Change in Patient Outcomes After Augmenting a Low-level Implementation Strategy in Community Practices That Are Slow to Adopt a Collaborative Chronic Care Model
A Cluster Randomized Implementation Trial
Bibliographic Data
BACKGROUND: Implementation strategies are essential for promoting the uptake of evidence-based practices and for patients to receive optimal care. Yet strategies differ substantially in their intensity and feasibility. Lower-intensity strategies (eg, training and technical support) are commonly used but may be insufficient for all clinics. Limited research has examined the comparative effectiveness of augmentations to low-level implementation strategies for nonresponding clinics. OBJECTIVES: To compare 2 augmentation strategies for improving uptake of an evidence-based collaborative chronic care model (CCM) on 18-month outcomes for patients with depression at community-based clinics nonresponsive to lower-level implementation support. RESEARCH DESIGN: Providers initially received support using a low-level implementation strategy, Replicating Effective Programs (REP). After 6 months, nonresponsive clinics were randomized to add either external facilitation (REP+EF) or external and internal facilitation (REP+EF/IF). MEASURES: The primary outcome was patient 12-item short form survey (SF-12) mental health score at month 18. Secondary outcomes were patient health questionnaire (PHQ-9) depression score at month 18 and receipt of the CCM during months 6 through 18. RESULTS: Twenty-seven clinics were nonresponsive after 6 months of REP. Thirteen clinics (N=77 patients) were randomized to REP+EF and 14 (N=92) to REP+EF/IF. At 18 months, patients in the REP+EF/IF arm had worse SF-12 [diff, 8.38; 95% confidence interval (CI), 3.59-13.18] and PHQ-9 scores (diff, 1.82; 95% CI, -0.14 to 3.79), and lower odds of CCM receipt (odds ratio, 0.67; 95% CI, 0.30-1.49) than REP+EF patients. CONCLUSIONS: Patients at sites receiving the more intensive REP+EF/IF saw less improvement in mood symptoms at 18 months than those receiving REP+EF and were no more likely to receive the CCM. For community-based clinics, EF augmentation may be more feasible than EF/IF for implementing CCMs
Anxiety · Confidence interval · Depression (economics) · Depressive symptoms · Facilitation · Family medicine · Logistic regression · Mental health · Odds · Odds ratio · Patient Health Questionnaire · Physical therapy · Psychiatry · Randomized controlled trial · Receipt · Diabetes Management and Education · Health Policy Implementation Science · Internal Medicine · Medicine · Mental Health and Patient Involvement · Psychology
Comparative Effectiveness of Collaborative Chronic Care Models for Mental Health Conditions Across Primary, Specialty, and Behavioral Health Care Settings
Implementation Research in Mental Health Services
A Compilation of Strategies for Implementing Clinical Innovations in Health and Mental Health
Global mortality, disability, and the contribution of risk factors
Enabling the implementation of evidence based practice
Evaluating the successful implementation of evidence into practice using the PARiHS framework
A refined compilation of implementation strategies
Implementing evidence-based interventions in health care
The World Health Organization Composite International Diagnostic Interview short‐form (CIDI‐SF)
A Brief Measure for Assessing Generalized Anxiety Disorder
A 12-Item Short-Form Health Survey
The PHQ-9
Validation and Utility of a Self-report Version of PRIME-MD The PHQ Primary Care Study
Self-efficacy
Collaborative Chronic Care Models for Mental Health Conditions
Primary Care and Behavioral Health Practice Size
| Citations per year | 0.33 |
|---|---|
| Citation span | 2023 - 2023 (1) |
| Highly cited | No |