Enhancing outreach for persons with serious mental illness: 12-month results from a cluster randomized trial of an adaptive implementation strategy

Abstract

BackgroundFew implementation strategies have been empirically tested for their effectiveness in improving uptake of evidence-based treatments or programs. This study compared the effectiveness of an immediate versus delayed enhanced implementation strategy (Enhanced Replicating Effective Programs (REP)) for providers at Veterans Health Administration (VA) outpatient facilities (sites) on improved uptake of an outreach program (Re-Engage) among sites not initially responding to a standard implementation strategy.MethodsOne mental health provider from each U.S. VA site (N = 158) was initially given a REP-based package and training program in Re-Engage. The Re-Engage program involved giving each site provider a list of patients with serious mental illness who had not been seen at their facility for at least a year, requesting that providers contact these patients, assessing patient clinical status, and where appropriate, facilitating appointments to VA health services. At month 6, sites considered non-responsive (N = 89, total of 3,075 patients), defined as providers updating documentation for less than <80% of patients on their list, were randomized to two adaptive implementation interventions: Enhanced REP (provider coaching; N = 40 sites) for 6 months followed by Standard REP for 6 months; versus continued Standard REP (N = 49 sites) for 6 months followed by 6 months of Enhanced REP for sites still not responding. Outcomes included patient-level Re-Engage implementation and utilization.ResultsPatients from sites that were randomized to receive Enhanced REP immediately compared to Standard REP were more likely to have a completed contact (adjusted OR = 2.13; 95% CI: 1.09–4.19, P = 0.02). There were no differences in patient-level utilization between Enhanced and Standard REP sites.ConclusionsEnhanced REP was associated with greater Re-Engage program uptake (completed contacts) among sites not responding to a standard implementation strategy. Further research is needed to determine whether national implementation of Facilitation results in tangible changes in patient-level outcomes.Trial registrationISRCTN: ISRCTN21059161Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-014-0163-3) contains supplementary material, which is available to authorized users.

The Implementation &amp; Sustainment Facilitation Strategy improved implementation effectiveness and intervention effectiveness: Results from a cluster-randomized type 2 hybrid trial

“…We used a cluster-randomized, type 2 hybrid trial to simultaneously test the impact of the ISF strategy (as an adjunct to the ATTC strategy) on: (1) the integration of a MIBI for SUDs within HIV-CBOs across the United States, and (2) the effectiveness of the MIBI (as an adjunct to UC within HIV-CBOs). Contributing to the growing literature on the effectiveness of facilitation-based strategies (74)(75)(76)(77)(78)(79)(80)(81)(82) and the effectiveness of MIBIs for SUD within HIV service settings (18,(83)(84)(85)(86)(87)(88), we found at least two findings of significance. First, we found evidence that the ISF strategy had a significant impact on improving the integration of the MIBI for SUDs, at least in terms of significantly improving the consistency and quality of MIBI implementation during the implementation phase (i.e., implementation effectiveness).…”

The Implementation &amp; Sustainment Facilitation Strategy improved implementation effectiveness and intervention effectiveness: Results from a cluster-randomized type 2 hybrid trial

“…We used a cluster-randomized, type 2 hybrid trial to simultaneously test the impact of the ISF strategy (as an adjunct to the ATTC strategy) on: (1) the integration of a MIBI for SUDs within HIV-CBOs across the United States, and (2) the effectiveness of the MIBI (as an adjunct to UC within HIV-CBOs). Contributing to the growing literature on the effectiveness of facilitation-based strategies (74)(75)(76)(77)(78)(79)(80)(81)(82) and the effectiveness of MIBIs for SUD within HIV service settings (18,(83)(84)(85)(86)(87)(88), we found at least two findings of significance. First, we found evidence that the ISF strategy had a significant impact on improving the integration of the MIBI for SUDs, at least in terms of significantly improving the consistency and quality of MIBI implementation during the implementation phase (i.e., implementation effectiveness).…”

The Balanced Opioid Initiative: protocol for a clustered, sequential, multiple-assignment randomized trial to construct an adaptive implementation strategy to improve guideline-concordant opioid prescribing in primary care

“…This combination of a sequenced and tailored approach to systems consultation is known as an adaptive implementation strategy [25][26][27][28][29][30]. However, two sets of challenges prevent us from evaluating or recommending Quanbeck et al Implementation Science (2020) 15:26 such an approach to addressing opioid prescribing in primary care using the results of our pilot alone.…”