Effectiveness of Implementing a Collaborative Chronic Care Model for Clinician Teams on Patient Outcomes and Health Status in Mental Health

Abstract

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.

Iterative Decision‐making for Evaluation of Adaptations (IDEA): A decision tree for balancing adaptation, fidelity, and intervention impact

“…In conjunction with evaluation frameworks such as the FRAME (Wiltsey‐Stirman et al, ), it lays out a way to consider and document the process of adaptation itself. We also demonstrate how the IDEA can be applied to implementation projects, using the example of the BHIP‐CCM Enhancement Project (Bauer, Miller et al, ) and a hypothetical community‐based implementation of trauma‐focused psychotherapy.…”

“…In this section we demonstrate application of the IDEA to the Behavioral Health Interdisciplinary Program (BHIP) Enhancement Project. The project was jointly funded as research and quality improvement (Bauer et al, ; Bauer, Weaver et al, ) by the US Department of Veterans Affairs (VA). The overarching goal of the BHIP Enhancement Project was to align care processes with the collaborative care model (CCM; Wagner, Austin, & Von Korff, ) in VA‐based outpatient mental health teams consisting of about 6–8 full‐time clinical staff known as BHIPs.…”

“…The BHIP‐CCM Enhancement Guide was then used to implement the adapted CCM in nine additional BHIP teams in the context of a larger implementation trial (VA QUERI QUE #15–289; Bauer et al, ; Bauer, Weaver et al, ). That study demonstrated improvements in hospitalization rates for Veterans treated by CCM‐enhanced teams, as well as improved mental health‐related quality of life for patients with three or more mental health diagnoses.…”

Does Balancing Site Characteristics Result in Balanced Population Characteristics in a Cluster-Randomized Controlled Trial?

“…The Behavioral Health Interdisciplinary Program -Collaborative Chronic Care Model (BHIP-CCM) cluster randomized controlled trial (ClinicalTrials.gov, NCT02543840) utilized a stepped wedge design (SWD) to stagger implementation of an evidence-based team care program in general mental health clinics at nine VA medical centers. (10,11) Briefly, all sites received implementation support to establish mental health teams structured according to the evidence-based collaborative care model; (12,13) however, sites were randomized with regard to the timing of the receipt of implementation support, which was stepped out in three waves of three sites each. (10)…”

“…The eligible study population consisted of Veterans who had at least two visits in the prior year (with at least one visit within the past three months) to a general mental health clinic at one of nine Veteran Affairs Medical Centers (VAMCs) (n = 5,596). (10,11,16) A subset of up to 500 individuals from each VAMC were selected to complete a telephone-administered survey battery at baseline, 6, and 12 months with a total of 1,050 Veterans who completed an interview (n = 1,436 total interviews). Women were oversampled to increase gender balance.…”