Behavioral Health Interdisciplinary Program - Collaborative Chronic Care Model (BHIP-CCM) Enhancement Project 2.0 (BHIP-CCM)

Behavioral Health Interdisciplinary Program - Collaborative Chronic Care Model (BHIP-CCM) Enhancement Project 2.0 (QUE 20-026)

This quality improvement project aims to help outpatient mental health teams, known as Behavioral Health Interdisciplinary Program (BHIP) teams, adopt more collaborative care practices (consistent with the collaborative chronic care model or CCM). The investigators therefore aim to use two different implementation strategies -- centralized technical assistance and implementation facilitation -- to align BHIP teams' care practices more closely with the principles of the CCM.

Study Overview

• Status: Active, not recruiting
• Conditions: Mental Health
• Intervention / Treatment: Other: Implementation Facilitation; Other: Centralized Technical Assistance

Detailed Description

This quality improvement project aims to help outpatient mental health teams, known as Behavioral Health Interdisciplinary Program (BHIP) teams, adopt more collaborative care practices (consistent with the collaborative chronic care model or CCM). The investigators therefore aim to use two different implementation strategies -- centralized technical assistance and implementation facilitation -- to align BHIP teams' care practices more closely with the principles of the CCM.

The two primary outcomes of this project are:

1. BHIP team collaboration, as evidenced by improved scores in the Role Clarity and Team Primacy dimensions of the Team Development Measure (TDM)
2. BHIP team clinical effectiveness, as evidenced by reduction in mental health hospitalizations among Veterans treated by the BHIP teams that have received the two types of implementation strategies described above.

• Study Type: Interventional
• Enrollment (Actual): 81424
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Arizona
    • Prescott, Arizona, United States, 86313
      • Northern Arizona VA Health Care System, Prescott, AZ
    • Tucson, Arizona, United States, 85723-0001
      • Southern Arizona VA Health Care System, Tucson, AZ
  • California
    • Palo Alto, California, United States, 94304-1207
      • VA Palo Alto Health Care System, Palo Alto, CA
    • West Los Angeles, California, United States, 90073-1003
      • VA Greater Los Angeles Healthcare System, West Los Angeles, CA
  • Florida
    • Orlando, Florida, United States, 32827
      • Orlando VA Medical Center, Orlando, FL
  • Indiana
    • Indianapolis, Indiana, United States, 46202-2884
      • Richard L. Roudebush VA Medical Center, Indianapolis, IN
  • Massachusetts
    • Boston, Massachusetts, United States, 02130-4817
      • VA Boston Healthcare System Jamaica Plain Campus, Jamaica Plain, MA
  • North Carolina
    • Fayetteville, North Carolina, United States, 28301-3856
      • Fayetteville VA Medical Center, Fayetteville, NC
  • Oklahoma
    • Muskogee, Oklahoma, United States, 74401
      • Jackson C. Montgomery VA Medical Center, Muskogee, OK
  • Tennessee
    • Memphis, Tennessee, United States, 38104-2127
      • Memphis VA Medical Center, Memphis, TN
  • Texas
    • Big Spring, Texas, United States, 79720
      • West Texas VA Health Care System, Big Spring, TX
    • Dallas, Texas, United States, 75216-7167
      • VA North Texas Health Care System Dallas VA Medical Center, Dallas, TX
    • Houston, Texas, United States, 77030-4211
      • Michael E. DeBakey VA Medical Center, Houston, TX
  • Vermont
    • White River Junction, Vermont, United States, 05001-3833
      • White River Junction VA Medical Center, White River Junction, VT
  • Virginia
    • Salem, Virginia, United States, 24153-6404
      • Salem VA Medical Center, Salem, VA
  • West Virginia
    • Clarksburg, West Virginia, United States, 26301-4155
      • Clarksburg Louis A. Johnson VA Medical Center, Clarksburg, WV
    • Huntington, West Virginia, United States, 25704-9300
      • Huntington VA Medical Center, Huntington, WV

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Note that treatment assignment will be at the facility level, and given the stepped wedge design, sites in Waves 2-4 will cross over from Centralized Technical Assistance to Implementation Facilitation.
• At the provider level (for completing the TDM), the primary inclusion criterion is clinicians working on BHIP Teams at the participating medical centers.
• At the patient level (for mental health hospitalizations, costs, and all-cause mortality), the primary inclusion criterion is Veterans treated by the BHIP teams at the participating medical centers.
• Note that, for mental health hospitalizations, separate sites have been identified as comparators using a balancing algorithm.

