Peers on PACT: Evaluation of Peer Specialists on VA PACTs
Sponsor
VA Office of Research and Development (U.S. Fed)
Overall Status
Completed
CT.gov ID
NCT02732600
Collaborator
US Department of Veterans Affairs (U.S. Fed)
5,616
25
2
46
224.6
4.9
Study Details
Study Description
Brief Summary
In August 2014, the White House issued an Executive Action mandating that 25 VA medical centers place Peer Specialists (Veterans recovered from mental illness who are trained to support other Veterans with mental illness) on Primary Care Teams. Research shows that the success of adding new staff to existing teams can be improved by outside aid and facilitation. This quality improvement project will evaluate whether providing expanded support to half of the Primary Care Teams will lead to better outcomes when compared with teams that do not get extra support.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
N/A |
Detailed Description
Peer Specialists are individuals with mental illness currently deployed to serve Veterans in specialty mental health clinics based upon their lived experiences. Peer Specialist delivered interventions have been shown to improve patient activation in multiple studies. In August 2014, the White House issued an Executive Action mandating that 25 VA medical centers pilot the deployment of Peer Specialists in their Patient Aligned Care Teams (PACTs). This project expands upon this nationally mandated Peer Specialist pilot with the integration of a cluster randomized implementation trial. This quality improvement project will evaluate the impact of facilitated implementation vs. standard implementation to support on the deployment of Peer Specialists in PACTs.
The 25 sites will be divided into three cohorts (n=8,8,9). Each cohort will begin over three successive six-month blocks beginning in early 2016. Within each cohort, sites will be randomized to receive either facilitated or standard implementation. Facilitated Implementation sites will receive one year of support based on the i-PARIHS implementation model which includes training, implementation planning, ongoing external facilitation, feedback and consultation. Standard Implementation sites will receive written guidance and limited consultation by the investigators' team. The investigators will compare the groups on
- the percent of their target population that actually received PS services; 2) ratings on PS workload productivity including ; 3) Peer Implementation and Services scores; 4) assessment of Veteran's change over time on the outcome variables of satisfaction, activation, and functioning ; 5) qualitative analysis of how well PSs were deployed and their impact.
Study Design
Study Type:
Interventional
Actual Enrollment
:
5616 participants
Allocation:
Randomized
Intervention Model:
Parallel Assignment
Masking:
None (Open Label)
Primary Purpose:
Other
Official Title:
Program Evaluation of Peer Specialists on VA PACTS: A Quality Improvement Project (QUE 15-289)
Actual Study Start Date
:
Jan 1, 2016
Actual Primary Completion Date
:
Mar 31, 2019
Actual Study Completion Date
:
Oct 31, 2019
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| No Intervention: Standard Implementation Standard Implementation sites will receive written guidance and limited consultation by the investigators' team. |
|
| Experimental: Facilitated Implementation Facilitated Implementation sites will receive one year of support based on the i-PARIHS implementation model which includes training, implementation planning, ongoing external facilitation, feedback and consultation. |
Other: Facilitated Implementation
Facilitated Implementation sites will receive one year of support based on the i-PARIHS implementation model which includes training, implementation planning, ongoing external facilitation, feedback and consultation
|
Outcome Measures
Primary Outcome Measures
- Patient Activation Measure Change [Baseline, 6 months, 1 year]
The Patient Activation Measure (PAM) is a 13-item survey that measures an individual's perceived ability to manage his or her illness and health behaviors and act as an effective patient. It has been shown to be reliable, valid, sensitive to change and correlates with measures of improved self-management. Scores for this outcome range from Zero to One Hundred with higher scores indicating higher levels of patient activation (better outcome).
Secondary Outcome Measures
- Team Development Measure [Baseline, 6 months, 1 year]
The Team Development Measure is a 31 item self-report survey that evaluates the degree to which a team has and uses the components needed for highly effective teamwork including cohesiveness, communication, role clarity, and goals and means clarity. All components min scores are zero % and maximum is 100%; higher percentages mean positive responses.
- Peer Fidelity Measure [6 months, 1 year]
The Peer Fidelity Measure assesses: a) peer specialist services and b) peer specialist implementation. The first part has 5 domains of peer services critical to the VA's peer support model (e.g., being a role model that recovery is possible; share personal recovery story). The second has 7 domains of implementation factors shown to either help or hinder PS deployment (e.g., role clarity, support for PS at higher organizational levels, regular supervision). Each domain has 1-2 questions (responses ranging from 1= not at all through 5=Very much with higher scores indicating higher fidelity. Min Value=1 and Max value =5. The Peer Fidelity Measure will be administered to both Peer Specialists and their supervisors. Analyses looked at discrepancies (difference in difference) between Peer Specialists and their Supervisors at each time point. Min discrepancy score is -4 and Max discrepancy score is 4. (calculated as Peer Specialist minus Peer Supervisor score)
- The Satisfaction Index-Mental Health [Baseline, 6 months, 1 year]
The Satisfaction Index-Mental Health is a 12-item, unidimensional measure of patient satisfaction with care. It has been used with Veteran populations and has been shown to be valid, reliable, and sensitive to change in a sample of Veterans with mental illnesses being treated in primary care settings. It will be administered to Veterans who receive care from the Peer Specialists involved in the project. Minimum score is 12 and the maximum score is 72; higher scores mean more satisfaction.
- Number of Unique Veterans Seen (Adjusted for Employment Period and Hours Worked Per Week) [one year, across two years]
This adjusted workload variables took into consideration both the employment period (many PSs did not start immediately or may have left prior to the end of the 2 years) and weekly hours worked (varying from one hour to 40 hours per week). Visits during each PS's employment period were divided by the total number of hours worked, then multiplied by 40 to calculate adjusted values for operationalization above. Because this variable was significantly skewed, we used a log transformation to improve their distributional properties. Differences between intervention conditions were then compared with a series of Analyses of Covariance models with age, gender and race as covariates. Since these variables are measured at the PS level, the covariates were the average across the Veterans sesn by each PS (mean age, percent White and percent male). N's are number of Veterans
- Average Number of Visits Per Veteran Per Peer Specialist-Adjusted (Across Both Years) [across both years]
See Variable 5 above for details about adjustment. Since this variable this is a Veteran level variable, a General Linear Mixed Model (GSLMM) was used with PS specified as a random effect and Veteran age, race and gender. N's are number of Veterans
- Average Total Number of Services Provided-Adjusted (First Year Only and Across Both Years) [one year and across both years]
This adjusted workload variables took into consideration both the employment period (many PSs did not start immediately or may have left prior to the end of the 2 years) and weekly hours worked (varying from one hour to 40 hours per week). Visits during each PS's employment period were divided by the total number of hours worked, then multiplied by 40 to calculate adjusted values for operationalization above. Because this variable was significantly skewed, we used a log transformation to improve their distributional properties. Differences between intervention conditions were then compared with a series of Analyses of Covariance models with age, gender and race as covariates. Since these variables are measured at the PS level, the covariates were the average across the Veterans sesn by each PS (mean age, percent White and percent male). N's are number of Veterans
- Time to First Service [variable from baseline to time of first service delivered by Peer Specialists]
This variable represents count of days from time study at each site started (baseline) until first service was delivered.
