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SDR 16-195 – HSR&D Study

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SDR 16-195
Risk Stratified Enhancements to Clinical Care: Targeting Care for Patients Identified Through Predictive Modeling as Being at High Risk for Suicide, with the Office of Mental Health Operations
Sara J. Landes PhD
Central Arkansas Veterans Healthcare System Eugene J. Towbin Healthcare Center, Little Rock, AR
No. Little Rock, AR
Funding Period: April 2016 - September 2020

BACKGROUND/RATIONALE:
The Department of Veterans Affairs recently implemented a new suicide prevention clinical initiative that utilizes predictive modeling and existing medical record data to identify Veterans at highest risk of suicide; this program is entitled Recovery Engagement and Coordination for Health - Veterans Enhanced Treatment or REACH VET. REACH VET coordinators at each facility are responsible for monitoring the REACH VET dashboard that both identifies those at high risk and tracks next steps for coordinators and providers. Following identification of patients at risk, coordinators notify each patient's provider of their high-risk status and orient the provider to the dashboard. Providers are required to re-evaluate the patient's care, determine if care enhancements are needed, and contact the patient.

In partnership with the Office of Mental Health and Suicide Prevention (OMHSP), the evaluation team (PI Landes) applied for and received VA Health Services Research and Development (HSR&D) funding for a randomized program evaluation of the implementation of REACH VET. The standard implementation strategies used includes policy memos, identification of a coordinator at each of the 140 VA healthcare systems, web-based training, educational and support materials, and technical assistance. For sites having difficulty fully implementing the program external implementation facilitation is being provided. OMHSP is providing facilitation in a stepped wedge design to 7 VISNs that were identified as needing additional implementation support. The four lowest performing facilities in each participating VISN will receive facilitation. These 28 sites will be included in the evaluation.

OBJECTIVE(S):
The goal of the proposed study is to evaluate the implementation of REACH VET and the use of facilitation as an implementation strategy.

The specific aims are:

Specific Aim 1: Evaluate the impact of virtual external facilitation versus standard implementation.

Specific Aim 2: Develop and evaluate the augmentation of REACH VET using caring letters, an evidence-based suicide prevention intervention.

Specific Aim 3: Collect preliminary cost data on facilitation and the REACH VET intervention.

METHODS:
The overall design will be a hybrid effectiveness-implementation controlled program evaluation using a mixed methods approach. Clinical intervention outcomes will include suicide attempts and completed suicides (these will be evaluated by SMITREC led by Dr. John McCarthy). Implementation outcomes will include cost of intervention, cost of implementation strategy, reach, adoption, and implementation. Qualitative interviews will be conducted with implementation facilitators, Suicide Prevention Coordinator(s), clinical leadership, providers, and Veterans.

FINDINGS/RESULTS:
No findings or results to date.

IMPACT:
The anticipated impact on the VA health care system of this project is to improve targeting of VA suicide prevention resources through understanding how to best implement such an intervention across a system.

PUBLICATIONS:

Journal Articles

  1. Reger MA, Luxton DD, Tucker R, Comtois KA, Keen AD, Landes SJ, Matarazzo BB, Thompson C. Implementation Methods for the Caring Contacts Suicide Prevention Intervention. Professional Psychology, Research and Practice. 2017 Oct 1; 48(5):369-377.


DRA: Mental, Cognitive and Behavioral Disorders
DRE: none
Keywords: Implementation, Information Management, Suicide
MeSH Terms: none