Exclusion Criteria:

• Patients with a diagnosis of dementia in the electronic medical record.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Non-Randomized
• Interventional Model: Crossover Assignment
• Masking: None (Open Label)

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Other: Wave 1; Study design is a stepped wedge; Wave 1 begins by receiving Implementation Facilitation	Other: Implementation Facilitation; Implementation Facilitation involves and External Facilitator (from outside of the participating medical center) and an Internal Facilitator (from inside the participating medical center) working together to help BHIP teams within the site adopt care practices that are more consistent with the CCM; Other Names: IF
Other: Wave 2; Study design is a stepped wedge; Wave 2 begins by receiving Centralized Technical Assistance before crossing over to Implementation Facilitation	Other: Implementation Facilitation; Implementation Facilitation involves and External Facilitator (from outside of the participating medical center) and an Internal Facilitator (from inside the participating medical center) working together to help BHIP teams within the site adopt care practices that are more consistent with the CCM; Other Names: IF; Other: Centralized Technical Assistance; Centralized Technical Assistance involves having external experts available for ad hoc consultation related to collaborative BHIP care practices.; Other Names: CTA
Other: Wave 3; Study design is a stepped wedge; Wave 3 begins by receiving Centralized Technical Assistance before crossing over to Implementation Facilitation	Other: Implementation Facilitation; Implementation Facilitation involves and External Facilitator (from outside of the participating medical center) and an Internal Facilitator (from inside the participating medical center) working together to help BHIP teams within the site adopt care practices that are more consistent with the CCM; Other Names: IF; Other: Centralized Technical Assistance; Centralized Technical Assistance involves having external experts available for ad hoc consultation related to collaborative BHIP care practices.; Other Names: CTA
Other: Wave 4; Study design is a stepped wedge; Wave 4 begins by receiving Centralized Technical Assistance before crossing over to Implementation Facilitation	Other: Implementation Facilitation; Implementation Facilitation involves and External Facilitator (from outside of the participating medical center) and an Internal Facilitator (from inside the participating medical center) working together to help BHIP teams within the site adopt care practices that are more consistent with the CCM; Other Names: IF; Other: Centralized Technical Assistance; Centralized Technical Assistance involves having external experts available for ad hoc consultation related to collaborative BHIP care practices.; Other Names: CTA

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Role Clarity and Team Primacy subdomains of the Team Development Measure (TDM)	The TDM is a measure of team functioning, and the two listed subdomains represent the co-primary outcome for the study. Note that, due to the stepped wedge design, only Wave 3 and Wave 4 sites will also have a pre-centralized technical assistance administration of the TDM. Also note that the primary time frame for this outcome, as listed above, will be post-implementation facilitation (8 months after the pre-implementation administration). Secondary analysis will also investigate one year post-implementation facilitation (20 months after the pre-implementation administration).	Primary comparison will be between pre-implementation facilitation and post-implementation facilitation (8 months after the pre-implementation administration).
Mental health hospitalization rate among Veterans treated within each BHIP team.	Mental health hospitalizations represent a measure of clinical effectiveness (co-primary outcome for the study). Note that, due to the stepped wedge design, only Wave 3 and Wave 4 sites will also have a pre-centralized technical assistance calculation of the mental health hospitalization rate. Also note that the primary time frame for this outcome, as listed above, will be post-implementation facilitation (8 months after the pre-implementation administration). Secondary analysis will also investigate one year post-implementation facilitation (20 months after the pre-implementation administration).	Primary comparison will be between pre-implementation facilitation and post-implementation facilitation (8 months after the pre-implementation administration).

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Treatment cost	The investigators will calculate estimated treatment costs for Veterans treated by participating BHIP teams. Note that the primary time frame for this outcome, as listed above, will be post-implementation facilitation (8 months after the pre-implementation administration). Secondary analysis will also investigate one year post-implementation facilitation (20 months after the pre-implementation administration).	Primary comparison will be between pre-implementation facilitation and post-implementation facilitation (8 months after the pre-implementation administration).
All-cause mortality	The investigators will calculate all-cause mortality for Veterans treated by participating BHIP teams. Note that the primary time frame for this outcome, as listed above, will be post-implementation facilitation (8 months after the pre-implementation administration). Secondary analysis will also investigate one year post-implementation facilitation (20 months after the pre-implementation administration).	Primary comparison will be between pre-implementation facilitation and post-implementation facilitation (8 months after the pre-implementation administration).
Treatment costs and hospitalization data compared to non-intervention sites	For mental health hospitalization and treatment costs, the investigators will compare results from intervention sites to other sites that did not undergo implementation facilitation (i.e. sites from outside the trial that are similar to intervention sites on variables like facility complexity and urban/rural location).	Post-facilitation (8 months after start of implementation facilitation) and post-sustainment (12 months after post-facilitation)

Collaborators and Investigators

• Sponsor: VA Office of Research and Development
• Collaborators: US Department of Veterans Affairs Office of Mental Health and Suicide Prevention
• Investigators: Principal Investigator: Christopher J. Miller, PhD, VA Boston Healthcare System Jamaica Plain Campus, Jamaica Plain, MA; Principal Investigator: Sara J. Landes, PhD MA BA, Central Arkansas Veterans Healthcare System , Little Rock, AR

Study record dates

Study Major Dates

• Study Start (Actual): July 14, 2023
• Primary Completion (Actual): October 30, 2024
• Study Completion (Estimated): October 30, 2025

Study Registration Dates

• First Submitted: August 1, 2023
• First Submitted That Met QC Criteria: August 11, 2023
• First Posted (Actual): August 18, 2023

Study Record Updates

• Last Update Posted (Actual): November 6, 2024
• Last Update Submitted That Met QC Criteria: November 4, 2024
• Last Verified: November 1, 2024

More Information

Terms related to this study

• Keywords: collaborative care
• Other Study ID Numbers: QUX 23-002

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No