- Average Number of Visits Per Veteran Per Peer Specialist-Adjusted (First Year Only) [1st year only]
See Variable 5 above for details about adjustment. Since this variable this is a Veteran level variable, a General Linear Mixed Model (GSLMM) was used with PS specified as a random effect and Veteran age, race and gender. N's are number of Veterans
Eligibility Criteria
Criteria
Ages Eligible for Study:
18 Years
and Older
Sexes Eligible for Study:
All
Accepts Healthy Volunteers:
No
Inclusion Criteria:
- Included sites must be VA PACT Primary Care Health teams with existing Peer Specialists who are able to include an existing Peer Specialist on their team for a minimum of 10 hours per week for one year
Exclusion Criteria:
- Non VA PACT teams, VA sites without an existing Peer Specialists, and VA PACT primary care teams that cannot commit a Peer Specialist to Primary Care for a minimum of 10 hours per week are excluded
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Southern Arizona VA Health Care System, Tucson, AZ | Tucson | Arizona | United States | 85723 |
| 2 | VA Palo Alto Health Care System, Palo Alto, CA | Palo Alto | California | United States | 94304-1290 |
| 3 | San Francisco VA Medical Center, San Francisco, CA | San Francisco | California | United States | 94121 |
| 4 | VA Connecticut Healthcare System West Haven Campus, West Haven, CT | West Haven | Connecticut | United States | 06516 |
| 5 | North Florida/South Georgia Veterans Health System, Gainesville, FL | Gainesville | Florida | United States | 32608 |
| 6 | West Palm Beach VA Medical Center, West Palm Beach, FL | West Palm Beach | Florida | United States | 33410 |
| 7 | Atlanta VA Medical and Rehab Center, Decatur, GA | Decatur | Georgia | United States | 30033 |
| 8 | Jesse Brown VA Medical Center, Chicago, IL | Chicago | Illinois | United States | 60612 |
| 9 | Edward Hines Jr. VA Hospital, Hines, IL | Hines | Illinois | United States | 60141-5000 |
| 10 | VA Northern Indiana Health Care System Marion Campus, Marion, IN | Marion | Indiana | United States | 46953 |
| 11 | Lexington VA Medical Center, Lexington, KY | Lexington | Kentucky | United States | 40502 |
| 12 | Maine VA Medical Center, Augusta, ME | Togus | Maine | United States | 04330 |
| 13 | Baltimore VA Medical Center VA Maryland Health Care System, Baltimore, MD | Baltimore | Maryland | United States | 21201 |
| 14 | Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA | Bedford | Massachusetts | United States | 01730 |
| 15 | John D. Dingell VA Medical Center, Detroit, MI | Detroit | Michigan | United States | 48201 |
| 16 | St. Louis VA Medical Center John Cochran Division, St. Louis, MO | Saint Louis | Missouri | United States | 63106 |
| 17 | Syracuse VA Medical Center, Syracuse, NY | Syracuse | New York | United States | 13210 |
| 18 | Salisbury W.G. (Bill) Hefner VA Medical Center, Salisbury, NC | Salisbury | North Carolina | United States | 28144 |
| 19 | Chillicothe VA Medical Center, Chillicothe, OH | Chillicothe | Ohio | United States | 45601 |
| 20 | Cincinnati VA Medical Center, Cincinnati, OH | Cincinnati | Ohio | United States | 45220 |
| 21 | Chalmers P. Wylie Ambulatory Care Center, Columbus, OH | Columbus | Ohio | United States | 43203-1278 |
| 22 | Philadelphia VA Medical Center, Philadelphia, PA | Philadelphia | Pennsylvania | United States | 19104 |
| 23 | VA Pittsburgh Healthcare System University Drive Division, Pittsburgh, PA | Pittsburgh | Pennsylvania | United States | 15240 |
| 24 | Wm. Jennings Bryan Dorn VA Medical Center, Columbia, SC | Columbia | South Carolina | United States | 29209 |
| 25 | White River Junction VA Medical Center, White River Junction, VT | White River Junction | Vermont | United States | 05009-0001 |
Sponsors and Collaborators
- VA Office of Research and Development
- US Department of Veterans Affairs
Investigators
- Principal Investigator: Matthew J. Chinman, PhD, VA Pittsburgh Healthcare System University Drive Division, Pittsburgh, PA
- Principal Investigator: Richard W Goldberg, PhD, Baltimore VA Medical Center VA Maryland Health Care System, Baltimore, MD
Study Documents (Full-Text)
More Information
Publications
None provided.Responsible Party:
VA Office of Research and Development
ClinicalTrials.gov Identifier:
NCT02732600
Other Study ID Numbers:
- QUX 16-001
First Posted:
Apr 8, 2016
Last Update Posted:
Apr 2, 2021
Last Verified:
Mar 1, 2021
Individual Participant Data (IPD) Sharing Statement:
No
Plan to Share IPD:
No
Studies a U.S. FDA-regulated Drug Product:
No
Studies a U.S. FDA-regulated Device Product:
No
Product Manufactured in and Exported from the U.S.:
No
Keywords provided by VA Office of Research and Development
Additional relevant MeSH terms:
Study Results
Participant Flow
| Recruitment Details | numbers of participants is presented at three time points: 1. Baseline 2. 6-months, and 3. 1-year |
|---|---|
| Pre-assignment Detail |
| Arm/Group Title | Standard Implementation | Facilitated Implementation |
|---|---|---|
| Arm/Group Description | Standard Implementation sites will receive written guidance and limited consultation by the investigators' team. | Facilitated Implementation sites will receive one year of support based on the i-PARIHS implementation model which includes training, implementation planning, ongoing external facilitation, feedback and consultation. Facilitated Implementation: Facilitated Implementation sites will receive one year of support based on the i-PARIHS implementation model which includes training, implementation planning, ongoing external facilitation, feedback and consultation |
| Period Title: Overall Study | ||
| STARTED | 3525 | 2091 |
| Sub-set of Sites Newly Delivering PS Services | 899 | 1484 |
| Veteran Baseline Veteran (Sub-set of 23 Sites) | 118 | 145 |
| Veteran 6-months (Sub-set 23 Sites) | 70 | 84 |
| Veteran 1-year (Sub-set 23 Sites) | 54 | 71 |
| Peer Specialist Responses at 6-months (All 25 Sites) | 12 | 14 |
| Peer Specialist Responses at 1-year (All 25 Sites) | 5 | 12 |
| Supervisor Responses 6-months (All 25 Sites) | 10 | 21 |
| Supervisor 1-year (All 25 Sites) | 6 | 10 |
| COMPLETED | 100 | 113 |
| NOT COMPLETED | 3425 | 1978 |
Baseline Characteristics
| Arm/Group Title | Standard Implementation | Facilitated Implementation | Total |
|---|---|---|---|
| Arm/Group Description | Standard Implementation sites will receive written guidance and limited consultation by the investigators' team. | Facilitated Implementation sites will receive one year of support based on the i-PARIHS implementation model which includes training, implementation planning, ongoing external facilitation, feedback and consultation. Facilitated Implementation: Facilitated Implementation sites will receive one year of support based on the i-PARIHS implementation model which includes training, implementation planning, ongoing external facilitation, feedback and consultation | Total of all reporting groups |
| Overall Participants | 194 | 221 | 415 |
| Age (years) [Mean (Standard Deviation) ] | |||
| Mean (Standard Deviation) [years] |
61.1
(10.7)
|
61.2
(13.8)
|
61.2
(12.5)
|
| Sex: Female, Male (Count of Participants) | |||
| Female |
28
14.4%
|
17
7.7%
|
45
10.8%
|
| Male |
132
68%
|
186
84.2%
|
318
76.6%
|
| Race (NIH/OMB) (Count of Participants) | |||
| American Indian or Alaska Native |
0
0%
|
0
0%
|
0
0%
|
| Asian |
0
0%
|
0
0%
|
0
0%
|
| Native Hawaiian or Other Pacific Islander |
0
0%
|
0
0%
|
0
0%
|
| Black or African American |
37
19.1%
|
64
29%
|
101
24.3%
|
| White |
109
56.2%
|
121
54.8%
|
230
55.4%
|
| More than one race |
0
0%
|
0
0%
|
0
0%
|
| Unknown or Not Reported |
6
3.1%
|
11
5%
|
17
4.1%
|
Outcome Measures
| Title | Patient Activation Measure Change |
|---|---|
| Description | The Patient Activation Measure (PAM) is a 13-item survey that measures an individual's perceived ability to manage his or her illness and health behaviors and act as an effective patient. It has been shown to be reliable, valid, sensitive to change and correlates with measures of improved self-management. Scores for this outcome range from Zero to One Hundred with higher scores indicating higher levels of patient activation (better outcome). |
| Time Frame | Baseline, 6 months, 1 year |
Outcome Measure Data
| Analysis Population Description |
|---|
| Comparison across two conditions on PAM Total Score - PAM Total Score (0-100) |
