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

Not Applicable

Active, not recruiting

• Conditions: Mental Health

• Registration Number: NCT05997836
• Lead Sponsor: VA Office of Research and Development

Brief Summary

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.

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 Timeline

• Study Start: 2023-07-14
• Study First Submitted: 2023-08-01
• Study First Submitted QC: 2023-08-11
• Study First Posted: 2023-08-18
• Primary Completion: 2024-10-30
• Status Verified: 2024-11
• Last Update Submitted: 2024-11-04
• Last Update Posted: 2024-11-06
• Study Completion: 2025-10-30

Recruitment & Eligibility

• Status: ACTIVE_NOT_RECRUITING
• Sex: All
• Target Recruitment: 81424

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 & Design

• Study Type: INTERVENTIONAL
• Study Design: CROSSOVER

Primary Outcome Measures

Name	Time	Method
Role Clarity and Team Primacy subdomains of the Team Development Measure (TDM)	Primary comparison will be between pre-implementation facilitation and post-implementation facilitation (8 months after the pre-implementation administration).	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).
Mental health hospitalization rate among Veterans treated within each BHIP team.	Primary comparison will be between pre-implementation facilitation and post-implementation facilitation (8 months after the pre-implementation administration).	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).

Secondary Outcome Measures

Name	Time	Method
Treatment cost	Primary comparison will be between pre-implementation facilitation and post-implementation facilitation (8 months after the pre-implementation administration).	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).
All-cause mortality	Primary comparison will be between pre-implementation facilitation and post-implementation facilitation (8 months after the pre-implementation administration).	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).
Treatment costs and hospitalization data compared to non-intervention sites	Post-facilitation (8 months after start of implementation facilitation) and post-sustainment (12 months after post-facilitation)	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).

Trial Locations

Locations (17)

Northern Arizona VA Health Care System, Prescott, AZ; 🇺🇸 Prescott, Arizona, United States

Southern Arizona VA Health Care System, Tucson, AZ; 🇺🇸 Tucson, Arizona, United States

VA Palo Alto Health Care System, Palo Alto, CA; 🇺🇸 Palo Alto, California, United States

VA Greater Los Angeles Healthcare System, West Los Angeles, CA; 🇺🇸 West Los Angeles, California, United States

Orlando VA Medical Center, Orlando, FL; 🇺🇸 Orlando, Florida, United States

Richard L. Roudebush VA Medical Center, Indianapolis, IN; 🇺🇸 Indianapolis, Indiana, United States

VA Boston Healthcare System Jamaica Plain Campus, Jamaica Plain, MA; 🇺🇸 Boston, Massachusetts, United States

Fayetteville VA Medical Center, Fayetteville, NC; 🇺🇸 Fayetteville, North Carolina, United States

Jackson C. Montgomery VA Medical Center, Muskogee, OK; 🇺🇸 Muskogee, Oklahoma, United States

Memphis VA Medical Center, Memphis, TN; 🇺🇸 Memphis, Tennessee, United States

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