The Collaborative Chronic Care Model for Mental Health Conditions

Bauer, Mark S.; Weaver, Kendra; Kim, Bo; Miller, Christopher J.; Lew, Robert A.; Stolzmann, Kelly; Sullivan, Jennifer L.; Riendeau, Rachel P.; Connolly, Samantha L.; Pitcock, Jeffery A.; Ludvigsen, Stig M.; Elwy, A. Rani

doi:10.1097/mlr.0000000000001145

Cited by 27 publications

(17 citation statements)

References 31 publications

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“…Two noncomprehensive features of a learning health care system are (i) the capacity to synthesize the best evidence available for policies that maximally improve the quality of care, especially those that improve collaborative care practices and (ii) application of embedded processes to facilitate the collection and use of health informatics (among other factors) in real-time for continuous assessment and improvement of health care quality. The primary implementation trial this study was based on exemplified the PLOS ONE first feature, resulting in VA wide policies based on evidence synthesis for CCM in a general mental health patient population; additionally, the second feature was demonstrated in followup work with facilitators in VA's Transformational Coach program (known as 'T-Coaches') intended to expand capacity for facilitated implementation support in service of scaling CCM to VA sites outside the implementation trial [33].…”

Section: Significance For Health Care Systems Quality Improvement Amentioning

confidence: 99%

Time course and heterogeneity of treatment effect of the collaborative chronic care model on psychiatric hospitalization rates: A survival analysis using routinely collected electronic medical records

et al. 2021

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Background Health systems are undergoing widespread adoption of the collaborative chronic care model (CCM). Care structured around the CCM may reduce costly psychiatric hospitalizations. Little is known, however, about the time course or heterogeneity of treatment effects (HTE) for CCM on psychiatric hospitalization. Rationale Assessment of CCM implementation support on psychiatric hospitalization might be more efficient if the timing were informed by an expected time course. Further, understanding HTE could help determine who should be referred for intervention. Objectives (i) Estimate the trajectory of CCM effect on psychiatric hospitalization rates. (ii) Explore HTE for CCM across demographic and clinical characteristics. Methods Data from a stepped wedge CCM implementation trial were reanalyzed using 5 570 patients in CCM treatment and 46 443 patients receiving usual care. Time-to-event data was constructed from routine medical records. Effect trajectory of CCM on psychiatric hospitalization was simulated from an extended Cox model over one year of implementation support. Covariate risk contributions were estimated from subset stratified Cox models without using simulation. Ratios of hazard ratios (RHR) allowed comparison by trial arm for HTE analysis, also without simulation. No standard Cox proportional hazards models were used for either estimating the time-course or heterogeneity of treatment effect. Results The effect of CCM implementation support increased most rapidly immediately after implementation start and grew more gradually throughout the rest of the study. On the final study day, psychiatric hospitalization rates in the treatment arm were 17% to 49% times lower than controls, with adjustment for all model covariates (HR 0.66; 95% CI 0.51–0.83). Our analysis of HTE favored usual care for those with a history of prior psychiatric hospitalization (RHR 4.92; 95% CI 3.15–7.7) but favored CCM for those with depression (RHR 0.61; 95% CI: 0.41–0.91). Having a single medical diagnosis, compared to having none, favored CCM (RHR 0.52; 95% CI 0.31–0.86). Conclusion Reduction of psychiatric hospitalization is evident immediately after start of CCM implementation support, but assessments may be better timed once the effect size begins to stabilize, which may be as early as six months. HTE findings for CCM can guide future research on utility of CCM in specific populations.

