Behavioral Health Interdisciplinary Program - Collaborative Chronic Care Model (BHIP-CCM) Enhancement Project 2.0
Study Details
Study Description
Brief 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.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
N/A |
Detailed 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:
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BHIP team collaboration, as evidenced by improved scores in the Role Clarity and Team Primacy dimensions of the Team Development Measure (TDM)
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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.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Other: Wave 1 Study design is a stepped wedge; Wave 1 begins by receiving Implementation Facilitation |
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
Other Names:
|
| Other: Wave 2 Study design is a stepped wedge; Wave 2 begins by receiving Centralized Technical Assistance before crossing over to Implementation Facilitation |
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
Other Names:
Other: Centralized Technical Assistance
Centralized Technical Assistance involves having external experts available for ad hoc consultation related to collaborative BHIP care practices.
Other Names:
|
| Other: Wave 3 Study design is a stepped wedge; Wave 3 begins by receiving Centralized Technical Assistance before crossing over to Implementation Facilitation |
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
Other Names:
Other: Centralized Technical Assistance
Centralized Technical Assistance involves having external experts available for ad hoc consultation related to collaborative BHIP care practices.
Other Names:
|
| Other: Wave 4 Study design is a stepped wedge; Wave 4 begins by receiving Centralized Technical Assistance before crossing over to Implementation Facilitation |
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
Other Names:
Other: Centralized Technical Assistance
Centralized Technical Assistance involves having external experts available for ad hoc consultation related to collaborative BHIP care practices.
Other Names:
|
Outcome Measures
Primary Outcome Measures
- Role Clarity and Team Primacy subdomains of the Team Development Measure (TDM) [Primary comparison will be between pre-implementation facilitation and post-implementation facilitation (8 months after the pre-implementation administration).]
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).
- Mental health hospitalization rate among Veterans treated within each BHIP team. [Primary comparison will be between pre-implementation facilitation and post-implementation facilitation (8 months after the pre-implementation administration).]
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).
Secondary Outcome Measures
- Treatment cost [Primary comparison will be between pre-implementation facilitation and post-implementation facilitation (8 months after the pre-implementation administration).]
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).
- All-cause mortality [Primary comparison will be between pre-implementation facilitation and post-implementation facilitation (8 months after the pre-implementation administration).]
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).
- Treatment costs and hospitalization data compared to non-intervention sites [Post-facilitation (8 months after start of implementation facilitation) and post-sustainment (12 months after post-facilitation)]
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).
Eligibility Criteria
Criteria
Inclusion Criteria:
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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.
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At the provider level (for completing the TDM), the primary inclusion criterion is clinicians working on BHIP Teams at the participating medical centers.
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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.
Exclusion Criteria:
- Patients with a diagnosis of dementia in the electronic medical record.
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | VA Palo Alto Health Care System, Palo Alto, CA | Palo Alto | California | United States | 94304-1207 |
| 2 | VA Greater Los Angeles Healthcare System, West Los Angeles, CA | West Los Angeles | California | United States | 90073-1003 |
| 3 | Orlando VA Medical Center, Orlando, FL | Orlando | Florida | United States | 32827 |
| 4 | Richard L. Roudebush VA Medical Center, Indianapolis, IN | Indianapolis | Indiana | United States | 46202-2884 |
| 5 | VA Boston Healthcare System Jamaica Plain Campus, Jamaica Plain, MA | Boston | Massachusetts | United States | 02130-4817 |
| 6 | West Texas VA Health Care System, Big Spring, TX | Big Spring | Texas | United States | 79720 |
| 7 | White River Junction VA Medical Center, White River Junction, VT | White River Junction | Vermont | United States | 05001-3833 |
| 8 | Salem VA Medical Center, Salem, VA | Salem | Virginia | United States | 24153-6404 |
| 9 | Clarksburg Louis A. Johnson VA Medical Center, Clarksburg, WV | Clarksburg | West Virginia | United States | 26301-4155 |
Sponsors and Collaborators
- VA Office of Research and Development
- US Department of Veterans Affairs Office of Mental Health and Suicide Prevention
Investigators
- Principal Investigator: Christopher J. Miller, PhD, VA Boston Healthcare System Jamaica Plain Campus, Jamaica Plain, MA
- Principal Investigator: Sara J. Landes, PhD MA BA, Central Arkansas Veterans Healthcare System Eugene J. Towbin Healthcare Center, Little Rock, AR
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- QUX 23-002