2019 HSR&D/QUERI National Conference

4001 — Collaborative Chronic Care Model Implementation within Outpatient Behavioral Health Care Teams: Qualitative Results from a Multisite Trial

Lead/Presenter: Jennifer Sullivan,  COIN - Bedford/Boston
All Authors: Sullivan JL (CHOIR, BU School of Public Health), Kim, B (CHOIR, Harvard), Miller, C (CHOIR, Harvard) Drummond, KL (Little Rock COIN) Elwy, AR (CHOIR, Brown U, BU SPH) Riendeau, R (CHOIR, UIowa) Bauer, M (CHOIR, Harvard)

As part of a hybrid II stepped-wedge trial to implement interdisciplinary team-based behavioral health care using blended facilitation at 9 Veterans Health Administration (VHA) medical centers, we interviewed providers to understand how collaborative care had been influenced by facilitation. The objective of this study was to compare alignment of sites' clinical processes with Collaborative Chronic Care Model (CCM) elements at baseline and 12-months post-trial.

We conducted semi-structured interviews with outpatient mental health team providers to assess the extent to which 6 CCM elements were in place: work role redesign, patient self-management support, provider decision support, clinical information systems, linkages to community resources, and leadership support. There were 27 interviews at baseline and 31 interviews 12-month post-implementation. Interviews were transcribed and a priori CCM elements were coded using a directed content analysis. The team then rated CCM element evidence from 1 (not at all present) to 5 (stably and broadly established) and compared scores across the 9 sites at the two time points.

Three CCM elements were most frequently present across the sites pre-trial: work role redesign, patient self-management support, and provider decision support. Twelve-months post-trial, the same 3 elements were also implemented most frequently. The CCM elements with the greatest magnitude of change from baseline to 12-months post-trial were: work role redesign, patient self-management support, and clinical information systems. Notably, the score for one CCM element, leadership support, had decreased slightly post-trial.

We observed that sites participating in our implementation trial made progress on implementing several CCM elements. The most progress was made in the CCM elements where sites had already had certain associated processes in place at baseline, speaking to the potential need to focus additional implementation efforts toward CCM elements that are less familiar to each site.

Some CCM elements were more easily moved by facilitation support, whereas other elements were less amenable to change. To improve adoption of collaborative care within behavioral health teams, it is crucial to focus on garnering and sustaining leadership support as well as considering necessary resources and training to implement the CCM.