| Arm/Group Title | Standard Implementation | Facilitated Implementation |
|---|---|---|
| Arm/Group Description | Standard Implementation sites will receive written guidance and limited consultation by the investigators' team. | Facilitated Implementation sites will receive one year of support based on the i-PARIHS implementation model which includes training, implementation planning, ongoing external facilitation, feedback and consultation. Facilitated Implementation: Facilitated Implementation sites will receive one year of support based on the i-PARIHS implementation model which includes training, implementation planning, ongoing external facilitation, feedback and consultation |
| Measure Participants | 194 | 221 |
| Baseline-PAM Total |
41.0
(5.9)
|
41.6
(6.2)
|
| 6-Month-PAM Total |
39.9
(5.6)
|
40.6
(5.7)
|
| 1-year-PAM Total |
39.8
(6.2)
|
40.8
(5.5)
|
Statistical Analysis 1
| Statistical Analysis Overview | Comparison Group Selection | Standard Implementation, Facilitated Implementation |
|---|---|---|
| Comments | Analysis 1 is Comparison Across Conditions at BASELINE Analysis 2 is Comparison Across Conditions at 6 Months Analysis 3 is Comparison Across Conditions at 1 year | |
| Type of Statistical Test | Superiority | |
| Comments | ||
| Statistical Test of Hypothesis | p-Value | 0.39 |
| Comments | ||
| Method | t-test, 2 sided | |
| Comments | ||
| Method of Estimation | Estimation Parameter | Mean Difference (Final Values) |
| Estimated Value | 0.51 | |
| Confidence Interval |
(2-Sided) 95% -0.66 to 1.68 |
|
| Parameter Dispersion |
Type: Standard Error of the Mean Value: 0.59 |
|
| Estimation Comments | ||
Statistical Analysis 2
| Statistical Analysis Overview | Comparison Group Selection | Standard Implementation, Facilitated Implementation |
|---|---|---|
| Comments | Analysis 1 is Comparison Across Conditions at BASELINE Analysis 2 is Comparison Across Conditions at 6 Months Analysis 3 is Comparison Across Conditions at 1 year | |
| Type of Statistical Test | Superiority | |
| Comments | ||
| Statistical Test of Hypothesis | p-Value | 0.35 |
| Comments | ||
| Method | t-test, 2 sided | |
| Comments | ||
| Method of Estimation | Estimation Parameter | Mean Difference (Final Values) |
| Estimated Value | 0.65 | |
| Confidence Interval |
(2-Sided) 95% -0.75 to 2.06 |
|
| Parameter Dispersion |
Type: Standard Error of the Mean Value: 0.71 |
|
| Estimation Comments | ||
Statistical Analysis 3
| Statistical Analysis Overview | Comparison Group Selection | Standard Implementation, Facilitated Implementation |
|---|---|---|
| Comments | Analysis 1 is Comparison Across Conditions at BASELINE Analysis 2 is Comparison Across Conditions at 6 Months Analysis 3 is Comparison Across Conditions at 1 year | |
| Type of Statistical Test | Superiority | |
| Comments | ||
| Statistical Test of Hypothesis | p-Value | 0.21 |
| Comments | ||
| Method | t-test, 2 sided | |
| Comments | ||
| Method of Estimation | Estimation Parameter | Mean Difference (Final Values) |
| Estimated Value | 1.01 | |
| Confidence Interval |
(2-Sided) 95% -0.57 to 2.60 |
|
| Parameter Dispersion |
Type: Standard Error of the Mean Value: 0.81 |
|
| Estimation Comments | ||
| Title | Team Development Measure |
|---|---|
| Description | The Team Development Measure is a 31 item self-report survey that evaluates the degree to which a team has and uses the components needed for highly effective teamwork including cohesiveness, communication, role clarity, and goals and means clarity. All components min scores are zero % and maximum is 100%; higher percentages mean positive responses. |
| Time Frame | Baseline, 6 months, 1 year |
Outcome Measure Data
| Analysis Population Description |
|---|
| number of site based leadership and supervisors who responded |
| Arm/Group Title | Standard Implementation | Facilitated Implementation |
|---|---|---|
| Arm/Group Description | Standard Implementation sites will receive written guidance and limited consultation by the investigators' team. | Facilitated Implementation sites will receive one year of support based on the i-PARIHS implementation model which includes training, implementation planning, ongoing external facilitation, feedback and consultation. Facilitated Implementation: Facilitated Implementation sites will receive one year of support based on the i-PARIHS implementation model which includes training, implementation planning, ongoing external facilitation, feedback and consultation |
| Measure Participants | 21 | 30 |
| cohesiveness-Baseline |
91.1
(15.5)
|
96.7
(10.3)
|
| Communication Baseline |
85.0
(22.4)
|
93.0
(19.5)
|
| Role Clarity Baseline |
76.0
(28.6)
|
84.4
(16.3)
|
| Goals Baseline |
67.9
(38.9)
|
82.0
(29.9)
|
| Cohesiveness 6 month |
89.6
(21.8)
|
89.1
(23.5)
|
| Communication 6 month |
84.7
(26.9)
|
86.0
(26.9)
|
| Role Clarity 6 months |
77.0
(31.8)
|
83.2
(22.3)
|
| Goals 6 months |
74.8
(28.6)
|
77.0
(19.8)
|
| Cohesiveness 1 year |
85.2
(35.0)
|
94.3
(13.2)
|
| Communication 1 year |
80.0
(32.1)
|
83.2
(22.9)
|
| Role Clarity 1 year |
70.8
(40.6)
|
82.3
(21.5)
|
| Goals 1 year |
77.5
(24.9)
|
87.5
(17.7)
|
Statistical Analysis 1
| Statistical Analysis Overview | Comparison Group Selection | Standard Implementation, Facilitated Implementation |
|---|---|---|
| Comments | t-test used to compare group differences in Cohesiveness at BASELINE | |
| Type of Statistical Test | Superiority | |
| Comments | ||
| Statistical Test of Hypothesis | p-Value | 0.156 |
| Comments | ||
| Method | t-test, 2 sided | |
| Comments | ||
| Method of Estimation | Estimation Parameter | Mean Difference (Final Values) |
| Estimated Value | 5.61 | |
| Confidence Interval |
(2-Sided) 95% -2.2 to 13.48 |
|
| Parameter Dispersion |
Type: Standard Error of the Mean Value: 3.6 |
|
| Estimation Comments | ||
Statistical Analysis 2
| Statistical Analysis Overview | Comparison Group Selection | Standard Implementation, Facilitated Implementation |
|---|---|---|
| Comments | t-test to compare group means on Communication at BASELINE | |
| Type of Statistical Test | Superiority | |
| Comments | ||
| Statistical Test of Hypothesis | p-Value | 0.182 |
| Comments | ||
| Method | t-test, 2 sided | |
| Comments | ||
| Method of Estimation | Estimation Parameter | Mean Difference (Final Values) |
| Estimated Value | 7.97 | |
| Confidence Interval |
(2-Sided) 95% -3.85 to 19.8 |
|
| Parameter Dispersion |
Type: Standard Error of the Mean Value: 5.89 |
|
| Estimation Comments | ||
Statistical Analysis 3
| Statistical Analysis Overview | Comparison Group Selection | Standard Implementation, Facilitated Implementation |
|---|---|---|
| Comments | t-test to compare group differences on Role Clarity at BASELINE | |
| Type of Statistical Test | Superiority | |
| Comments | ||
| Statistical Test of Hypothesis | p-Value | 0.234 |
| Comments | ||
| Method | t-test, 2 sided | |
| Comments | ||
| Method of Estimation | Estimation Parameter | Mean Difference (Final Values) |
| Estimated Value | 8.41 | |
| Confidence Interval |
(2-Sided) 95% -5.74 to 22.57 |
|
| Parameter Dispersion |
Type: Standard Error of the Mean Value: 6.31 |
|
| Estimation Comments | ||
Statistical Analysis 4
| Statistical Analysis Overview | Comparison Group Selection | Standard Implementation, Facilitated Implementation |
|---|---|---|
| Comments | t-test to compare group values on Goals at Baseline | |
| Type of Statistical Test | Superiority | |
| Comments | ||
| Statistical Test of Hypothesis | p-Value | 0.149 |
| Comments | ||
| Method | t-test, 2 sided | |
| Comments | ||
| Method of Estimation | Estimation Parameter | Mean Difference (Final Values) |
| Estimated Value | 14.14 | |
| Confidence Interval |
(2-Sided) 95% -5.22 to 33.5 |
|
| Parameter Dispersion |
Type: Standard Error of the Mean Value: 9.63 |
|
| Estimation Comments | ||
Statistical Analysis 5
| Statistical Analysis Overview | Comparison Group Selection | Standard Implementation, Facilitated Implementation |
|---|---|---|
| Comments | t-test of differences between groups on Cohesiveness at 6-Months | |
| Type of Statistical Test | Superiority | |
| Comments | ||
| Statistical Test of Hypothesis | p-Value | 0.947 |
| Comments | ||
| Method | t-test, 2 sided | |
| Comments | ||
| Method of Estimation | Estimation Parameter | Mean Difference (Final Values) |
| Estimated Value | -0.47 | |
| Confidence Interval |
(2-Sided) 95% -14.7 to 13.8 |
|
| Parameter Dispersion |
Type: Standard Error of the Mean Value: 7.1 |
