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2015 HSR&D/QUERI National Conference Abstract

3043 — Rapid framework assessment of VA policy implementation of interdisciplinary mental health care

Miller CJ, VA Boston CHOIR; Elwy AR, VA Bedford CHOIR; Holmes SK, VA Boston CHOIR; Kim B, VA Bedford CHOIR; Bauer MS, VA Boston CHOIR;

The Department of Veterans Affairs (VA) has mandated the creation of Behavioral Health Interdisciplinary Program (BHIP) teams within mental health clinics nationally. Aside from recommended staffing, however, little guidance has been provided regarding specific steps to implement BHIPs. The Collaborative Chronic Care Model (CCM) is an evidence-based care delivery model around which BHIPs can be built. Assessing the delivery of collaborative care, however, remains a challenge.

We conducted qualitative interviews with mental health providers at three clinics with various levels of BHIP experience. Based upon a framework of directed content analysis, we used an iterative procedure to develop a codebook for assessing the extent to which care at these three sites was consistent with each of the six core CCM elements: workrole redesign, patient self-management support, provider decision support, clinical information systems, linkages to community resources, and leadership/organizational support. We then applied this codebook to qualitative interview transcripts via consensus-based rapid coding procedures and ratings of site fidelity to CCM principles. These procedures were initially applied at the quote level, and later expanded to the site level.

Initial attempts to establish reliability at the quote-level were unsuccessful, but site-level analyses quickly yielded consensus ratings. Our codebook based on the CCM elements was able to distinguish systematic differences among the three sites regarding consistency with CCM principles. Among the CCM elements, interview respondents provided the most information regarding workrole redesign principles.

Our directed content analysis allowed us to investigate the extent to which three outpatient mental health clinics within VA delivered care consistent with the CCM. Such procedures could be used at other sites to guide quality improvement efforts to enhance the delivery of collaborative care across clinics.

The advent of BHIPs represents an important reorganization of VA-based mental health care. The CCM represents an evidence-based care delivery model for improving mental health outcomes within these teams, and the qualitative analytic methodology we used for this project can be used to guide further CCM implementation.