1) Anticipated impacts on Veteran's healthcare Using common facilitation techniques and common measures, this QUERI program will enhance and inform team-based care for Veterans with behavioral health conditions. Specifically, we will advance VA's knowledge of how team-based behavioral health care can be improved through use of implementation facilitation strategies, with anticipated improvements in Veteran outcomes. Data will be relevant to care within VHA and VA/non-VA shared care. 2) Project background Team-based care is emphasized in several recent VHA national initiatives, including Patient-Aligned Care Teams (PACT), Primary Care Mental Health Integration (PC-MHI), and Behavioral Health Interdisciplinary Program (BHIP) teams. Team-based care also occurs beyond the bricks and mortar of VHA, as recent enactment of the Veterans Choice Act requires VA to better understand how Veterans experience care delivered by non-VA community providers or that is shared between VHA and non-VHA providers. 3) Project objectives Our Program Impact Goal is to: Improve coordination, quality, equity, and outcomes of team-based care for Veterans with behavioral health conditions. We define team-based care broadly to include care provided through interdisciplinary VA clinical teams, across disciplines, as well as care of Veterans shared by VA and non-VA providers. Overall program aims include:
Aim 1 : Understand (through rigorous evaluation) and enhance (through facilitation) coordination, quality, equity and outcomes of care for Veterans treated within interdisciplinary VA treatment teams and via shared care across VA and non-VA community service providers.
Aim 2 : Advance (through facilitation) measurement-based care delivery strategies that enhance personalized, proactive, and patient-driven care for Veterans.
Aim 3 : Advance implementation science by developing, evaluating and refining new tools and resources to support use of facilitation to implement clinical programs/practices that are responsive to VA priorities. 4) Project methods Through an intensive strategic planning process, we identified a suite of highly coordinated and integrated projects to achieve our program aims, advance implementation science, and address system priorities in terms of clinical program and policy implementation. Foci of program projects include: 1) a quality improvement project implementing telemental health in VISN 20; 2) implementing BHIP teams in later adopter sites based on evidence-based collaborative chronic care models; 3) improving use of patient reported outcome measures within PC-MHI teams; 3); 4) enhancing understanding of Veteran perspectives on coordination and quality of behavioral health care received from VA and non-VA providers; and 5) implementing peer specialists in PACT teams in response to a White House executive action. Our Implementation Core synthesizes cross-cutting scientific themes, design elements, and measures applied across our projects. Projects will collect common measures pertaining to organizational context, team development, health-related quality-of-life and Veteran satisfaction, and we will aggregate these data across projects to produce program-level findings on: a) influence of contextual factors on implementation success and facilitation intensity; and b) effects of implementation facilitation on RE-AIM domains, team development and Veteran outcomes. We will also develop a new implementation facilitation fidelity tool and produce an updated Implementation Facilitation Training Manual for use by VA operations and researchers.
This research will improve care for Veterans with behavioral health needs. By improving the way healthcare providers and Veterans work together, and by improving the way VA and non-VA healthcare providers coordinate care, the research will lead to better health outcomes for Veterans. This research will allow more rural Veterans to access care using telemental health, and improve the healthcare experience for Veterans seeking help with their behavioral health care needs from their primary care providers. It will also improve VA?s use of clinical measures to evaluate and improve the behavioral healthcare Veterans receive. It will support establishing behavioral healthcare teams for Veterans. The proposed research also will survey Veterans in the community about their experiences with VA and non-VA healthcare to learn more about their needs.