Examining the Effectiveness of an Adaptive Implementation Intervention to Improve Uptake of the VA Suicide Risk Identification Strategy (PEC 19-303)
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 138
- 试验地点
- 1
- 主要终点
- Change in Columbia Suicide Severity Rating Scale Screener (C-SSRS) Uptake- Phase 1
研究概览
简要总结
The overall objective of this national quality improvement project is to develop an adaptive implementation strategy to improve the implementation of suicide risk screening and evaluation in Veterans Health Administration ambulatory care settings (i.e., VA Risk ID).
详细描述
VA Risk ID is the largest implementation of population-based suicide risk screening and evaluation in any United States healthcare system to date. Given the considerable scope of this initiative, several strategies have been employed to support national implementation. To facilitate continuous quality improvement, ongoing evaluation of VA Risk ID and interventions to improve implementation of the three-stage screening and evaluation process are needed. This project is intended to help VHA facilities address challenges to implementing VA Risk ID to fidelity using a sequence of evidence-based implementation strategies (audit and feedback followed by audit and feedback plus external facilitation). By doing so, it will ensure that more Veterans are screened and evaluated for suicide risk, which is the basis of effective, patient-centered suicide risk management. By adapting the implementation intervention "dose" based on facility performance and monitoring implementation over time, this project will allow the program office to focus resources where and when needed the most.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Sequential
- 主要目的
- Health Services Research
- 盲法
- None
入排标准
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Intervention occurs at the site/facility level. Up to 140 VHA facilities across the country will participate in the project. Sites will be allocated to various interventions based on performance (i.e., pre-determined benchmarks for adequate implementation).
排除标准
- •This is a national quality improvement project. Sites that are randomized to different intervention arms based on performance may refuse to participate in the implementation interventions.
研究组 & 干预措施
Implementation as Usual
Implementation support consisting of clinical decision support tools, trainings, technical assistance and quality assurance to support implementation of VA Suicide Risk Identification Strategy. Available to all facilities.
Audit and Feedback
Audit and Feedback will serve as the first stage implementation intervention for sites that do not meet the benchmark for adequate implementation following 9 months of implementation as usual.
干预措施: Audit and Feedback (Behavioral)
External Facilitation
Audit and Feedback plus External Facilitation will serve as the second stage implementation intervention for sites that still do not meet the benchmark for adequate implementation following 9 months of implementation as usual plus audit and feedback.
干预措施: Audit and Feedback (Behavioral)
External Facilitation
Audit and Feedback plus External Facilitation will serve as the second stage implementation intervention for sites that still do not meet the benchmark for adequate implementation following 9 months of implementation as usual plus audit and feedback.
干预措施: External Facilitation (Behavioral)
结局指标
主要结局
Change in Columbia Suicide Severity Rating Scale Screener (C-SSRS) Uptake- Phase 1
时间窗: Change from baseline and intervention Phase 1 month 8
C-SSRS uptake is a site level adherence measure of the percentage of patients in ambulatory care who received a timely annual suicide risk screen (i.e., during the first encounter/visit after the annual suicide risk screen reminder was due). Adherence ranges from 0 to 100, higher scores reflect higher adherence. The outcome measure is reported as the change in facility adherence from baseline to month 8 of intervention Phase 1. Higher numbers reflect greater change in adherence from baseline to month 8 of intervention Phase 1.
Change in Comprehensive Suicide Risk Evaluation (CSRE) Uptake- Phase 1
时间窗: Change from baseline and intervention Phase 1 month 8
CSRE uptake is a site level adherence measure of the percentage of patients in ambulatory care who had a positive C-SSRS screener and received the CSRE as intended (same day and by the appropriate provider). The score is a facility adherence score. Adherence ranges from 0 to 100, higher scores reflect higher adherence. The outcome measure is reported as the change in facility adherence from baseline to month 8 of intervention Phase 1. Higher numbers reflect greater change in adherence from baseline to month 8 of intervention Phase 1.
次要结局
- Change in Columbia Suicide Severity Rating Scale Screener (C-SSRS) Uptake- Phase 2b(Change from month 9 of intervention phase 1 and month 9 of intervention phase 2)
- Change in Columbia Suicide Severity Rating Scale Screener (C-SSRS) Uptake- Phase 2a(Change from month 9 of intervention phase 1 and month 9 of intervention phase 2)
- Change in Comprehensive Suicide Risk Evaluation (CSRE) Uptake-Phase 2a(Change from month 9 of intervention phase 1 and month 9 of intervention phase 2)
- Change in Comprehensive Suicide Risk Evaluation (CSRE) Uptake-Phase 2b(Change from month 9 of intervention phase 1 and month 9 of intervention phase 2)