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Sustaining the collaborative chronic care model in outpatient mental health: a matrixed multiple case study.
Kim, Bo; Sullivan, Jennifer L; Brown, Madisen E; Connolly, Samantha L; Spitzer, Elizabeth G; Bailey, Hannah M; Sippel, Lauren M; Weaver, Kendra; Miller, Christopher J.
Afiliação
  • Kim B; Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA, 02130, USA. bo.kim@va.gov.
  • Sullivan JL; Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA. bo.kim@va.gov.
  • Brown ME; Center of Innovation in Long Term Services and Supports (LTSS COIN), VA Providence Healthcare System, 385 Niagara Street, Providence, RI, 02907, USA.
  • Connolly SL; Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, USA.
  • Spitzer EG; Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA, 02130, USA.
  • Bailey HM; Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA, 02130, USA.
  • Sippel LM; Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
  • Weaver K; Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA, 02130, USA.
  • Miller CJ; VA Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), 1700 N Wheeling Street, Aurora, CO, 80045, USA.
Implement Sci ; 19(1): 16, 2024 Feb 19.
Article em En | MEDLINE | ID: mdl-38373979
ABSTRACT

BACKGROUND:

Sustaining evidence-based practices (EBPs) is crucial to ensuring care quality and addressing health disparities. Approaches to identifying factors related to sustainability are critically needed. One such approach is Matrixed Multiple Case Study (MMCS), which identifies factors and their combinations that influence implementation. We applied MMCS to identify factors related to the sustainability of the evidence-based Collaborative Chronic Care Model (CCM) at nine Department of Veterans Affairs (VA) outpatient mental health clinics, 3-4 years after implementation support had concluded.

METHODS:

We conducted a directed content analysis of 30 provider interviews, using 6 CCM elements and 4 Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) domains as codes. Based on CCM code summaries, we designated each site as high/medium/low sustainability. We used i-PARIHS code summaries to identify relevant factors for each site, the extent of their presence, and the type of influence they had on sustainability (enabling/neutral/hindering/unclear). We organized these data into a sortable matrix and assessed sustainability-related cross-site trends.

RESULTS:

CCM sustainability status was distributed among the sites, with three sites each being high, medium, and low. Twenty-five factors were identified from the i-PARIHS code summaries, of which 3 exhibited strong trends by sustainability status (relevant i-PARIHS domain in square brackets) "Collaborativeness/Teamwork [Recipients]," "Staff/Leadership turnover [Recipients]," and "Having a consistent/strong internal facilitator [Facilitation]" during and after active implementation. At most high-sustainability sites only, (i) "Having a knowledgeable/helpful external facilitator [Facilitation]" was variably present and enabled sustainability when present, while (ii) "Clarity about what CCM comprises [Innovation]," "Interdisciplinary coordination [Recipients]," and "Adequate clinic space for CCM team members [Context]" were somewhat or less present with mixed influences on sustainability.

CONCLUSIONS:

MMCS revealed that CCM sustainability in VA outpatient mental health clinics may be related most strongly to provider collaboration, knowledge retention during staff/leadership transitions, and availability of skilled internal facilitators. These findings have informed a subsequent CCM implementation trial that prospectively examines whether enhancing the above-mentioned factors within implementation facilitation improves sustainability. MMCS is a systematic approach to multi-site examination that can be used to investigate sustainability-related factors applicable to other EBPs and across multiple contexts.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Saúde Mental / Serviços de Saúde Mental Limite: Humans Idioma: En Revista: Implement Sci Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Estados Unidos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Saúde Mental / Serviços de Saúde Mental Limite: Humans Idioma: En Revista: Implement Sci Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Estados Unidos