Method: This study was embedded within a large multi-site NIMH funded RTC examining the implementation of PCCP in CMHCs. This sample consisted of 7 CMHCs whose providers had been trained in PCCP, a practice that orients the service plan to the individual's personal life goals. Fidelity to PCCP was measured with an objective quantitative fidelity measure, assessing the person-centeredness of service plans using 13 items. Service plans were assessed from each site at baseline (N=126), 12 months (N=126), and 18 months (N=126). Of this sample, 4 sites (N=240 service plans) had an EHR system, and 3 sites (N=138 service plans) did not. Differences in PCCP fidelity among service plans from sites with and without EHR systems were examined at each timepoint using OLS regression with a random intercept at the site level to account for the nested data. The fully adjusted model controlled for leadership quality, organizational climate, and client level demographic variables.
Results: Having an EHR system was not significantly associated with PCCP fidelity among providers trained in PCCP at baseline. However, having an EHR system did predict higher fidelity to PCCP at both 12 (b=3.45, p<.001) and 18-months (b=3.93, p<.001). Leadership quality predicted higher PCCP fidelity at baseline only (b=3.5, p<.05). Organizational climate was negatively associated with fidelity at baseline (b=-.4, p<.05), 12 (b=-.87, p<.001) and 18 months (b=-1.03, p<.001). At 12 months, PCCP fidelity was higher for service plans of younger consumers (b=1.06, p<.05), and lower among service plans of African American clients (b=-1.2 p<.01)
Conclusions and Implications: These findings suggest that EHR systems can be used to support the delivery of PCCP in CMHCs. Service user and organizational factors also predict person-centered care. The lack of baseline differences in PCCP fidelity suggest that EHRs may not promote greater person-centeredness by themselves, but in tandem with a practice change effort designed to promote person-centered care, they can lead to greater fidelity. Overall, more research is needed to understand the role of EHRs in the implementation of new practice initiatives, particularly those that are person-centered.