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Section: Significance For Health Care Systems Quality Improvement Amentioning

confidence: 99%

Time course and heterogeneity of treatment effect of the collaborative chronic care model on psychiatric hospitalization rates: A survival analysis using routinely collected electronic medical records

et al. 2021

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“…The evidence base for clinical models and approaches for integrated mental health varies and depends on several factors (Bauer et al, 2019;Raney et al, 2015). Clinical models and protocolized approaches include the Collaborative Care Model, the VA Primary Care Mental Health model, and the Screening, Brief Intervention, and Referral to Treatment (SBIRT).…”

Section: Healthcare Delivery Systems and Clinical Modelsmentioning

confidence: 99%

“…However, these clinical models and approaches, when implemented, lead to wide variations in success. The evidence is good to fair to variable and dependent upon several factors (Bauer et al, 2019;Raney & American Psychiatric Association, 2015). These clinical models portray a vision for integration.…”

mentioning

confidence: 99%

Implementing Patient‐Centred Behavioural Health Integration into Primary Care Using Model‐Based Systems Engineering

Khayal

McGovern

2020

Syst Res Behav Sci

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Psychiatric and substance use disorders, such as depression and/or opioid use disorders, are categorized as behavioural health conditions. In the United States, approximately one in four adults suffers from a behavioural health condition in any given year. These conditions are prevalent and costly. The current delivery of behavioural health services follows a primary to specialty referral practice, which has led to poor treatment initiation outcomes. These poor outcomes stem from a care delivery model that does not fully cater to the needs of patients. Patients prefer to receive both physical and mental health care within a single primary care setting. In response, healthcare delivery systems developed clinical models and approaches for behavioural health integration into primary care. These clinical models portray a sense of integration. However, these clinical models lack the necessary detail to describe the key components of a system and instead focus heavily on describing the system's physical form. By doing so, clinical models lack the ability to incorporate a broader range of patient needs and the details to describe a system to ensure it produces its intended outcomes. These limitations lead to variations in implementation success. Systematic approaches, including the development of system models, have been used to describe and develop complex systems. In this paper, we detail the design considerations for a patient‐centred system model and describe its utilization in an implementation of a patient‐centered behavioural health integration into primary care.

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“…Between 2016 and 2018, as part of a partnered evaluation with the VA’s Office of Mental Health and Suicide Prevention (OMHSP), our team conducted a hybrid type II stepped wedge cluster randomized trial to implement the evidence-based CCM in BHIP teams. Given the positive evidence regarding the success of the CCM to improve health outcomes and satisfaction, VA adopted the CCM as the model for the project using a workbook-guided approach [ 9 ]. We utilized an evidence-based implementation strategy known as blended or external-internal facilitation, in which an external facilitator brings both content and process improvement expertise to a site and works closely with an internal facilitator, who offers the knowledge of the site’s organizational culture and existing procedures [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…Clinicians within the teams experienced significant improvement in two aspects of team functioning (role clarity and focus on team priorities) [ 11 ]. Given the support from operational partners and results from this trial, the VA plans to implement CCM-aligned general mental health teams more widely throughout the healthcare system [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Collaborative chronic care model implementation within outpatient behavioral health care teams: qualitative results from a multisite trial using implementation facilitation

Sullivan

Kim

Miller

et al. 2021

Implement Sci Commun

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Background This paper reports on a qualitative evaluation of a hybrid type II stepped-wedge, cluster randomized 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 analysis is 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. Methods 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 a priori CCM elements were coded using a directed content analysis approach at times 1 and 2. We sought consensus on, and compared, the extent to which each CCM element was in place at times 1 and 2. Results 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. For the provider decision support element, we saw little change in the extent of its implementation. Conclusions 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 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. Trial registration Clinical Trials NCT02543840.

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The Collaborative Chronic Care Model for Mental Health Conditions

Cited by 27 publications

References 31 publications

Time course and heterogeneity of treatment effect of the collaborative chronic care model on psychiatric hospitalization rates: A survival analysis using routinely collected electronic medical records

Time course and heterogeneity of treatment effect of the collaborative chronic care model on psychiatric hospitalization rates: A survival analysis using routinely collected electronic medical records

Implementing Patient‐Centred Behavioural Health Integration into Primary Care Using Model‐Based Systems Engineering

Collaborative chronic care model implementation within outpatient behavioral health care teams: qualitative results from a multisite trial using implementation facilitation

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