Enhancing implementation of measurement-based mental health care in primary care: a mixed-methods randomized effectiveness evaluation of implementation facilitation
Abstract Background Mental health care lags behind other forms of medical care in its reliance on subjective clinician assessment. Although routine use of standardized patient-reported outcome measures, measurement-based care (MBC), can improve patient outcomes and engagement, clinician efficiency,...
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| Format: | Article |
| Language: | English |
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BMC
2018-10-01
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| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12913-018-3493-z |
| _version_ | 1818553665360756736 |
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| author | Laura O. Wray Mona J. Ritchie David W. Oslin Gregory P. Beehler |
| author_facet | Laura O. Wray Mona J. Ritchie David W. Oslin Gregory P. Beehler |
| author_sort | Laura O. Wray |
| collection | DOAJ |
| description | Abstract Background Mental health care lags behind other forms of medical care in its reliance on subjective clinician assessment. Although routine use of standardized patient-reported outcome measures, measurement-based care (MBC), can improve patient outcomes and engagement, clinician efficiency, and, collaboration across care team members, full implementation of this complex practice change can be challenging. This study seeks to understand whether and how an intensive facilitation strategy can be effective in supporting the implementation of MBC. Implementation researchers partnering with US Department of Veterans Affairs (VA) leaders are conducting the study within the context of a national initiative to support MBC implementation throughout VA mental health services. This study will focus specifically on VA Primary Care-Mental Health Integration (PCMHI) programs. Methods A mixed-methods, multiple case study design will include 12 PCMHI sites recruited from the 23 PCMHI programs that volunteered to participate in the VA national initiative. Guided by a study partnership panel, sites are clustered into similar groups using administrative metrics. Site pairs are recruited from within these groups. Within pairs, sites are randomized to the implementation facilitation strategy (external facilitation plus QI team) or standard VA national support. The implementation strategy provides an external facilitator and MBC experts who work with intervention sites to form a QI team, develop an implementation plan, and, identify and overcome barriers to implementation. The RE-AIM framework guides the evaluation of the implementation facilitation strategy which will utilize data from administrative, medical record, and primary qualitative and quantitative sources. Guided by the iPARIHS framework and using a mixed methods approach, we will also examine factors associated with implementation success. Finally, we will explore whether implementation of MBC increases primary care team communication and function related to the care of mental health conditions. Discussion MBC has significant potential to improve mental health care but it represents a major change in practice. Understanding factors that can support MBC implementation is essential to attaining its potential benefits and spreading these benefits across the health care system. |
| first_indexed | 2024-12-12T09:28:48Z |
| format | Article |
| id | doaj.art-17d905160d054722ba4e6f2d1e6e7b4d |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-12-12T09:28:48Z |
| publishDate | 2018-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-17d905160d054722ba4e6f2d1e6e7b4d2022-12-22T00:28:56ZengBMCBMC Health Services Research1472-69632018-10-0118111210.1186/s12913-018-3493-zEnhancing implementation of measurement-based mental health care in primary care: a mixed-methods randomized effectiveness evaluation of implementation facilitationLaura O. Wray0Mona J. Ritchie1David W. Oslin2Gregory P. Beehler3Department of Veterans Affairs, VA Center for Integrated HealthcareDepartment of Veterans Affairs, VA Quality Enhancement Research Initiative (QUERI) for Team-Based Behavioral HealthVISN 4 Mental Illness Research, Education, and Clinical Center, Corporal Michael J. Crescenz VA Medical CenterDepartment of Veterans Affairs, VA Center for Integrated HealthcareAbstract Background Mental health care lags behind other forms of medical care in its reliance on subjective clinician assessment. Although routine use of standardized patient-reported outcome measures, measurement-based care (MBC), can improve patient outcomes and engagement, clinician efficiency, and, collaboration across care team members, full implementation of this complex practice change can be challenging. This study seeks to understand whether and how an intensive facilitation strategy can be effective in supporting the implementation of MBC. Implementation researchers partnering with US Department of Veterans Affairs (VA) leaders are conducting the study within the context of a national initiative to support MBC implementation throughout VA mental health services. This study will focus specifically on VA Primary Care-Mental Health Integration (PCMHI) programs. Methods A mixed-methods, multiple case study design will include 12 PCMHI sites recruited from the 23 PCMHI programs that volunteered to participate in the VA national initiative. Guided by a study partnership panel, sites are clustered into similar groups using administrative metrics. Site pairs are recruited from within these groups. Within pairs, sites are randomized to the implementation facilitation strategy (external facilitation plus QI team) or standard VA national support. The implementation strategy provides an external facilitator and MBC experts who work with intervention sites to form a QI team, develop an implementation plan, and, identify and overcome barriers to implementation. The RE-AIM framework guides the evaluation of the implementation facilitation strategy which will utilize data from administrative, medical record, and primary qualitative and quantitative sources. Guided by the iPARIHS framework and using a mixed methods approach, we will also examine factors associated with implementation success. Finally, we will explore whether implementation of MBC increases primary care team communication and function related to the care of mental health conditions. Discussion MBC has significant potential to improve mental health care but it represents a major change in practice. Understanding factors that can support MBC implementation is essential to attaining its potential benefits and spreading these benefits across the health care system.http://link.springer.com/article/10.1186/s12913-018-3493-zImplementationFacilitationMeasurement-based careIntegrated primary careMental healthPrimary care |
| spellingShingle | Laura O. Wray Mona J. Ritchie David W. Oslin Gregory P. Beehler Enhancing implementation of measurement-based mental health care in primary care: a mixed-methods randomized effectiveness evaluation of implementation facilitation BMC Health Services Research Implementation Facilitation Measurement-based care Integrated primary care Mental health Primary care |
| title | Enhancing implementation of measurement-based mental health care in primary care: a mixed-methods randomized effectiveness evaluation of implementation facilitation |
| title_full | Enhancing implementation of measurement-based mental health care in primary care: a mixed-methods randomized effectiveness evaluation of implementation facilitation |
| title_fullStr | Enhancing implementation of measurement-based mental health care in primary care: a mixed-methods randomized effectiveness evaluation of implementation facilitation |
| title_full_unstemmed | Enhancing implementation of measurement-based mental health care in primary care: a mixed-methods randomized effectiveness evaluation of implementation facilitation |
| title_short | Enhancing implementation of measurement-based mental health care in primary care: a mixed-methods randomized effectiveness evaluation of implementation facilitation |
| title_sort | enhancing implementation of measurement based mental health care in primary care a mixed methods randomized effectiveness evaluation of implementation facilitation |
| topic | Implementation Facilitation Measurement-based care Integrated primary care Mental health Primary care |
| url | http://link.springer.com/article/10.1186/s12913-018-3493-z |
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