|
| Estimation Comments | ||
Statistical Analysis 6
| Statistical Analysis Overview | Comparison Group Selection | Standard Implementation, Facilitated Implementation |
|---|---|---|
| Comments | t-test of groups differences on Communication at 6 Months | |
| Type of Statistical Test | Superiority | |
| Comments | ||
| Statistical Test of Hypothesis | p-Value | 0.870 |
| Comments | ||
| Method | t-test, 2 sided | |
| Comments | ||
| Method of Estimation | Estimation Parameter | Mean Difference (Final Values) |
| Estimated Value | 1.38 | |
| Confidence Interval |
(2-Sided) 95% -15.6 to 18.4 |
|
| Parameter Dispersion |
Type: Standard Error of the Mean Value: 8.4 |
|
| Estimation Comments | ||
Statistical Analysis 7
| Statistical Analysis Overview | Comparison Group Selection | Standard Implementation, Facilitated Implementation |
|---|---|---|
| Comments | t-test of group differences on Role Clarity at 6 months | |
| Type of Statistical Test | Superiority | |
| Comments | ||
| Statistical Test of Hypothesis | p-Value | 0.478 |
| Comments | ||
| Method | t-test, 2 sided | |
| Comments | ||
| Method of Estimation | Estimation Parameter | Mean Difference (Final Values) |
| Estimated Value | 6.18 | |
| Confidence Interval |
(2-Sided) 95% -11.26 to 23.63 |
|
| Parameter Dispersion |
Type: Standard Error of the Mean Value: 8.62 |
|
| Estimation Comments | ||
Statistical Analysis 8
| Statistical Analysis Overview | Comparison Group Selection | Standard Implementation, Facilitated Implementation |
|---|---|---|
| Comments | t-test of group differences on Goals at 6 Months | |
| Type of Statistical Test | Superiority | |
| Comments | ||
| Statistical Test of Hypothesis | p-Value | 0.773 |
| Comments | ||
| Method | t-test, 2 sided | |
| Comments | ||
| Method of Estimation | Estimation Parameter | Mean Difference (Final Values) |
| Estimated Value | 2.23 | |
| Confidence Interval |
(2-Sided) 95% -13.35 to 17.83 |
|
| Parameter Dispersion |
Type: Standard Error of the Mean Value: 7.71 |
|
| Estimation Comments | ||
Statistical Analysis 9
| Statistical Analysis Overview | Comparison Group Selection | Standard Implementation, Facilitated Implementation |
|---|---|---|
| Comments | t-test of group differences on Cohesiveness at 1year | |
| Type of Statistical Test | Superiority | |
| Comments | ||
| Statistical Test of Hypothesis | p-Value | 0.498 |
| Comments | ||
| Method | t-test, 2 sided | |
| Comments | ||
| Method of Estimation | Estimation Parameter | Mean Difference (Final Values) |
| Estimated Value | 9.09 | |
| Confidence Interval |
(2-Sided) 95% -20.4 to 38.6 |
|
| Parameter Dispersion |
Type: Standard Error of the Mean Value: 9.8 |
|
| Estimation Comments | ||
Statistical Analysis 10
| Statistical Analysis Overview | Comparison Group Selection | Standard Implementation, Facilitated Implementation |
|---|---|---|
| Comments | t-test of group differences on Communication at 1 year | |
| Type of Statistical Test | Superiority | |
| Comments | ||
| Statistical Test of Hypothesis | p-Value | 0.780 |
| Comments | ||
| Method | t-test, 2 sided | |
| Comments | ||
| Method of Estimation | Estimation Parameter | Mean Difference (Final Values) |
| Estimated Value | 3.21 | |
| Confidence Interval |
(2-Sided) 95% -20.3 to 26.7 |
|
| Parameter Dispersion |
Type: Standard Error of the Mean Value: 11.4 |
|
| Estimation Comments | ||
Statistical Analysis 11
| Statistical Analysis Overview | Comparison Group Selection | Standard Implementation, Facilitated Implementation |
|---|---|---|
| Comments | t-test of group differences on Role Clarity at 1 year | |
| Type of Statistical Test | Superiority | |
| Comments | ||
| Statistical Test of Hypothesis | p-Value | 0.474 |
| Comments | ||
| Method | t-test, 2 sided | |
| Comments | ||
| Method of Estimation | Estimation Parameter | Mean Difference (Final Values) |
| Estimated Value | 11.46 | |
| Confidence Interval |
(2-Sided) 95% -23.19 to 46.11 |
|
| Parameter Dispersion |
Type: Standard Error of the Mean Value: 12.54 |
|
| Estimation Comments | ||
Statistical Analysis 12
| Statistical Analysis Overview | Comparison Group Selection | Standard Implementation, Facilitated Implementation |
|---|---|---|
| Comments | t-test of group differences on Goals at 1 year | |
| Type of Statistical Test | Superiority | |
| Comments | ||
| Statistical Test of Hypothesis | p-Value | 0.267 |
| Comments | ||
| Method | t-test, 2 sided | |
| Comments | ||
| Method of Estimation | Estimation Parameter | Mean Difference (Final Values) |
| Estimated Value | 10.0 | |
| Confidence Interval |
(2-Sided) 95% -8.21 to 28.21 |
|
| Parameter Dispersion |
Type: Standard Error of the Mean Value: 8.78 |
|
| Estimation Comments | ||
| Title | Peer Fidelity Measure |
|---|---|
| Description | The Peer Fidelity Measure assesses: a) peer specialist services and b) peer specialist implementation. The first part has 5 domains of peer services critical to the VA's peer support model (e.g., being a role model that recovery is possible; share personal recovery story). The second has 7 domains of implementation factors shown to either help or hinder PS deployment (e.g., role clarity, support for PS at higher organizational levels, regular supervision). Each domain has 1-2 questions (responses ranging from 1= not at all through 5=Very much with higher scores indicating higher fidelity. Min Value=1 and Max value =5. The Peer Fidelity Measure will be administered to both Peer Specialists and their supervisors. Analyses looked at discrepancies (difference in difference) between Peer Specialists and their Supervisors at each time point. Min discrepancy score is -4 and Max discrepancy score is 4. (calculated as Peer Specialist minus Peer Supervisor score) |
| Time Frame | 6 months, 1 year |
Outcome Measure Data
| Analysis Population Description |
|---|
| 6 months and 1 year |
| Arm/Group Title | Standard Implementation | Facilitated Implementation |
|---|---|---|
| Arm/Group Description | Standard Implementation sites will receive written guidance and limited consultation by the investigators' team. | Facilitated Implementation sites will receive one year of support based on the i-PARIHS implementation model which includes training, implementation planning, ongoing external facilitation, feedback and consultation. Facilitated Implementation: Facilitated Implementation sites will receive one year of support based on the i-PARIHS implementation model which includes training, implementation planning, ongoing external facilitation, feedback and consultation |
| Measure Participants | 8 | 19 |
| Core Peer Specialist 6-moFunctions |
0.3
(0.3)
|
0.7
(1.1)
|
| Collaborate-Promoting Health 6-mo |
0.2
(0.7)
|
0.7
(1.2)
|
| Peer Specialist as Liaison 6-mo |
-0.1
(1.2)
|
1.1
(1.4)
|
| Provides Info on Services 6 mo |
-0.1
(1.1)
|
0.7
(0.8)
|
| Symptoms and Medications 6-mo |
0.2
(2.2)
|
1.0
(2.0)
|
| Training and Preparation 6-mo |
0.1
(1.1)
|
0.4
(1.6)
|
| Teams Integration and Relationships 6-mo |
-0.4
(1.3)
|
0.5
(1.5)
|
| Leadership Support 6-mo |
0.01
(1.2)
|
-0.2
(0.8)
|
| Fits to Experience and Needs 6-mo |
-0.4
(1.6)
|
-0.4
(2.1)
|
| Role Clarity 6-mo |
-0.3
(1.2)
|
0.2
(1.3)
|
| Resources 6-mo |
-0.1
(1.2)
|
0.7
(1.6)
|
| Performance Reviews 6-mo |
-0.1
(1.2)
|
-0.1
(2.3)
|
| Core PS functions 1-yr |
0.7
(0.5)
|
-0.1
(0.41)
|
| Collaborate on Promoting Health 1 year |
0.7
(0.1)
|
-0.01
(0.6)
|
| Peer Specialist as Liaison 1 year |
0.8
(1.1)
|
-0.2
(0.6)
|
| provides info on services 1 year |
0.0
(0.0)
|
-0.2
(0.5)
|
| Symptoms and Medication 1 year |
0.8
(2.5)
|
-0.1
(2.1)
|
| Training and Preparation 1 year |
0.5
(1.2)
|
-0.4
(1.1)
|
| Team Integration and relationships 1 year |
1.1
(0.4)
|
-0.2
(0.5)
|
| Leadership Support 1 year |
2.5
(0.7)
|
0.1
(1.1)
|
| Fit to experience and need 1 year |
0.0
(2.8)
|
-0.3
(0.8)
|
| Role Clarity 1 year |
1.3
(1.1)
|
-0.2
(0.9)
|
| Resources |
-0.5
(1.4)
|
-0.3
(0.5)
|
| Performance Review 1 year |
0.8
(0.4)
|
-0.7
(2.2)
|
Statistical Analysis 1
| Statistical Analysis Overview | Comparison Group Selection | Standard Implementation, Facilitated Implementation |
|---|---|---|
| Comments | t test comparison across groups on CORE PEER at 6 months | |
| Type of Statistical Test | Superiority | |
| Comments | ||
| Statistical Test of Hypothesis | p-Value | 0.098 |
| Comments | ||
| Method | t-test, 2 sided | |
| Comments | ||
