Background: The use of telemental health via videoconferencing (TMH-V) became critical during the Coronavirus disease 2019 (COVID-19) pandemic due to restriction of nonurgent in-person appointments. The current brief report demonstrates the rapid growth in TMH-V appointments in the weeks following the pandemic declaration within the Department of Veterans Affairs (VA), the largest healthcare system in the United States. Methods: COVID-19 changes in TMH-V appointments were captured during the six weeks following the World Health Organization's pandemic declaration (

Rosen served as lead for writing -original draft and writingreview and editing. Leslie A. Morland contributed equally to writing -review and editing and served in a supporting role for writing -original draft. Lisa H. Glassman served as lead for writing -review and editing and served in a supporting role for writing -original draft. Brian P. Marx served in a supporting role for conceptualization and writing -review and editing. Kendra Weaver served in a supporting role for conceptualization, data curation, and writing -review and editing. Clifford A. Smith served as lead for data curation and served in a supporting role for conceptualization and writing -review and editing. Stacey Pollack served in a supporting role for writing -review and editing. Paula P. Schnurr served in a supporting role for conceptualization and writing -review and editing. Craig S. Rosen, Leslie A. Morland, and Lisa H. Glassman contributed to conceptualization equally. Craig S. Rosen and Clifford A. Smith contributed to formal analysis equally. Craig S. Rosen and Leslie A. Morland contributed to project administration equally. The views expressed are those of the authors and do not necessarily reflect the position of the U.S. Veterans Health Administration or the government of the United States.

BackgroundOutcome for mental health conditions is suboptimal, and care is fragmented. Evidence from controlled trials indicates that collaborative chronic care models (CCMs) can improve outcomes in a broad array of mental health conditions. US Department of Veterans Affairs leadership launched a nationwide initiative to establish multidisciplinary teams in general mental health clinics in all medical centers. As part of this effort, leadership partnered with implementation researchers to develop a program evaluation protocol to provide rigorous scientific data to address two implementation questions: (1) Can evidence-based CCMs be successfully implemented using existing staff in general mental health clinics supported by internal and external implementation facilitation? (2) What is the impact of CCM implementation efforts on patient health status and perceptions of care?Methods/designHealth system operation leaders and researchers partnered in an iterative process to design a protocol that balances operational priorities, scientific rigor, and feasibility. Joint design decisions addressed identification of study sites, patient population of interest, intervention design, and outcome assessment and analysis. Nine sites have been enrolled in the intervention-implementation hybrid type III stepped-wedge design. Using balanced randomization, sites have been assigned to receive implementation support in one of three waves beginning at 4-month intervals, with support lasting 12 months. Implementation support consists of US Center for Disease Control’s Replicating Effective Programs strategy supplemented by external and internal implementation facilitation support and is compared to dissemination of materials plus technical assistance conference calls. Formative evaluation focuses on the recipients, context, innovation, and facilitation process. Summative evaluation combines quantitative and qualitative outcomes. Quantitative CCM fidelity measures (at the site level) plus health outcome measures (at the patient level; n = 765) are collected in a repeated measures design and analyzed with general linear modeling. Qualitative data from provider interviews at baseline and 1 year elaborate CCM fidelity data and provide insights into barriers and facilitators of implementation.DiscussionConducting a jointly designed, highly controlled protocol in the context of health system operational priorities increases the likelihood that time-sensitive questions of operational importance will be answered rigorously and that the outcomes will result in sustainable change in the health-care system.Trial registrationNCT02543840 (https://www.clinicaltrials.gov/ct2/show/NCT02543840).

Key Points Question Collaborative chronic care models for mental health conditions are supported by extensive randomized clinical trial data, but what is the evidence that these models can be implemented and can have beneficial effects in general clinical settings? Findings In this randomized clinical implementation trial of 5596 veterans, a collaborative chronic care model was shown to be effectively implemented with practical, scalable facilitation support for clinicians. Effects on self-reported health outcomes were limited, but mental health hospitalization rate improved. Meaning These findings suggest that collaborative chronic care models can be exported to general clinical practice settings using implementation facilitation and, at least for individuals with complex mental health conditions, can improve health outcomes.