Study Suggests Positive Effect of Collaborative Chronic Care Model on Mental Health Clinical Teams
This is one of the first studies to evaluate Collaborative Chronic Care Model (CCM) implementation for individuals treated in mental health clinics, and the first CCM trial to assess implementation impact in a multi-diagnosis mental health population. Investigators partnered with VA's Office of Mental Health and Suicide Prevention to conduct a randomized implementation trial to establish CCM-based teams in nine outpatient general mental health clinics from February 2016 through February 2018. This study included 5,596 Veterans treated in mental health clinic Behavioral Health Interdisciplinary Program (BHIP) teams (excluding Veterans with dementia) and 62 VA providers on those BHIP teams. CCM implementation support focused on facilitating local solutions for local challenges that could be developed with evidence-based guidance, which required team-building and attention to healthcare processes. Implementation activities led teams through self-assessment and process improvement efforts to align clinical processes with the CCM elements (leadership support, work role redesign, Veteran self-management, provider decision support, information management, and community linkages). Implementation outcomes focused on team function (communication, cohesion, role clarity, and team primacy) plus concordance of team processes with the six CCM elements. Veteran health status and satisfaction data were gathered during telephone interviews at baseline, 6, and 12 months of implementation support.
- Results suggest that implementation efforts at the clinician level enhance evidence-based care organization, which may result in improvements in outcomes for more complex individuals and those at risk for hospitalization.
- Mental health hospitalizations decreased significantly for Veterans treated on facilitated BHIP teams compared to Veterans treated in other mental health clinics in those facilities.
- Although no improvement in population-level Veteran self-ratings of health status was seen, in post-hoc analyses mental health status improved in Veterans with >3 treated mental health diagnoses versus others.
- This implementation initiative used existing clinical staff, with external facilitation the only added research-supported effort, totaling less than 3 hours per week per facility, and still decreased hospitalization rates and, for complex individuals, improved mental health status.
- There was no independent control group due to healthcare system policy priorities and trial practicalities. However, the design incorporated strengths recommended for quasi-experimental designs, i.e., partial randomization, balancing of sites, and use of baseline measures.
This study was funded by the Quality Enhancement Research Initiative (QUERI) and HSR&D, in partnership with VA's Office of Mental Health and Suicide Prevention. Drs. Bauer, Miller, and Kim are part of HSR&D's Center for Healthcare Organization and Implementation Research (CHOIR) and QUERI for Team-Based Behavioral Health.
Bauer M, Miller C, Kim B, et al. Effectiveness of Implementing a Collaborative Care Model for Clinician Teams on Patient Outcomes and Health Status in Mental Health: A Randomized Clinical Trial. JAMA Network Open. March 1, 2019;2(3):e190230.