| Method of Estimation | Estimation Parameter | Mean Difference (Final Values) |
| Estimated Value | 0.45 | |
| Confidence Interval |
(2-Sided) 95% -0.09 to 1.00 |
|
| Parameter Dispersion |
Type: Standard Error of the Mean Value: 0.38 |
|
| Estimation Comments | ||
Statistical Analysis 2
| Statistical Analysis Overview | Comparison Group Selection | Standard Implementation, Facilitated Implementation |
|---|---|---|
| Comments | t-test comparison across groups on COLLABORATION at 6 months | |
| Type of Statistical Test | Superiority | |
| Comments | ||
| Statistical Test of Hypothesis | p-Value | 0.282 |
| Comments | ||
| Method | t-test, 2 sided | |
| Comments | ||
| Method of Estimation | Estimation Parameter | Mean Difference (Final Values) |
| Estimated Value | 0.5 | |
| Confidence Interval |
(2-Sided) 95% -0.43 to 1.43 |
|
| Parameter Dispersion |
Type: Standard Error of the Mean Value: 1.1 |
|
| Estimation Comments | ||
Statistical Analysis 3
| Statistical Analysis Overview | Comparison Group Selection | Standard Implementation, Facilitated Implementation |
|---|---|---|
| Comments | t-test comparison across groups on PEER SPECIALIST AS LIAISON at 6 months | |
| Type of Statistical Test | Superiority | |
| Comments | ||
| Statistical Test of Hypothesis | p-Value | 0.06 |
| Comments | ||
| Method | t-test, 2 sided | |
| Comments | ||
| Method of Estimation | Estimation Parameter | Mean Difference (Final Values) |
| Estimated Value | 1.1 | |
| Confidence Interval |
(2-Sided) 95% -0.05 to 2.29 |
|
| Parameter Dispersion |
Type: Standard Error of the Mean Value: 0.56 |
|
| Estimation Comments | ||
Statistical Analysis 4
| Statistical Analysis Overview | Comparison Group Selection | Standard Implementation, Facilitated Implementation |
|---|---|---|
| Comments | t-test comparison across groups on PROVIDES INFO ON SERVICES at 6 months | |
| Type of Statistical Test | Superiority | |
| Comments | ||
| Statistical Test of Hypothesis | p-Value | 0.34 |
| Comments | ||
| Method | t-test, 2 sided | |
| Comments | ||
| Method of Estimation | Estimation Parameter | Mean Difference (Final Values) |
| Estimated Value | 0.83 | |
| Confidence Interval |
(2-Sided) 95% 0.07 to 1.59 |
|
| Parameter Dispersion |
Type: Standard Error of the Mean Value: 0.86 |
|
| Estimation Comments | ||
Statistical Analysis 5
| Statistical Analysis Overview | Comparison Group Selection | Standard Implementation, Facilitated Implementation |
|---|---|---|
| Comments | t-test comparison across groups on Symptoms and Medication at 6-months | |
| Type of Statistical Test | Superiority | |
| Comments | ||
| Statistical Test of Hypothesis | p-Value | 0.34 |
| Comments | ||
| Method | t-test, 2 sided | |
| Comments | ||
| Method of Estimation | Estimation Parameter | Mean Difference (Final Values) |
| Estimated Value | 0.83 | |
| Confidence Interval |
(2-Sided) 95% -0.94 to 2.62 |
|
| Parameter Dispersion |
Type: Value: |
|
| Estimation Comments | ||
Statistical Analysis 6
| Statistical Analysis Overview | Comparison Group Selection | Standard Implementation, Facilitated Implementation |
|---|---|---|
| Comments | t-test comparison across groups on Training and Preparation at 6-months | |
| Type of Statistical Test | Superiority | |
| Comments | ||
| Statistical Test of Hypothesis | p-Value | 0.66 |
| Comments | ||
| Method | t-test, 2 sided | |
| Comments | ||
| Method of Estimation | Estimation Parameter | Mean Difference (Final Values) |
| Estimated Value | 0.28 | |
| Confidence Interval |
(2-Sided) 95% -1.03 to 1.50 |
|
| Parameter Dispersion |
Type: Standard Error of the Mean Value: 0.64 |
|
| Estimation Comments | ||
Statistical Analysis 7
| Statistical Analysis Overview | Comparison Group Selection | Standard Implementation, Facilitated Implementation |
|---|---|---|
| Comments | t-test comparison across groups on Team Integration and Relationships at 6 Months | |
| Type of Statistical Test | Superiority | |
| Comments | ||
| Statistical Test of Hypothesis | p-Value | 0.15 |
| Comments | ||
| Method | t-test, 2 sided | |
| Comments | ||
| Method of Estimation | Estimation Parameter | Mean Difference (Final Values) |
| Estimated Value | 0.90 | |
| Confidence Interval |
(2-Sided) 95% -0.36 to 2.16 |
|
| Parameter Dispersion |
Type: Standard Error of the Mean Value: 0.61 |
|
| Estimation Comments | ||
Statistical Analysis 8
| Statistical Analysis Overview | Comparison Group Selection | Standard Implementation, Facilitated Implementation |
|---|---|---|
| Comments | t-test comparison across groups on Leadership at 6-months | |
| Type of Statistical Test | Superiority | |
| Comments | ||
| Statistical Test of Hypothesis | p-Value | 0.59 |
| Comments | ||
| Method | t-test, 2 sided | |
| Comments | ||
| Method of Estimation | Estimation Parameter | Mean Difference (Final Values) |
| Estimated Value | -0.21 | |
| Confidence Interval |
(2-Sided) 95% -1.01 to 0.59 |
|
| Parameter Dispersion |
Type: Standard Error of the Mean Value: 0.39 |
|
| Estimation Comments | ||
Statistical Analysis 9
| Statistical Analysis Overview | Comparison Group Selection | Standard Implementation, Facilitated Implementation |
|---|---|---|
| Comments | t-test comparison across groups on Fits to Experience at 6 months | |
| Type of Statistical Test | Superiority | |
| Comments | ||
| Statistical Test of Hypothesis | p-Value | 0.95 |
| Comments | ||
| Method | t-test, 2 sided | |
| Comments | ||
| Method of Estimation | Estimation Parameter | Mean Difference (Final Values) |
| Estimated Value | -0.05 | |
| Confidence Interval |
(2-Sided) 95% -1.77 to 1.68 |
|
| Parameter Dispersion |
Type: Standard Error of the Mean Value: 0.84 |
|
| Estimation Comments | ||
Statistical Analysis 10
| Statistical Analysis Overview | Comparison Group Selection | Standard Implementation, Facilitated Implementation |
|---|---|---|
| Comments | t-test comparison across groups on Role Clarity at 6 months | |
| Type of Statistical Test | Superiority | |
| Comments | ||
| Statistical Test of Hypothesis | p-Value | 0.32 |
| Comments | ||
| Method | t-test, 2 sided | |
| Comments | ||
| Method of Estimation | Estimation Parameter | Mean Difference (Final Values) |
| Estimated Value | 0.55 | |
| Confidence Interval |
(2-Sided) 95% -0.58 to 1.68 |
|
| Parameter Dispersion |
Type: Standard Error of the Mean Value: 0.55 |
|
| Estimation Comments | ||
Statistical Analysis 11
| Statistical Analysis Overview | Comparison Group Selection | Standard Implementation, Facilitated Implementation |
|---|---|---|
| Comments | t-test comparison across both groups on Resources at 6 months | |
| Type of Statistical Test | Superiority | |
| Comments | ||
| Statistical Test of Hypothesis | p-Value | 0.27 |
| Comments | ||
| Method | t-test, 2 sided | |
| Comments | ||
| Method of Estimation | Estimation Parameter | Mean Difference (Final Values) |
| Estimated Value | 0.72 | |
| Confidence Interval |
(2-Sided) 95% -0.60 to 2.04 |
|
| Parameter Dispersion |
Type: Standard Error of the Mean Value: 0.64 |
|
| Estimation Comments | ||
Statistical Analysis 12
| Statistical Analysis Overview | Comparison Group Selection | Standard Implementation, Facilitated Implementation |
|---|---|---|
| Comments | t-test comparison across groups on Performance Reviews at 6 months | |
| Type of Statistical Test | Superiority | |
| Comments | ||
| Statistical Test of Hypothesis | p-Value | 0.93 |
| Comments | ||
| Method | t-test, 2 sided | |
| Comments | ||
| Method of Estimation | Estimation Parameter | Mean Difference (Final Values) |
| Estimated Value | 0.07 | |
| Confidence Interval |
(2-Sided) 95% -1.71 to 1.85 |
|
| Parameter Dispersion |
Type: Standard Error of the Mean Value: 0.86 |
|
| Estimation Comments | ||
Statistical Analysis 13
| Statistical Analysis Overview | Comparison Group Selection | Standard Implementation, Facilitated Implementation |
|---|---|---|
| Comments | t-test comparison across groups on CORE PEER at 1 year | |
| Type of Statistical Test | Superiority | |
| Comments | ||
| Statistical Test of Hypothesis | p-Value | 0.15 |
| Comments | ||
| Method | t-test, 2 sided | |
| Comments | ||
| Method of Estimation | Estimation Parameter | Mean Difference (Final Values) |
| Estimated Value | -0.73 | |
| Confidence Interval |
(2-Sided) 95% -1.45 to -0.005 |
|
| Parameter Dispersion |
Type: Standard Error of the Mean Value: 0.32 |
|
| Estimation Comments | ||
Statistical Analysis 14
