TY - JOUR
KW - Facilitation
KW - Implementation Research
KW - integrated primary care
KW - Mental Health
KW - primary care
AU - M. J. Ritchie
AU - J. E. Kirchner
AU - J. C. Townsend
AU - J. A. Pitcock
AU - K. M. Dollar
AU - C. F. Liu
A1 - 
AB - BACKGROUND: Integrating mental health services into primary care settings is complex and challenging. Although facilitation strategies have successfully supported implementation of primary care mental health integration and other complex innovations, we know little about the time required or its cost. OBJECTIVE: To examine the time and organizational cost of facilitating implementation of primary care mental health integration. DESIGN: Descriptive analysis. PARTICIPANTS: One expert external facilitator and two internal regional facilitators who helped healthcare system stakeholders, e.g., leaders, managers, clinicians, and non-clinical staff, implement primary care mental health integration at eight clinics. INTERVENTION: Implementation facilitation tailored to the needs and resources of the setting and its stakeholders. MAIN MEASURES: We documented facilitators' and stakeholders' time and types of activities using a structured spreadsheet collected from facilitators on a weekly basis. We obtained travel costs and salary information. We conducted descriptive analysis of time data and estimated organizational cost. KEY RESULTS: The external facilitator devoted 263 h (0.09 FTE), including travel, across all 8 clinics over 28 months. Internal facilitator time varied across networks (1792 h versus 1169 h), as well as clinics. Stakeholder participation time was similar across networks (1280.6 versus 1363.4 person hours) but the number of stakeholders varied (133 versus 199 stakeholders). The organizational cost of providing implementation facilitation also varied across networks ($263,490 versus $258,127). Stakeholder participation accounted for 35% of the cost of facilitation activities in one network and 47% of the cost in the other. CONCLUSIONS: Although facilitation can improve implementation of primary care mental health integration, it requires substantial organizational investments that may vary by site and implementation effort. Furthermore, the cost of using an external expert to transfer facilitation skills and build capacity for implementation efforts appears to be minimal.
AD - VA Quality Enhancement Research Initiative (QUERI) Program for Team-Based Behavioral Health, U.S. Department of Veterans Affairs, North Little Rock, AR, USA. mona.ritchie@va.gov.; Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA. mona.ritchie@va.gov.; VA Quality Enhancement Research Initiative (QUERI) Program for Team-Based Behavioral Health, U.S. Department of Veterans Affairs, North Little Rock, AR, USA.; Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA.; VA Quality Enhancement Research Initiative (QUERI) Program for Team-Based Behavioral Health, U.S. Department of Veterans Affairs, North Little Rock, AR, USA.; Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA.; VA Quality Enhancement Research Initiative (QUERI) Program for Team-Based Behavioral Health, U.S. Department of Veterans Affairs, North Little Rock, AR, USA.; VA Center for Integrated Healthcare, Syracuse, NY, USA.; Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA.; Department of Health Services, University of Washington, Seattle, WA, USA.
BT - Journal of general internal medicine
C5 - Education & Workforce; Financing & Sustainability
CP - 4
DO - 10.1007/s11606-019-05537-y
IS - 4
JF - Journal of general internal medicine
LA - eng
M1 - Journal Article
N2 - BACKGROUND: Integrating mental health services into primary care settings is complex and challenging. Although facilitation strategies have successfully supported implementation of primary care mental health integration and other complex innovations, we know little about the time required or its cost. OBJECTIVE: To examine the time and organizational cost of facilitating implementation of primary care mental health integration. DESIGN: Descriptive analysis. PARTICIPANTS: One expert external facilitator and two internal regional facilitators who helped healthcare system stakeholders, e.g., leaders, managers, clinicians, and non-clinical staff, implement primary care mental health integration at eight clinics. INTERVENTION: Implementation facilitation tailored to the needs and resources of the setting and its stakeholders. MAIN MEASURES: We documented facilitators' and stakeholders' time and types of activities using a structured spreadsheet collected from facilitators on a weekly basis. We obtained travel costs and salary information. We conducted descriptive analysis of time data and estimated organizational cost. KEY RESULTS: The external facilitator devoted 263 h (0.09 FTE), including travel, across all 8 clinics over 28 months. Internal facilitator time varied across networks (1792 h versus 1169 h), as well as clinics. Stakeholder participation time was similar across networks (1280.6 versus 1363.4 person hours) but the number of stakeholders varied (133 versus 199 stakeholders). The organizational cost of providing implementation facilitation also varied across networks ($263,490 versus $258,127). Stakeholder participation accounted for 35% of the cost of facilitation activities in one network and 47% of the cost in the other. CONCLUSIONS: Although facilitation can improve implementation of primary care mental health integration, it requires substantial organizational investments that may vary by site and implementation effort. Furthermore, the cost of using an external expert to transfer facilitation skills and build capacity for implementation efforts appears to be minimal.
PY - 2020
SN - 1525-1497; 0884-8734; 0884-8734
SP - 1001
EP - 1010
EP - 
T1 - Time and Organizational Cost for Facilitating Implementation of Primary Care Mental Health Integration
T2 - Journal of general internal medicine
TI - Time and Organizational Cost for Facilitating Implementation of Primary Care Mental Health Integration
U1 - Education & Workforce; Financing & Sustainability
U2 - 31792866
U3 - 10.1007/s11606-019-05537-y
VL - 35
VO - 1525-1497; 0884-8734; 0884-8734
Y1 - 2020
Y2 - Apr
ER -