Collaborative Chronic Care Model Implementation within Outpatient Behavioral Health Care Teams: Qualitative Results from a Multisite Trial using Implementation Facilitation

Abstract

<jats:title>Abstract</jats:title> <jats:p><jats:bold>Background:</jats:bold> This paper reports on a qualitative evaluation of a hybrid II stepped-wedge trial using implementation facilitation to implement team-based care in the form of the Collaborative Chronic Care Model (CCM) in interdisciplinary outpatient mental health teams. The objective of this study was to compare the alignment of sites’ clinical processes with the CCM elements at baseline (Time 1) and after 12 months of implementation facilitation (Time 2) from the perspective of providers.<jats:bold>Methods:</jats:bold> We conducted semi-structured interviews to assess the extent to which six CCM elements were in place: work role redesign, patient self-management support, provider decision support, clinical information systems, linkages to community resources, and organizational/leadership support. Interviews were transcribed and <jats:italic>a priori </jats:italic>CCM elements were coded using a directed content analysis approach at Time 1 and 2. We sought consensus on, and compared, the extent to which each CCM element was in place at Times 1 and 2.<jats:bold>Results:</jats:bold> We conducted 27 and 31 telephone interviews at Times 1 and 2, respectively, with outpatient mental health providers at nine participating sites. At Time 1 and Time 2, three CCM elements were most frequently present across the sites: work role redesign, patient self-management support, and provider decision support. The CCM elements with increased implementation from Time 1 to Time 2 were: work role redesign, patient self-management support, and clinical information systems. For two CCM elements, linkages to community resources and organizational/leadership support, some sites had increased implementation at Time 2 compared to Time 1, while others had reductions.<jats:bold>Conclusions: </jats:bold>Sites increased the extent of implementation on several CCM elements. The most progress was made in the CCM elements where sites had CCM-aligned processes already in place at Time 1. Teams made progress on elements they could more easily control, such as work role redesign. Our results suggest that maximizing the benefits of CCM-based outpatient mental health care may require targeting resources and training toward specific CCM elements—especially in the use of clinical information systems and linking with community resources. <jats:bold>Trial Registration: </jats:bold>Clinical Trials NCT02543840Registered 7 September 2015.</jats:p>

Time–motion analysis of external facilitation for implementing the Collaborative Chronic Care Model in general mental health clinics: Use of an interval-based data collection approach

“…The trial also assessed the impact of CCM implementation on health outcomes of team-treated individuals. Published articles provide additional information regarding the stepped wedge design used (Bauer et al, 2016; Bauer et al, 2019), the implemented evidence-based CCM (Miller et al, 2019; Sullivan et al, 2021), and the EFs who worked with the sites (Connolly et al, 2020). Research procedures were approved by the VA Central Institutional Review Board (IRB).…”

“…Implementation facilitation consists of various forms of support (e.g., task management, accountability checks, process monitoring, and relationship building) that is provided to personnel at a site implementing an evidence-based practice (Kitson et al, 1998; Olmos Ochoa et al, 2021). A common feature of implementation facilitation is to utilize an external facilitator (EF) who may bring a range of expertise including or such as content and process improvement expertise to an implementation site (Sullivan et al, 2021). Recent years have seen a noticeable increase in the use of external facilitation in implementation efforts.…”