| Statistical Analysis Overview | Comparison Group Selection | Standard Implementation, Facilitated Implementation |
|---|---|---|
| Comments | t-test comparison across groups on Collaboration at 1 year | |
| Type of Statistical Test | Superiority | |
| Comments | ||
| Statistical Test of Hypothesis | p-Value | 0.04 |
| Comments | ||
| Method | t-test, 2 sided | |
| Comments | ||
| Method of Estimation | Estimation Parameter | Mean Difference (Final Values) |
| Estimated Value | -0.7 | |
| Confidence Interval |
(2-Sided) 95% -1.7 to 0.32 |
|
| Parameter Dispersion |
Type: Standard Error of the Mean Value: 0.45 |
|
| Estimation Comments | ||
Statistical Analysis 15
| Statistical Analysis Overview | Comparison Group Selection | Standard Implementation, Facilitated Implementation |
|---|---|---|
| Comments | t-test comparison across groups on Peer Specialists as Liaison at 1 year | |
| Type of Statistical Test | Superiority | |
| Comments | ||
| Statistical Test of Hypothesis | p-Value | 0.08 |
| Comments | ||
| Method | t-test, 2 sided | |
| Comments | ||
| Method of Estimation | Estimation Parameter | Hazard Ratio, log |
| Estimated Value | -0.95 | |
| Confidence Interval |
(2-Sided) 95% -2.07 to 0.17 |
|
| Parameter Dispersion |
Type: Standard Error of the Mean Value: 0.50 |
|
| Estimation Comments | ||
Statistical Analysis 16
| Statistical Analysis Overview | Comparison Group Selection | Standard Implementation, Facilitated Implementation |
|---|---|---|
| Comments | t-test comparison across groups on Provides Info on Services at 1 year | |
| Type of Statistical Test | Superiority | |
| Comments | ||
| Statistical Test of Hypothesis | p-Value | 0.26 |
| Comments | ||
| Method | t-test, 2 sided | |
| Comments | ||
| Method of Estimation | Estimation Parameter | Mean Difference (Final Values) |
| Estimated Value | -0.2 | |
| Confidence Interval |
(2-Sided) 95% -0.58 to 0.18 |
|
| Parameter Dispersion |
Type: Standard Error of the Mean Value: 0.39 |
|
| Estimation Comments | ||
Statistical Analysis 17
| Statistical Analysis Overview | Comparison Group Selection | Standard Implementation, Facilitated Implementation |
|---|---|---|
| Comments | t-test comparison between groups on Symptoms and Medication at 1 year | |
| Type of Statistical Test | Superiority | |
| Comments | ||
| Statistical Test of Hypothesis | p-Value | 0.61 |
| Comments | ||
| Method | t-test, 2 sided | |
| Comments | ||
| Method of Estimation | Estimation Parameter | Mean Difference (Final Values) |
| Estimated Value | -0.85 | |
| Confidence Interval |
(2-Sided) 95% -4.53 to 2.83 |
|
| Parameter Dispersion |
Type: Standard Error of the Mean Value: 1.65 |
|
| Estimation Comments | ||
Statistical Analysis 18
| Statistical Analysis Overview | Comparison Group Selection | Standard Implementation, Facilitated Implementation |
|---|---|---|
| Comments | t-test comparison across groups on Training and Preparation at 1 year | |
| Type of Statistical Test | Superiority | |
| Comments | ||
| Statistical Test of Hypothesis | p-Value | 0.30 |
| Comments | ||
| Method | t-test, 2 sided | |
| Comments | ||
| Method of Estimation | Estimation Parameter | Mean Difference (Final Values) |
| Estimated Value | -0.93 | |
| Confidence Interval |
(2-Sided) 95% -2.87 to 1.01 |
|
| Parameter Dispersion |
Type: Standard Error of the Mean Value: 0.87 |
|
| Estimation Comments | ||
Statistical Analysis 19
| Statistical Analysis Overview | Comparison Group Selection | Standard Implementation, Facilitated Implementation |
|---|---|---|
| Comments | t-test comparison across groups on Team Integration and Relationships at 1 year | |
| Type of Statistical Test | Superiority | |
| Comments | ||
| Statistical Test of Hypothesis | p-Value | 0.004 |
| Comments | ||
| Method | t-test, 2 sided | |
| Comments | ||
| Method of Estimation | Estimation Parameter | Mean Difference (Final Values) |
| Estimated Value | -1.3 | |
| Confidence Interval |
(2-Sided) 95% -2.08 to -0.52 |
|
| Parameter Dispersion |
Type: Standard Error of the Mean Value: 0.35 |
|
| Estimation Comments | ||
Statistical Analysis 20
| Statistical Analysis Overview | Comparison Group Selection | Standard Implementation, Facilitated Implementation |
|---|---|---|
| Comments | t-test comparison across groups on Leadership at 1 year | |
| Type of Statistical Test | Superiority | |
| Comments | ||
| Statistical Test of Hypothesis | p-Value | 0.01 |
| Comments | ||
| Method | t-test, 2 sided | |
| Comments | ||
| Method of Estimation | Estimation Parameter | Mean Difference (Final Values) |
| Estimated Value | -2.4 | |
| Confidence Interval |
(2-Sided) 95% -4.20 to -0.60 |
|
| Parameter Dispersion |
Type: Standard Error of the Mean Value: 0.81 |
|
| Estimation Comments | ||
Statistical Analysis 21
| Statistical Analysis Overview | Comparison Group Selection | Standard Implementation, Facilitated Implementation |
|---|---|---|
| Comments | t-test comparison across groups on Fits to Experience at 1 year | |
| Type of Statistical Test | Superiority | |
| Comments | ||
| Statistical Test of Hypothesis | p-Value | 0.90 |
| Comments | ||
| Method | t-test, 2 sided | |
| Comments | ||
| Method of Estimation | Estimation Parameter | Mean Difference (Final Values) |
| Estimated Value | -0.3 | |
| Confidence Interval |
(2-Sided) 95% -24.1 to 23.5 |
|
| Parameter Dispersion |
Type: Standard Error of the Mean Value: 0.90 |
|
| Estimation Comments | ||
Statistical Analysis 22
| Statistical Analysis Overview | Comparison Group Selection | Standard Implementation, Facilitated Implementation |
|---|---|---|
| Comments | t-test comparison across groups on Role Clarity at 1 year | |
| Type of Statistical Test | Superiority | |
| Comments | ||
| Statistical Test of Hypothesis | p-Value | 0.06 |
| Comments | ||
| Method | t-test, 2 sided | |
| Comments | ||
| Method of Estimation | Estimation Parameter | Mean Difference (Final Values) |
| Estimated Value | -1.45 | |
| Confidence Interval |
(2-Sided) 95% -3.02 to 0.12 |
|
| Parameter Dispersion |
Type: Standard Error of the Mean Value: 0.70 |
|
| Estimation Comments | ||
Statistical Analysis 23
| Statistical Analysis Overview | Comparison Group Selection | Standard Implementation, Facilitated Implementation |
|---|---|---|
| Comments | t-test comparison across groups on Resources at 1 year | |
| Type of Statistical Test | Superiority | |
| Comments | ||
| Statistical Test of Hypothesis | p-Value | 0.71 |
| Comments | ||
| Method | t-test, 2 sided | |
| Comments | ||
| Method of Estimation | Estimation Parameter | Mean Difference (Final Values) |
| Estimated Value | 0.20 | |
| Confidence Interval |
(2-Sided) 95% -0.97 to 1.37 |
|
| Parameter Dispersion |
Type: Standard Error of the Mean Value: 0.53 |
|
| Estimation Comments | ||
Statistical Analysis 24
| Statistical Analysis Overview | Comparison Group Selection | Standard Implementation, Facilitated Implementation |
|---|---|---|
| Comments | t-test comparison on Performance Reviews at 1 year | |
| Type of Statistical Test | Superiority | |
| Comments | ||
| Statistical Test of Hypothesis | p-Value | 0.41 |
| Comments | ||
| Method | t-test, 2 sided | |
| Comments | ||
| Method of Estimation | Estimation Parameter | Mean Difference (Final Values) |
| Estimated Value | -1.40 | |
| Confidence Interval |
(2-Sided) 95% -5.03 to 2.23 |
|
| Parameter Dispersion |
Type: Standard Error of the Mean Value: 1.63 |
|
| Estimation Comments | ||
| Title | The Satisfaction Index-Mental Health |
|---|---|
| Description | The Satisfaction Index-Mental Health is a 12-item, unidimensional measure of patient satisfaction with care. It has been used with Veteran populations and has been shown to be valid, reliable, and sensitive to change in a sample of Veterans with mental illnesses being treated in primary care settings. It will be administered to Veterans who receive care from the Peer Specialists involved in the project. Minimum score is 12 and the maximum score is 72; higher scores mean more satisfaction. |
| Time Frame | Baseline, 6 months, 1 year |
Outcome Measure Data
| Analysis Population Description |
|---|
| Veterans responding to survey |
| Arm/Group Title | Standard Implementation | Facilitated Implementation |
|---|---|---|
