Lead/Presenter: Mark Bauer, COIN - Bedford/Boston
All Authors: Bauer MS (CHOIR & Behavioral Health QUERI), Weaver K (VACO Office of Mental Health and Suicide Prevention), Kim B (CHOIR & Behavioral Health QUERI) Miller C (CHOIR & Behavioral Health QUERI) Lew R (CHOIR & MAVERIC) Stolzmann K (CHOIR) Sullivan J (CHOIR & Behavioral Health QUERI) Riendeau R (CHOIR) Connolly S (CHOIR) Pitcock J (Behavioral Health QUERI Ludvigsen S (VACO Office of Veterans Access to Care) Elwy AR (CHOIR & Behavioral Health QUERI)
Collaborative Chronic Care Models (CCMs) have extensive controlled trial evidence for effectiveness in serious mental illnesses, but there is little evidence regarding feasibility or impact in typical practice conditions. In partnership with the VA Office of Mental Health and Suicide Prevention (OMHSP) we conducted a QUERI-funded randomized, stepped wedge implementation trial using blended internal-external facilitation to implement CCMs in Behavioral Health Interdisciplinary Program (BHIP) teams in the general mental health clinics of nine VA medical centers. Based on experience in this trial, OMHSP launched an initiative to scale-up and spread the implementation effort more broadly.
QUERI researchers and OMHSP engaged with Transformational Coaches (T-Coaches) from the VA Office of Veterans Access to Care to serve as external facilitators to engage additional VA medical centers across the country. T-Coaches are senior facilitators with skills in team-building and process redesign from diverse professional disciplines. Trial external facilitators and OMHSP leadership trained 17 T-Coaches in methods used in the trial. Sites were recruited by OMHSP. Blended facilitation was conducted for 12 months as in the QUERI-funded trial. Each of the T-Coaches partnered with a BHIP-CCM subject matter expert for the effort, and they conferred on a regular basis throughout the year.
Thirty-nine sites were approached, and of these 35 (89.7%) signed a letter of agreement. Of these, 28 facilities (80.0%) completed a site visit and entered the ongoing virtual facilitation process. Of these, 21 facilities (75.0%) completed the one-year facilitation and submitted CCM-concordance process summaries. The proportion of CCM-concordant processes ranged widely across facilities, with the more concordant sites equaling rates seen in the QUERI-funded trial and a broader low-end distribution (trial: 44-89, T-Coach scale-up: 13-93%).
In summary there was, not surprisingly, a broader range of CCM-concordance among these scale-up sites compared to the QUERI-funded trial. Nonetheless, taken together, the two BHIP-CCM implementation efforts reached 30 VA medical centers, of which 17 (56.7%) aligned over half of designated care processes with the evidence-based CCM.
With strong operational partnerships and support, implementation trial efforts can be scaled up and spread to achieve broader healthcare system impact.