TY - JOUR
AU - J. E. Kirchner
AU - M. J. Ritchie
AU - J. A. Pitcock
AU - L. E. Parker
AU - G. M. Curran
AU - J. C. Fortney
A1 - 
AB - BACKGROUND: Implementing new programs and practices is challenging, even when they are mandated. Implementation Facilitation (IF) strategies that focus on partnering with sites show promise for addressing these challenges. OBJECTIVE: Our aim was to evaluate the effectiveness of an external/internal IF strategy within the context of a Department of Veterans Affairs (VA) mandate of Primary Care-Mental Health Integration (PC-MHI). DESIGN: This was a quasi-experimental, Hybrid Type III study. Generalized estimating equations assessed differences across sites. PARTICIPANTS: Patients and providers at seven VA primary care clinics receiving the IF intervention and national support and seven matched comparison clinics receiving national support only participated in the study. INTERVENTION: We used a highly partnered IF strategy incorporating evidence-based implementation interventions. MAIN MEASURES: We evaluated the IF strategy using VA administrative data and RE-AIM framework measures for two 6-month periods. KEY RESULTS: Evaluation of RE-AIM measures from the first 6-month period indicated that PC patients at IF clinics had nine times the odds (OR=8.93, p<0.001) of also being seen in PC-MHI (Reach) compared to patients at non-IF clinics. PC providers at IF clinics had seven times the odds (OR=7.12, p=0.029) of referring patients to PC-MHI (Adoption) than providers at non-IF clinics, and a greater proportion of providers' patients at IF clinics were referred to PC-MHI (Adoption) compared to non-IF clinics (beta=0.027, p<0.001). Compared to PC patients at non-IF sites, patients at IF clinics did not have lower odds (OR=1.34, p=0.232) of being referred for first-time mental health specialty clinic visits (Effectiveness), or higher odds (OR=1.90, p=0.350) of receiving same-day access (Implementation). Assessment of program sustainability (Maintenance) was conducted by repeating this analysis for a second 6-month time period. Maintenance analyses results were similar to the earlier period. CONCLUSION: The addition of a highly partnered IF strategy to national level support resulted in greater Reach and Adoption of the mandated PC-MHI initiative, thereby increasing patient access to VA mental health care.
BT - Journal of general internal medicine
C5 - General Literature
CY - United States
DO - 10.1007/s11606-014-3027-2
JF - Journal of general internal medicine
N2 - BACKGROUND: Implementing new programs and practices is challenging, even when they are mandated. Implementation Facilitation (IF) strategies that focus on partnering with sites show promise for addressing these challenges. OBJECTIVE: Our aim was to evaluate the effectiveness of an external/internal IF strategy within the context of a Department of Veterans Affairs (VA) mandate of Primary Care-Mental Health Integration (PC-MHI). DESIGN: This was a quasi-experimental, Hybrid Type III study. Generalized estimating equations assessed differences across sites. PARTICIPANTS: Patients and providers at seven VA primary care clinics receiving the IF intervention and national support and seven matched comparison clinics receiving national support only participated in the study. INTERVENTION: We used a highly partnered IF strategy incorporating evidence-based implementation interventions. MAIN MEASURES: We evaluated the IF strategy using VA administrative data and RE-AIM framework measures for two 6-month periods. KEY RESULTS: Evaluation of RE-AIM measures from the first 6-month period indicated that PC patients at IF clinics had nine times the odds (OR=8.93, p<0.001) of also being seen in PC-MHI (Reach) compared to patients at non-IF clinics. PC providers at IF clinics had seven times the odds (OR=7.12, p=0.029) of referring patients to PC-MHI (Adoption) than providers at non-IF clinics, and a greater proportion of providers' patients at IF clinics were referred to PC-MHI (Adoption) compared to non-IF clinics (beta=0.027, p<0.001). Compared to PC patients at non-IF sites, patients at IF clinics did not have lower odds (OR=1.34, p=0.232) of being referred for first-time mental health specialty clinic visits (Effectiveness), or higher odds (OR=1.90, p=0.350) of receiving same-day access (Implementation). Assessment of program sustainability (Maintenance) was conducted by repeating this analysis for a second 6-month time period. Maintenance analyses results were similar to the earlier period. CONCLUSION: The addition of a highly partnered IF strategy to national level support resulted in greater Reach and Adoption of the mandated PC-MHI initiative, thereby increasing patient access to VA mental health care.
PP - United States
PY - 2014
SN - 1525-1497; 0884-8734
SP - 904
EP - 912
EP - 
T1 - Outcomes of a partnered facilitation strategy to implement primary care-mental health
T2 - Journal of general internal medicine
TI - Outcomes of a partnered facilitation strategy to implement primary care-mental health
U1 - General Literature
U2 - 25355087
U3 - 10.1007/s11606-014-3027-2
VL - 29 Suppl 4
VO - 1525-1497; 0884-8734
Y1 - 2014
ER -