Hybrid Collaborative Care Randomized Program Evaluation
| Status: | Completed |
|---|---|
| Conditions: | Psychiatric |
| Therapuetic Areas: | Psychiatry / Psychology |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 5/5/2018 |
| Start Date: | March 7, 2016 |
| End Date: | April 26, 2018 |
Hybrid Controlled Trial to Implement Collaborative Care in General Mental Health
This randomized program evaluation is undertaken in conjunction with the Department of
Veterans Affairs Office of Mental Health Operations and the Quality Enhancement Research
Initiative. It is designed to answer two related questions: (1) Can an evidence-based
implementation strategy using the CDC's Replicating Effective Programs plus External
Facilitation (REP-F)enhance the adoption of team-based care in VA General Mental Health
Clinics, and (2) Does the establishment of such teams via implementation enhance Veterans'
health status, satisfaction, and perceptions of care? The model for team-based care is the
evidence-based Collaborative Chronic Care Model (CCM).
In conjunction with a nation-wide roll-out of the VA's Behavioral Health Interdisciplinary
Program team (BHIP) initiative, the investigators have structured a randomized, controlled
program evaluation to answer these questions. Specifically, using a stepped wedge design the
investigators will randomize 9 VAMCs that have requested support in establishing a BHIP to 1
of 3 waves of REP-F support: immediate implementation support vs. 4-month vs. 8-month wait
with dissemination of CCM materials (3 sites per wave). Fidelity and health outcome measures
will be collected in a repeated measures design at 6-month intervals, and analyzed with
general linear modeling.
Veterans Affairs Office of Mental Health Operations and the Quality Enhancement Research
Initiative. It is designed to answer two related questions: (1) Can an evidence-based
implementation strategy using the CDC's Replicating Effective Programs plus External
Facilitation (REP-F)enhance the adoption of team-based care in VA General Mental Health
Clinics, and (2) Does the establishment of such teams via implementation enhance Veterans'
health status, satisfaction, and perceptions of care? The model for team-based care is the
evidence-based Collaborative Chronic Care Model (CCM).
In conjunction with a nation-wide roll-out of the VA's Behavioral Health Interdisciplinary
Program team (BHIP) initiative, the investigators have structured a randomized, controlled
program evaluation to answer these questions. Specifically, using a stepped wedge design the
investigators will randomize 9 VAMCs that have requested support in establishing a BHIP to 1
of 3 waves of REP-F support: immediate implementation support vs. 4-month vs. 8-month wait
with dissemination of CCM materials (3 sites per wave). Fidelity and health outcome measures
will be collected in a repeated measures design at 6-month intervals, and analyzed with
general linear modeling.
Based on an internal system-wide review of mental health services and the Mental Health
Action Plan submitted to Congress in November, 2011, OMHO has undertaken an effort to
establish BHIPs, which are intended to provide GMH care throughout VA. The BHIP goal is to
build effective interdisciplinary teams, which will provide the majority of care for Veterans
in GMH. It is now expected that every VAMC establish at least one BHIP in the current initial
phase (begun in late FY2013), and that the effort scale-up subsequently. Not surprisingly,
progress has been uneven.
In 2015 OMHO incorporated the Collaborative Chronic Care Model (CCM) as an evidence-based
model by which to structure BHIPs. Consistent with BHIP goals, CCMs were developed to provide
anticipatory, continuous, collaborative, evidence-based care. CCMs consist of 6 elements:
delivery system redesign, use of clinical information systems, provider decision support,
patient self-management support, linkage to community resources, and healthcare organization
support. Replicating Effective Programs with External Facilitation (REP-F) has been shown to
be effective in implementing complex care models, including CCMs for MH, both within and
beyond VHA.
Thus in conjunction with OMHO, the investigators propose this project with the Specific Aim
of evaluating the impact of REP-F in implementing CCM-based BHIPs and their effect on Veteran
health status. The investigators propose a Hybrid Type III implementation-effectiveness
stepped wedge controlled trial, specifically hypothesizing that:
H1: REP-F-based implementation to establish CCM-based BHIPs, compared to existing centralized
technical assistance will result in: (H1a) increased Veteran perceptions of CCM-based care,
(H1b) higher rates of achieving national BHIP clinical fidelity measures (implementation
outcomes), and (H1c) higher provider ratings of the presence of CCM elements.
H2: CCM-based BHIPs, supported by REP-F implementation, will result in improved Veteran
health outcomes compared to BHIPs supported by dissemination material alone (intervention
outcomes).
The investigators will utilize the national BHIP rollout as a vehicle for this project. Using
a stepped wedge design the investigators will randomize 9 VAMCs that have requested support
in establishing a BHIP to 1 of 3 waves of REP-F support: immediate implementation support vs.
4-month vs. 8-month wait with dissemination of CCM materials (3 sites per wave). Fidelity and
health outcome measures will be collected in a repeated measures design at 6-month intervals,
and analyzed with general linear modeling.
Action Plan submitted to Congress in November, 2011, OMHO has undertaken an effort to
establish BHIPs, which are intended to provide GMH care throughout VA. The BHIP goal is to
build effective interdisciplinary teams, which will provide the majority of care for Veterans
in GMH. It is now expected that every VAMC establish at least one BHIP in the current initial
phase (begun in late FY2013), and that the effort scale-up subsequently. Not surprisingly,
progress has been uneven.
In 2015 OMHO incorporated the Collaborative Chronic Care Model (CCM) as an evidence-based
model by which to structure BHIPs. Consistent with BHIP goals, CCMs were developed to provide
anticipatory, continuous, collaborative, evidence-based care. CCMs consist of 6 elements:
delivery system redesign, use of clinical information systems, provider decision support,
patient self-management support, linkage to community resources, and healthcare organization
support. Replicating Effective Programs with External Facilitation (REP-F) has been shown to
be effective in implementing complex care models, including CCMs for MH, both within and
beyond VHA.
Thus in conjunction with OMHO, the investigators propose this project with the Specific Aim
of evaluating the impact of REP-F in implementing CCM-based BHIPs and their effect on Veteran
health status. The investigators propose a Hybrid Type III implementation-effectiveness
stepped wedge controlled trial, specifically hypothesizing that:
H1: REP-F-based implementation to establish CCM-based BHIPs, compared to existing centralized
technical assistance will result in: (H1a) increased Veteran perceptions of CCM-based care,
(H1b) higher rates of achieving national BHIP clinical fidelity measures (implementation
outcomes), and (H1c) higher provider ratings of the presence of CCM elements.
H2: CCM-based BHIPs, supported by REP-F implementation, will result in improved Veteran
health outcomes compared to BHIPs supported by dissemination material alone (intervention
outcomes).
The investigators will utilize the national BHIP rollout as a vehicle for this project. Using
a stepped wedge design the investigators will randomize 9 VAMCs that have requested support
in establishing a BHIP to 1 of 3 waves of REP-F support: immediate implementation support vs.
4-month vs. 8-month wait with dissemination of CCM materials (3 sites per wave). Fidelity and
health outcome measures will be collected in a repeated measures design at 6-month intervals,
and analyzed with general linear modeling.
Inclusion Criteria:
At least three visits to the General Mental Health Clinic's BHIP team in prior year
Exclusion Criteria:
Chart evidence of dementia
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