Factors Leading to Patient Disengagement for Unknown Reasons in Virtual Collaborative Care

Introduction: Collaborative care (CoCM) has been utilized as one strategy for improving access to behavioral health treatment through the primary care setting. However, despite the increased prevalence rates, need for services, and expansion of behavioral health into primary care, there are patients who initiate treatment but disengage for unknown reasons and without communication with their care team. This study analyzes treatment factors by comparing patients who disengage from CoCM for known versus unknown reasons to identify factors that may enhance the ability of providers to implement strategies for retaining those who have initiated care. The analysis utilizes clinical data from Concert Health, a national behavioral health medical group providing CoCM across 19 states. Method: The full patient disengagement data set contains 3,317 patient-level observations. A backward stepwise logistic regression was used to analyze how patient characteristics and level of care impacted patient disengagement for unknown reasons relative to known reasons. Results: The number of clinical touchpoints a patient receives has a significant association with disengagement for unknown reasons. Specifically, more touchpoints and touchpoints early in treatment appear to be important in preventing unknown disengagement. Other significant variables associated with disengagement for unknown reasons include age, primary diagnosis and comorbidities, and improvement as measured by Generalized Anxiety Disorder-7 and Patient Health Questionnaire-9 scores. Discussion: This analysis sheds light on factors that impact patient disengagement from care for unknown reasons. The article concludes with a series of implications for enhancing care and patient retention based on these findings.