Participatory System Dynamics vs Usual Quality Improvement: Staff Use of Simulation as an Effective, Scalable and Affordable Way to Improve Timely Mental Health Care?

Launched by VA OFFICE OF RESEARCH AND DEVELOPMENT · Dec 18, 2019

Keywords

ClinConnect Summary

Background: Evidence-based practices (EBPs) are the most high value treatments to meet Veterans' addiction and mental health needs, reduce chronic impairment, and prevent suicide or overdose. Over 10 years, VA invested in dissemination of evidence-based psychotherapies and pharmacotherapies based on substantial evidence of effectiveness as compared to usual care. Quality metrics also track progress. Despite these investments, patients with prevalent needs, such as depression, PTSD and opioid use disorder often don't receive EBPs. Systems theory explains limited EBP reach as a system behavio...

Gender

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Eligibility criteria

• Inclusion Criteria:
• • 24 health care systems currently functioning below the median VA mental health recommendations for Strategic Analytics for Improvement \& Learning (SAIL) and below the median for 3 of 8 SAIL evidence-based treatment approaches.
• • VA divisions and community-based outpatient clinics (CBOCs) or 'clinics' from regional VA health systems
• • Must be below the overall VA quality median (as assessed by the Strategic Analytics for Improvement and Learning or SAIL), which includes 3 of 8 SAIL measures associated with four evidence-based psychotherapies and three evidence-based pharmacotherapies for depression, PTSD, and opioid use disorder.
• Exclusion Criteria:
• • Health care systems functioning above median VA mental health recommendations for Strategic Analytics for Improvement \& Learning (SAIL) and below the median for 3 of 8 SAIL evidence-based treatment approaches. Only one health care system can be included per arm - MTL vs QI.
• • clinics with less than 12 months of data in 2018
• • clinics involved in Office of Veterans Access to Care (OVACS) quality improvement program at baseline
• • clinics where the VA Cerner electronic health record (EHR) implementation rollout will occur during the project period (Veterans Integrated Services Networks (VISNs) 20, 21 ,22, and 7)
• • clinics who serve less than 122 unique patients each month on average
• • clinics without an onsite multidisciplinary team of mental health or addiction service providers (minimum required: 1 psychiatrist, 1 psychologist, 1 social worker onsite)