| Arm/Group Description | Standard Implementation sites will receive written guidance and limited consultation by the investigators' team. | Facilitated Implementation sites will receive one year of support based on the i-PARIHS implementation model which includes training, implementation planning, ongoing external facilitation, feedback and consultation. Facilitated Implementation: Facilitated Implementation sites will receive one year of support based on the i-PARIHS implementation model which includes training, implementation planning, ongoing external facilitation, feedback and consultation |
| Measure Participants | 194 | 221 |
| Baseline |
47.7
(12.1)
|
51.3
(11.5)
|
| 6-months |
49.7
(12.7)
|
52.3
(12.6)
|
| 1-year |
50.6
(13.0)
|
51.2
(13.6)
|
Statistical Analysis 1
| Statistical Analysis Overview | Comparison Group Selection | Standard Implementation, Facilitated Implementation |
|---|---|---|
| Comments | Group Comparison at Baseline | |
| Type of Statistical Test | Superiority | |
| Comments | ||
| Statistical Test of Hypothesis | p-Value | 0.002 |
| Comments | not adjusted for multiple comparisons | |
| Method | t-test, 2 sided | |
| Comments | ||
| Method of Estimation | Estimation Parameter | Mean Difference (Final Values) |
| Estimated Value | 3.59 | |
| Confidence Interval |
(2-Sided) 95% 1.29 to 5.88 |
|
| Parameter Dispersion |
Type: Standard Error of the Mean Value: 1.17 |
|
| Estimation Comments | ||
Statistical Analysis 2
| Statistical Analysis Overview | Comparison Group Selection | Standard Implementation, Facilitated Implementation |
|---|---|---|
| Comments | Group Comparison at 6 Months | |
| Type of Statistical Test | Superiority | |
| Comments | ||
| Statistical Test of Hypothesis | p-Value | 0.10 |
| Comments | ||
| Method | t-test, 2 sided | |
| Comments | ||
| Method of Estimation | Estimation Parameter | Mean Difference (Final Values) |
| Estimated Value | 2.62 | |
| Confidence Interval |
(2-Sided) 95% -0.54 to 5.78 |
|
| Parameter Dispersion |
Type: Standard Error of the Mean Value: 1.60 |
|
| Estimation Comments | ||
Statistical Analysis 3
| Statistical Analysis Overview | Comparison Group Selection | Standard Implementation, Facilitated Implementation |
|---|---|---|
| Comments | Group Comparison at 1 year | |
| Type of Statistical Test | Superiority | |
| Comments | ||
| Statistical Test of Hypothesis | p-Value | 0.77 |
| Comments | ||
| Method | t-test, 2 sided | |
| Comments | ||
| Method of Estimation | Estimation Parameter | Mean Difference (Final Values) |
| Estimated Value | 0.54 | |
| Confidence Interval |
(2-Sided) 95% -3.06 to 4.14 |
|
| Parameter Dispersion |
Type: Standard Error of the Mean Value: 1.83 |
|
| Estimation Comments | ||
| Title | Number of Unique Veterans Seen (Adjusted for Employment Period and Hours Worked Per Week) |
|---|---|
| Description | This adjusted workload variables took into consideration both the employment period (many PSs did not start immediately or may have left prior to the end of the 2 years) and weekly hours worked (varying from one hour to 40 hours per week). Visits during each PS's employment period were divided by the total number of hours worked, then multiplied by 40 to calculate adjusted values for operationalization above. Because this variable was significantly skewed, we used a log transformation to improve their distributional properties. Differences between intervention conditions were then compared with a series of Analyses of Covariance models with age, gender and race as covariates. Since these variables are measured at the PS level, the covariates were the average across the Veterans sesn by each PS (mean age, percent White and percent male). N's are number of Veterans |
| Time Frame | one year, across two years |
Outcome Measure Data
| Analysis Population Description |
|---|
| Unique Veteran encounters |
| Arm/Group Title | Standard Implementation | Facilitated Implementation |
|---|---|---|
| Arm/Group Description | Standard Implementation sites will receive written guidance and limited consultation by the investigators' team. | Facilitated Implementation sites will receive one year of support based on the i-PARIHS implementation model which includes training, implementation planning, ongoing external facilitation, feedback and consultation. Facilitated Implementation: Facilitated Implementation sites will receive one year of support based on the i-PARIHS implementation model which includes training, implementation planning, ongoing external facilitation, feedback and consultation |
| Measure Participants | 899 | 1,484 |
| 1st year |
1.3
(1.3)
|
4.8
(6.1)
|
| across both years |
5.8
(8.5)
|
6.0
(5.8)
|
Statistical Analysis 1
| Statistical Analysis Overview | Comparison Group Selection | Standard Implementation, Facilitated Implementation |
|---|---|---|
| Comments | ||
| Type of Statistical Test | Superiority | |
| Comments | ||
| Statistical Test of Hypothesis | p-Value | 0.02 |
| Comments | p value for 1st year only | |
| Method | t-test, 2 sided | |
| Comments | ||
| Method of Estimation | Estimation Parameter | Mean Difference (Final Values) |
| Estimated Value | 3.47 | |
| Confidence Interval |
(2-Sided) 95% 0.56 to 6.38 |
|
| Parameter Dispersion |
Type: Standard Error of the Mean Value: 1.56 |
|
| Estimation Comments | ||
Statistical Analysis 2
| Statistical Analysis Overview | Comparison Group Selection | Standard Implementation, Facilitated Implementation |
|---|---|---|
| Comments | ||
| Type of Statistical Test | Superiority | |
| Comments | ||
| Statistical Test of Hypothesis | p-Value | 0.93 |
| Comments | ||
| Method | t-test, 2 sided | |
| Comments | ||
| Method of Estimation | Estimation Parameter | Mean Difference (Final Values) |
| Estimated Value | 0.19 | |
| Confidence Interval |
(2-Sided) 95% -4.67 to 5.04 |
|
| Parameter Dispersion |
Type: Standard Error of the Mean Value: 2.39 |
|
| Estimation Comments | ||
| Title | Average Number of Visits Per Veteran Per Peer Specialist-Adjusted (Across Both Years) |
|---|---|
| Description | See Variable 5 above for details about adjustment. Since this variable this is a Veteran level variable, a General Linear Mixed Model (GSLMM) was used with PS specified as a random effect and Veteran age, race and gender. N's are number of Veterans |
| Time Frame | across both years |
Outcome Measure Data
| Analysis Population Description |
|---|
| Number of Visits per Veteran |
| Arm/Group Title | Standard Implementation | Facilitated Implementation |
|---|---|---|
| Arm/Group Description | Standard Implementation sites will receive written guidance and limited consultation by the investigators' team. | Facilitated Implementation sites will receive one year of support based on the i-PARIHS implementation model which includes training, implementation planning, ongoing external facilitation, feedback and consultation. Facilitated Implementation: Facilitated Implementation sites will receive one year of support based on the i-PARIHS implementation model which includes training, implementation planning, ongoing external facilitation, feedback and consultation |
| Measure Participants | 899 | 1,484 |
| Mean (Standard Deviation) [Count of Visits] |
2.2
(3.0)
|
3.2
(5.6)
|
Statistical Analysis 1
| Statistical Analysis Overview | Comparison Group Selection | Standard Implementation, Facilitated Implementation |
|---|---|---|
| Comments | ||
| Type of Statistical Test | Superiority | |
| Comments | ||
| Statistical Test of Hypothesis | p-Value | 0.0001 |
| Comments | ||
| Method | t-test, 2 sided | |
| Comments | p value for 1st year | |
| Method of Estimation | Estimation Parameter | Mean Difference (Final Values) |
| Estimated Value | 1.02 | |
| Confidence Interval |
(2-Sided) 95% 0.68 to 1.37 |
|
| Parameter Dispersion |
Type: Standard Error of the Mean Value: 0.20 |
|
| Estimation Comments | ||
| Title | Average Total Number of Services Provided-Adjusted (First Year Only and Across Both Years) |
|---|---|
| Description | This adjusted workload variables took into consideration both the employment period (many PSs did not start immediately or may have left prior to the end of the 2 years) and weekly hours worked (varying from one hour to 40 hours per week). Visits during each PS's employment period were divided by the total number of hours worked, then multiplied by 40 to calculate adjusted values for operationalization above. Because this variable was significantly skewed, we used a log transformation to improve their distributional properties. Differences between intervention conditions were then compared with a series of Analyses of Covariance models with age, gender and race as covariates. Since these variables are measured at the PS level, the covariates were the average across the Veterans sesn by each PS (mean age, percent White and percent male). N's are number of Veterans |
