Behavioral Health Interdisciplinary Program - Collaborative Chronic Care Model (BHIP-CCM) Enhancement Project 2.0

Mental Health Clinical Trial

— BHIP-CCM  

Official title:

Behavioral Health Interdisciplinary Program - Collaborative Chronic Care Model (BHIP-CCM) Enhancement Project 2.0 (QUE 20-026)

Clinical Trial Details — Status: Enrolling by invitation

Administrative data

• NCT number: NCT05997836
• Other study ID #: QUX 23-002
• Status: Enrolling by invitation
• Phase: N/A
• Start date: July 14, 2023
• Est. completion date: September 30, 2025

Study information

• Verified date: June 2024
• Source: VA Office of Research and Development
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This quality improvement project aims to help outpatient mental health teams, known as Behavioral Health Interdisciplinary Program (BHIP) teams, adopt more collaborative care practices (consistent with the collaborative chronic care model or CCM). The investigators therefore aim to use two different implementation strategies -- centralized technical assistance and implementation facilitation -- to align BHIP teams' care practices more closely with the principles of the CCM.

Description:

This quality improvement project aims to help outpatient mental health teams, known as Behavioral Health Interdisciplinary Program (BHIP) teams, adopt more collaborative care practices (consistent with the collaborative chronic care model or CCM). The investigators therefore aim to use two different implementation strategies -- centralized technical assistance and implementation facilitation -- to align BHIP teams' care practices more closely with the principles of the CCM.

The two primary outcomes of this project are:

1. BHIP team collaboration, as evidenced by improved scores in the Role Clarity and Team Primacy dimensions of the Team Development Measure (TDM)

2. BHIP team clinical effectiveness, as evidenced by reduction in mental health hospitalizations among Veterans treated by the BHIP teams that have received the two types of implementation strategies described above.

Recruitment information / eligibility

• Status: Enrolling by invitation
• Enrollment: 16000
• Est. completion date: September 30, 2025
• Est. primary completion date: September 30, 2024
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Note that treatment assignment will be at the facility level, and given the stepped wedge design, sites in Waves 2-4 will cross over from Centralized Technical Assistance to Implementation Facilitation.

• At the provider level (for completing the TDM), the primary inclusion criterion is clinicians working on BHIP Teams at the participating medical centers.

• At the patient level (for mental health hospitalizations, costs, and all-cause mortality), the primary inclusion criterion is Veterans treated by the BHIP teams at the participating medical centers.

• Note that, for mental health hospitalizations, separate sites have been identified as comparators using a balancing algorithm.

Exclusion Criteria:

• Patients with a diagnosis of dementia in the electronic medical record.

Related Conditions & MeSH terms

• Mental Health

Intervention

Other:
• Implementation Facilitation
Implementation Facilitation involves and External Facilitator (from outside of the participating medical center) and an Internal Facilitator (from inside the participating medical center) working together to help BHIP teams within the site adopt care practices that are more consistent with the CCM
• Centralized Technical Assistance
Centralized Technical Assistance involves having external experts available for ad hoc consultation related to collaborative BHIP care practices.

Locations

Country	Name	City	State
United States	West Texas VA Health Care System, Big Spring, TX	Big Spring	Texas
United States	VA Boston Healthcare System Jamaica Plain Campus, Jamaica Plain, MA	Boston	Massachusetts
United States	Clarksburg Louis A. Johnson VA Medical Center, Clarksburg, WV	Clarksburg	West Virginia
United States	VA North Texas Health Care System Dallas VA Medical Center, Dallas, TX	Dallas	Texas
United States	Fayetteville VA Medical Center, Fayetteville, NC	Fayetteville	North Carolina
United States	Michael E. DeBakey VA Medical Center, Houston, TX	Houston	Texas
United States	Huntington VA Medical Center, Huntington, WV	Huntington	West Virginia
United States	Richard L. Roudebush VA Medical Center, Indianapolis, IN	Indianapolis	Indiana
United States	Memphis VA Medical Center, Memphis, TN	Memphis	Tennessee
United States	Jackson C. Montgomery VA Medical Center, Muskogee, OK	Muskogee	Oklahoma
United States	Orlando VA Medical Center, Orlando, FL	Orlando	Florida
United States	VA Palo Alto Health Care System, Palo Alto, CA	Palo Alto	California
United States	Northern Arizona VA Health Care System, Prescott, AZ	Prescott	Arizona
United States	Salem VA Medical Center, Salem, VA	Salem	Virginia
United States	Southern Arizona VA Health Care System, Tucson, AZ	Tucson	Arizona
United States	VA Greater Los Angeles Healthcare System, West Los Angeles, CA	West Los Angeles	California
United States	White River Junction VA Medical Center, White River Junction, VT	White River Junction	Vermont

Sponsors (2)

Lead Sponsor	Collaborator
VA Office of Research and Development	US Department of Veterans Affairs Office of Mental Health and Suicide Prevention

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Role Clarity and Team Primacy subdomains of the Team Development Measure (TDM)	The TDM is a measure of team functioning, and the two listed subdomains represent the co-primary outcome for the study. Note that, due to the stepped wedge design, only Wave 3 and Wave 4 sites will also have a pre-centralized technical assistance administration of the TDM. Also note that the primary time frame for this outcome, as listed above, will be post-implementation facilitation (8 months after the pre-implementation administration). Secondary analysis will also investigate one year post-implementation facilitation (20 months after the pre-implementation administration).	Primary comparison will be between pre-implementation facilitation and post-implementation facilitation (8 months after the pre-implementation administration).
Primary	Mental health hospitalization rate among Veterans treated within each BHIP team.	Mental health hospitalizations represent a measure of clinical effectiveness (co-primary outcome for the study). Note that, due to the stepped wedge design, only Wave 3 and Wave 4 sites will also have a pre-centralized technical assistance calculation of the mental health hospitalization rate. Also note that the primary time frame for this outcome, as listed above, will be post-implementation facilitation (8 months after the pre-implementation administration). Secondary analysis will also investigate one year post-implementation facilitation (20 months after the pre-implementation administration).	Primary comparison will be between pre-implementation facilitation and post-implementation facilitation (8 months after the pre-implementation administration).
Secondary	Treatment cost	The investigators will calculate estimated treatment costs for Veterans treated by participating BHIP teams. Note that the primary time frame for this outcome, as listed above, will be post-implementation facilitation (8 months after the pre-implementation administration). Secondary analysis will also investigate one year post-implementation facilitation (20 months after the pre-implementation administration).	Primary comparison will be between pre-implementation facilitation and post-implementation facilitation (8 months after the pre-implementation administration).
Secondary	All-cause mortality	The investigators will calculate all-cause mortality for Veterans treated by participating BHIP teams. Note that the primary time frame for this outcome, as listed above, will be post-implementation facilitation (8 months after the pre-implementation administration). Secondary analysis will also investigate one year post-implementation facilitation (20 months after the pre-implementation administration).	Primary comparison will be between pre-implementation facilitation and post-implementation facilitation (8 months after the pre-implementation administration).
Secondary	Treatment costs and hospitalization data compared to non-intervention sites	For mental health hospitalization and treatment costs, the investigators will compare results from intervention sites to other sites that did not undergo implementation facilitation (i.e. sites from outside the trial that are similar to intervention sites on variables like facility complexity and urban/rural location).	Post-facilitation (8 months after start of implementation facilitation) and post-sustainment (12 months after post-facilitation)