QUERI – Quality Enhancement Research Initiative

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QUERI for Team-Based Behavioral Health

Little Rock, AR

Principal Investigators: JoAnn Kirchner, MD (Corresponding PI, VA Little Rock), Mark Bauer, MD (VA Boston), Project Principal Investigators: Matthew Chinman, PhD (VA Pittsburgh), Bradford Felker, MD (VA Puget Sound), Richard Goldberg, PhD (VA Baltimore), David Oslin, MD (VA Philadelphia), Laura Wray, PhD (VA Center for Integrated Health)

Principal Operational Partners: VA Patient Care Services - Mental Health, Mental Health Operations, Public Health, and the Office of Health Equity

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Executive Summary:

The evidence is clear: Team-based behavioral healthcare improves outcome and satisfaction for individuals with mental health conditions. However, healthcare teams do not develop naturally and require targeted support to form and be sustained. Using common facilitation techniques and common measures, this QUERI Program will enhance and inform team-based care for Veterans with behavioral health conditions. Specifically, this program will advance VA's knowledge of how team-based behavioral healthcare can be improved through the use of implementation facilitation strategies, with anticipated improvements in Veteran outcomes. Data will be relevant to care within VA and VA/non-VA shared care, since team-based care for Veterans occurs beyond the bricks and mortar of the VA healthcare system—an issue of increasing importance in the era of the Veterans Access, Choice and Accountability Act.

Program MyVA Goals: Enhance strategic partnerships through peer specialists and performance improvement. The MyVA initiative will reorient VA around Veterans' needs and empower employees to assist them in delivering excellent customer service to improve their experience with VA healthcare.

Program Objectives:

Improve coordination, quality, equity, and outcomes of team-based care for Veterans with behavioral health conditions. For this QUERI Program, team-based care is defined as treatment provided through interdisciplinary VA clinical teams, across disciplines, as well as care of Veterans shared by VA and non-VA providers. Specific objectives include:

Program Methods:

This Program will work to:

  • Implement a tele-mental health project in VISN 20
  • Implement Behavioral Health Interdisciplinary Program teams for general mental health clinics in later adopter sites, utilizing the evidence-based collaborative chronic care model
  • Improve use of patient reported outcome measures within PC-MHI teams
  • Implement peer specialists in PACT teams in response to a 2014 White House executive action

Project Summaries:

Project 1 (Quality Improvement): Implement a Telemental Health network through a Clinic-Based Telehealth Operations Manual and Telemental Health supplements in rurally located in community-based outpatient clinics VISN 20.

Project 2: In a hybrid effectiveness-implementation design, test impact of a Replicating Effective Programs (REP) and External Facilitation strategy for implementing Behavioral Health Interdisciplinary Programs based on evidence-based collaborative care model.

Project 3:Evaluate the effectiveness of external facilitation and local team-based quality improvement strategies for increasing the use of measurement based care to determine how best to implement patient-reported outcome measures.
Project 4 (Quality Improvement):Integrate a randomized implementation trial and evaluation into the pilot to implement Peer Specialists in VA PACTs.