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Understanding collaborative care implementation in the Department of Veterans Affairs: core functions and implementation challenges.
BMC Health Serv Res. 2017 Oct 10; 17(1):691.BH

Abstract

BACKGROUND

The collaborative care model is an evidence-based practice for treatment of depression in which designated care managers provide clinical services, often by telephone. However, the collaborative care model is infrequently adopted in the Department of Veterans Affairs (VA). Almost all VA medical centers have adopted a co-located or embedded approach to integrating mental health care for primary care patients. Some VA medical centers have also adopted a telephone-based collaborative care model where depression care managers support patient education, patient activation, and monitoring of adherence and progress over time. This study evaluated two research questions: (1) What does a dedicated care manager offer in addition to an embedded-only model? (2) What are the barriers to implementing a dedicated depression care manager?

METHODS

This study involved 15 qualitative, multi-disciplinary, key informant interviews at two VA medical centers where reimbursement options were the same- both with embedded mental health staff, but one with a depression care manager. Participant interviews were recorded and transcribed. Thematic analysis was used to identify descriptive and analytical themes.

RESULTS

Findings suggested that some of the core functions of depression care management are provided as part of embedded-only mental health care. However, formal structural attention to care management may improve the reliability of care management functions, in particular monitoring of progress over time. Barriers to optimal implementation were identified at both sites. Themes from the care management site included finding assertive care managers to hire, cross-discipline integration and collaboration, and primary care provider burden. Themes from interviews at the embedded site included difficulty getting care management on leaders' agendas amidst competing priorities and logistics (staffing and space).

CONCLUSIONS

Providers and administrators see depression care management as a valuable healthcare service that improves patient care. Barriers to implementation may be addressed by team-building interventions to improve cross-discipline integration and communication. Findings from this study are limited in scope to the VA healthcare system. Future investigation of whether alternative barriers exist in implementation of depression care management programs in non-VA hospital systems, where reimbursement rates may be a more prominent concern, would be valuable.

Links

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Authors+Show Affiliations

Lipschitz JM
Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 South Huntington Ave, Jamaica Plain,, Boston, MA, 02130, USA. Jessica.Lipschitz@va.gov. Harvard Medical School, Department of Psychiatry, Boston, USA. Jessica.Lipschitz@va.gov.
Benzer JK
Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 South Huntington Ave, Jamaica Plain,, Boston, MA, 02130, USA. Department of Health Policy and Management, Texas A&M University School of Public Health, College Station, USA. Central TX VA Healthcare System, VISN 17 Center for Research on Returning Veterans, Temple TX, USA.
Miller C
Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 South Huntington Ave, Jamaica Plain,, Boston, MA, 02130, USA. Harvard Medical School, Department of Psychiatry, Boston, USA.
Easley SR
Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 South Huntington Ave, Jamaica Plain,, Boston, MA, 02130, USA.
Leyson J
Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 South Huntington Ave, Jamaica Plain,, Boston, MA, 02130, USA.
Post EP
VA Office of Primary Care Services, Ann Arbor, USA. University of Michigan Medical School, Department of Internal Medicine, Ann Arbor, USA. VA Ann Arbor Healthcare System, Center for Clinical Management Research, Ann Arbor, USA.
Burgess JF
Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 South Huntington Ave, Jamaica Plain,, Boston, MA, 02130, USA. Boston University School of Public Health, Department of Health, Law, Policy and Management, Boston, USA.

MeSH

Cooperative BehaviorDelivery of Health CareDepressive DisorderEvidence-Based PracticeFemaleHealth PersonnelHumansInterviews as TopicMaleModels, OrganizationalPatient Education as TopicPrimary Health CareReproducibility of ResultsUnited StatesUnited States Department of Veterans AffairsVeterans

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29017488

Citation

Lipschitz, Jessica M., et al. "Understanding Collaborative Care Implementation in the Department of Veterans Affairs: Core Functions and Implementation Challenges." BMC Health Services Research, vol. 17, no. 1, 2017, p. 691.
Lipschitz JM, Benzer JK, Miller C, et al. Understanding collaborative care implementation in the Department of Veterans Affairs: core functions and implementation challenges. BMC Health Serv Res. 2017;17(1):691.
Lipschitz, J. M., Benzer, J. K., Miller, C., Easley, S. R., Leyson, J., Post, E. P., & Burgess, J. F. (2017). Understanding collaborative care implementation in the Department of Veterans Affairs: core functions and implementation challenges. BMC Health Services Research, 17(1), 691. https://doi.org/10.1186/s12913-017-2601-9
Lipschitz JM, et al. Understanding Collaborative Care Implementation in the Department of Veterans Affairs: Core Functions and Implementation Challenges. BMC Health Serv Res. 2017 Oct 10;17(1):691. PubMed PMID: 29017488.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Understanding collaborative care implementation in the Department of Veterans Affairs: core functions and implementation challenges. AU - Lipschitz,Jessica M, AU - Benzer,Justin K, AU - Miller,Christopher, AU - Easley,Siena R, AU - Leyson,Jenniffer, AU - Post,Edward P, AU - Burgess,James F,Jr Y1 - 2017/10/10/ PY - 2017/01/26/received PY - 2017/09/07/accepted PY - 2017/10/12/entrez PY - 2017/10/12/pubmed PY - 2018/5/4/medline SP - 691 EP - 691 JF - BMC health services research JO - BMC Health Serv Res VL - 17 IS - 1 N2 - BACKGROUND: The collaborative care model is an evidence-based practice for treatment of depression in which designated care managers provide clinical services, often by telephone. However, the collaborative care model is infrequently adopted in the Department of Veterans Affairs (VA). Almost all VA medical centers have adopted a co-located or embedded approach to integrating mental health care for primary care patients. Some VA medical centers have also adopted a telephone-based collaborative care model where depression care managers support patient education, patient activation, and monitoring of adherence and progress over time. This study evaluated two research questions: (1) What does a dedicated care manager offer in addition to an embedded-only model? (2) What are the barriers to implementing a dedicated depression care manager? METHODS: This study involved 15 qualitative, multi-disciplinary, key informant interviews at two VA medical centers where reimbursement options were the same- both with embedded mental health staff, but one with a depression care manager. Participant interviews were recorded and transcribed. Thematic analysis was used to identify descriptive and analytical themes. RESULTS: Findings suggested that some of the core functions of depression care management are provided as part of embedded-only mental health care. However, formal structural attention to care management may improve the reliability of care management functions, in particular monitoring of progress over time. Barriers to optimal implementation were identified at both sites. Themes from the care management site included finding assertive care managers to hire, cross-discipline integration and collaboration, and primary care provider burden. Themes from interviews at the embedded site included difficulty getting care management on leaders' agendas amidst competing priorities and logistics (staffing and space). CONCLUSIONS: Providers and administrators see depression care management as a valuable healthcare service that improves patient care. Barriers to implementation may be addressed by team-building interventions to improve cross-discipline integration and communication. Findings from this study are limited in scope to the VA healthcare system. Future investigation of whether alternative barriers exist in implementation of depression care management programs in non-VA hospital systems, where reimbursement rates may be a more prominent concern, would be valuable. SN - 1472-6963 UR - https://www.unboundmedicine.com/medline/citation/29017488/Understanding_collaborative_care_implementation_in_the_Department_of_Veterans_Affairs:_core_functions_and_implementation_challenges_ DB - PRIME DP - Unbound Medicine ER -