9% women) across 27 TBC practices and 75 TPM practices — fewer than 113 because some patients were treated in both models.
• Quality measures favored TBC on three of the reported measures: active depression screening 46.1% versus 24.1%, adherence to a diabetes care bundle 24.6% versus 19.5%, and documentation of self-care plans 48.4% versus 8.7%.
• One measure went the other way, and the paper reports it plainly: the proportion of patients with controlled hypertension (<140/90 mm Hg) was lower in TBC practices — 85.0% versus 97.7%.
• Utilization was lower in TBC practices per 100 person-years: emergency department visits 18.1 versus 23.5, hospital admissions 9.5 versus 10.6.
• Cost: payments to the delivery system were lower for TBC patients — $3400.62 versus $3515.71 — and the difference was smaller than the program's own investment costs. The paper's conclusion is stated as association, not causation.
• Authorship ties this to the wider program: Lucy Savitz and Brent James, the authors of the 2011 Health Affairs account of Intermountain's quality method, are coauthors here.

Verbatim

From the published abstract, quoted exactly:

Adult patients (aged ≥18 years) who received primary care at 113 unique Intermountain Healthcare Medical Group primary care practices from 2003 through 2005 and had yearly encounters with Intermountain Healthcare through 2013, including some patients who received care in both TBC and TPM practices.

— Abstract, "Setting and Participants"

During the study period (January 2010-December 2013), 113,452 unique patients (mean age, 56.1 years; women, 58.9%) accounted for 163,226 person-years of exposure in 27 TBC practices and 171,915 person-years in 75 TPM practices.

— Abstract, "Results"

higher rates of active depression screening (46.1% for TBC vs 24.1% for TPM; odds ratio [OR], 1.91 [95% CI, 1.75 to 2.08), adherence to a diabetes care bundle (24.6% for TBC vs 19.5% for TPM; OR, 1.26 [95% CI, 1.11 to 1.42]), and documentation of self-care plans (48.4% for TBC vs 8.7% for TPM; OR, 5.59 [95% CI, 4.27 to 7.33]), lower proportion of patients with controlled hypertension (<140/90 mm Hg) (85.0% for TBC vs 97.7% for TPM; OR, 0.87 [95% CI, 0.80 to 0.95])

— Abstract, "Results"

emergency department visits (18.1 for TBC vs 23.5 for TPM; incidence rate ratio [IRR], 0.77 [95% CI, 0.74 to 0.80]), hospital admissions (9.5 for TBC vs 10.6 for TPM; IRR, 0.89 [95% CI, 0.85 to 0.94])

— Abstract, "Results"

Payments to the delivery system were lower in the TBC group vs the TPM group ($3400.62 for TBC vs $3515.71 for TPM; β, -$115.09 [95% CI, -$199.64 to -$30.54]) and were less than investment costs of the TBC program.

— Abstract, "Results"

Reliability Notes

Primary tier: peer-reviewed, cited by DOI, permanently retrievable by it, so no archive snapshot is owed.

The design sets the ceiling on what it can prove. This is an observational cohort inside a single integrated system, not a randomized trial: practices were not assigned at random, patients were not blinded, and the authors state their findings as associations. Nearly every author is an Intermountain employee, so this is again an institution publishing on its own program — the countervailing evidence is that the paper reports a result against its own interest (worse hypertension control) rather than omitting it. Figures above come from the published abstract; the full text is behind the publisher's access controls, so subgroup detail, the cost model, and the seven quality measures not reproduced here should be read from the article itself before being cited.

The study window (2010–2013) is a decade old. It supports what Intermountain's team-based model achieved then, not what any current practice looks like.

Related Pages

• Intermountain Clinical Quality Improvement
• Source: How Intermountain Trimmed Health Care Costs (Health Affairs, 2011)