| Time Frame | one year and across both years |
Outcome Measure Data
| Analysis Population Description |
|---|
| Services Provided by each Peer Specialist |
| Arm/Group Title | Standard Implementation | Facilitated Implementation |
|---|---|---|
| Arm/Group Description | Standard Implementation sites will receive written guidance and limited consultation by the in vestigators' team. | Facilitated Implementation sites will receive one year of support based on the i-PARIHS implementation model which includes training, implementation planning, ongoing external facilitation, feedback and consultation. Facilitated Implementation: Facilitated Implementation sites will receive one year of support based on the i-PARIHS implementation model which includes training, implementation planning, ongoing external facilitation, feedback and consultation |
| Measure Participants | 899 | 1,484 |
| 1st Year Only |
2.7
(2.7)
|
8.4
(8.7)
|
| Across Both Years |
9.8
(8.7)
|
12.4
(8.7)
|
Statistical Analysis 1
| Statistical Analysis Overview | Comparison Group Selection | Standard Implementation, Facilitated Implementation |
|---|---|---|
| Comments | ||
| Type of Statistical Test | Superiority | |
| Comments | ||
| Statistical Test of Hypothesis | p-Value | 0.02 |
| Comments | ||
| Method | t-test, 2 sided | |
| Comments | ||
| Method of Estimation | Estimation Parameter | Mean Difference (Final Values) |
| Estimated Value | 5.7 | |
| Confidence Interval |
(2-Sided) 95% 1.46 to 9.96 |
|
| Parameter Dispersion |
Type: Standard Error of the Mean Value: 2.26 |
|
| Estimation Comments | ||
Statistical Analysis 2
| Statistical Analysis Overview | Comparison Group Selection | Standard Implementation, Facilitated Implementation |
|---|---|---|
| Comments | ||
| Type of Statistical Test | Superiority | |
| Comments | ||
| Statistical Test of Hypothesis | p-Value | 0.38 |
| Comments | ||
| Method | t-test, 2 sided | |
| Comments | ||
| Method of Estimation | Estimation Parameter | Mean Difference (Final Values) |
| Estimated Value | 2.60 | |
| Confidence Interval |
(2-Sided) 95% -3.14 to 8.54 |
|
| Parameter Dispersion |
Type: Standard Error of the Mean Value: 2.92 |
|
| Estimation Comments | ||
| Title | Time to First Service |
|---|---|
| Description | This variable represents count of days from time study at each site started (baseline) until first service was delivered. |
| Time Frame | variable from baseline to time of first service delivered by Peer Specialists |
Outcome Measure Data
| Analysis Population Description |
|---|
| [Not Specified] |
| Arm/Group Title | Standard Implementation | Facilitated Implementation |
|---|---|---|
| Arm/Group Description | Standard Implementation sites will receive written guidance and limited consultation by the investigators' team. | Facilitated Implementation sites will receive one year of support based on the i-PARIHS implementation model which includes training, implementation planning, ongoing external facilitation, feedback and consultation. Facilitated Implementation: Facilitated Implementation sites will receive one year of support based on the i-PARIHS implementation model which includes training, implementation planning, ongoing external facilitation, feedback and consultation |
| Measure Participants | 16 | 21 |
| Mean (Standard Deviation) [Number of Days] |
188.2
(123.4)
|
88.7
(65.0)
|
Statistical Analysis 1
| Statistical Analysis Overview | Comparison Group Selection | Standard Implementation, Facilitated Implementation |
|---|---|---|
| Comments | ||
| Type of Statistical Test | Superiority | |
| Comments | ||
| Statistical Test of Hypothesis | p-Value | 0.027 |
| Comments | ||
| Method | t-test, 2 sided | |
| Comments | ||
| Method of Estimation | Estimation Parameter | Mean Difference (Final Values) |
| Estimated Value | -99.4 | |
| Confidence Interval |
(2-Sided) 95% -186.2 to -12.66 |
|
| Parameter Dispersion |
Type: Standard Error of the Mean Value: 41.73 |
|
| Estimation Comments | ||
| Title | Average Number of Visits Per Veteran Per Peer Specialist-Adjusted (First Year Only) |
|---|---|
| Description | See Variable 5 above for details about adjustment. Since this variable this is a Veteran level variable, a General Linear Mixed Model (GSLMM) was used with PS specified as a random effect and Veteran age, race and gender. N's are number of Veterans |
| Time Frame | 1st year only |
Outcome Measure Data
| Analysis Population Description |
|---|
| number of visits per Veteran |
| Arm/Group Title | Standard Implementation | Facilitated Implementation |
|---|---|---|
| Arm/Group Description | Standard Implementation sites will receive written guidance and limited consultation by the investigators' team. | Facilitated Implementation sites will receive one year of support based on the i-PARIHS implementation model which includes training, implementation planning, ongoing external facilitation, feedback and consultation. Facilitated Implementation: Facilitated Implementation sites will receive one year of support based on the i-PARIHS implementation model which includes training, implementation planning, ongoing external facilitation, feedback and consultation |
| Measure Participants | 459 | 767 |
| Mean (Standard Deviation) [Count of Visits] |
2.0
(2.1)
|
2.6
(3.6)
|
Statistical Analysis 1
| Statistical Analysis Overview | Comparison Group Selection | Standard Implementation, Facilitated Implementation |
|---|---|---|
| Comments | ||
| Type of Statistical Test | Superiority | |
| Comments | ||
| Statistical Test of Hypothesis | p-Value | 0.001 |
| Comments | ||
| Method | t-test, 2 sided | |
| Comments | ||
| Method of Estimation | Estimation Parameter | Mean Difference (Final Values) |
| Estimated Value | 0.60 | |
| Confidence Interval |
(2-Sided) 95% 0.28 to 0.92 |
|
| Parameter Dispersion |
Type: Standard Error of the Mean Value: 0.18 |
|
| Estimation Comments | ||
Adverse Events
| Time Frame | adverse events were not monitored or collected | |||
|---|---|---|---|---|
| Adverse Event Reporting Description | adverse events were not monitored or collected | |||
| Arm/Group Title | Standard Implementation | Facilitated Implementation | ||
| Arm/Group Description | Standard Implementation sites will receive written guidance and limited consultation by the investigators' team. | Facilitated Implementation sites will receive one year of support based on the i-PARIHS implementation model which includes training, implementation planning, ongoing external facilitation, feedback and consultation. Facilitated Implementation: Facilitated Implementation sites will receive one year of support based on the i-PARIHS implementation model which includes training, implementation planning, ongoing external facilitation, feedback and consultation | ||
All Cause Mortality |
||||
| Standard Implementation | Facilitated Implementation | |||
| Affected / at Risk (%) | # Events | Affected / at Risk (%) | # Events | |
| Total | 0/0 (NaN) | 0/0 (NaN) | ||
Serious Adverse Events |
||||
| Standard Implementation | Facilitated Implementation | |||
| Affected / at Risk (%) | # Events | Affected / at Risk (%) | # Events | |
| Total | 0/0 (NaN) | 0/0 (NaN) | ||
Other (Not Including Serious) Adverse Events |
||||
| Standard Implementation | Facilitated Implementation | |||
| Affected / at Risk (%) | # Events | Affected / at Risk (%) | # Events | |
| Total | 0/0 (NaN) | 0/0 (NaN) | ||
Limitations/Caveats
While the uploaded Study Protocol is in publication form, this represents the only written study protocol. Because the study was classified as non-research, there is no IRB protocol.
More Information
Certain Agreements
All Principal Investigators ARE employed by the organization sponsoring the study.
There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed.
Results Point of Contact
| Name/Title | Richard Goldberg |
|---|---|
| Organization | VISN 5 Mental Illness Research, Education, and Clinical Center |
| Phone | 410-637-1851 |
| Richard.Goldberg@va.gov |
Responsible Party:
VA Office of Research and Development
ClinicalTrials.gov Identifier:
NCT02732600
Other Study ID Numbers:
- QUX 16-001
First Posted:
Apr 8, 2016
Last Update Posted:
Apr 2, 2021
Last Verified:
Mar 1, 2021