Mental Health Disorders Clinical Trial
Official title:
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 (VA) Office of Mental Health Operations (OMHO) and the Quality Enhancement
Research Initiative. It is designed to answer two related questions: (1) Can an
evidence-based implementation strategy using the Center for Disease Control (CDC)'s
Replicating Effective Programs plus External Facilitation (REP-F) enhance the adoption of
team-based care in VA General Mental Health (GMH) 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, the Office of Mental Health Operations
(OMHO) has undertaken an effort to establish behavioral health interdisciplinary plans
(BHIPs), which are intended to provide General Mental Health (GMH) care throughout the
Department of Veterans Affairs (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 Veterans Affairs Medical Center (VAMC) establish at least one BHIP in the current
initial phase (begun in late fiscal year 2013), 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 mental health, both
within and beyond VA.
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.
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