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Randomized Controlled Trial
. 2014 Dec 28:9:163.
doi: 10.1186/s13012-014-0163-3.

Enhancing outreach for persons with serious mental illness: 12-month results from a cluster randomized trial of an adaptive implementation strategy

Amy M Kilbourne  1   2 , Daniel Almirall  3 , David E Goodrich  4   5 , Zongshan Lai  6   7 , Kristen M Abraham  8   9 , Kristina M Nord  10   11 , Nicholas W Bowersox  12   13
Affiliations
Randomized Controlled Trial

Enhancing outreach for persons with serious mental illness: 12-month results from a cluster randomized trial of an adaptive implementation strategy

Amy M Kilbourne et al. Implement Sci. .

Abstract

Background: Few implementation strategies have been empirically tested for their effectiveness in improving uptake of evidence-based treatments or programs. This study compared the effectiveness of an immediate versus delayed enhanced implementation strategy (Enhanced Replicating Effective Programs (REP)) for providers at Veterans Health Administration (VA) outpatient facilities (sites) on improved uptake of an outreach program (Re-Engage) among sites not initially responding to a standard implementation strategy.

Methods: One mental health provider from each U.S. VA site (N = 158) was initially given a REP-based package and training program in Re-Engage. The Re-Engage program involved giving each site provider a list of patients with serious mental illness who had not been seen at their facility for at least a year, requesting that providers contact these patients, assessing patient clinical status, and where appropriate, facilitating appointments to VA health services. At month 6, sites considered non-responsive (N = 89, total of 3,075 patients), defined as providers updating documentation for less than <80% of patients on their list, were randomized to two adaptive implementation interventions: Enhanced REP (provider coaching; N = 40 sites) for 6 months followed by Standard REP for 6 months; versus continued Standard REP (N = 49 sites) for 6 months followed by 6 months of Enhanced REP for sites still not responding. Outcomes included patient-level Re-Engage implementation and utilization.

Results: Patients from sites that were randomized to receive Enhanced REP immediately compared to Standard REP were more likely to have a completed contact (adjusted OR = 2.13; 95% CI: 1.09-4.19, P = 0.02). There were no differences in patient-level utilization between Enhanced and Standard REP sites.

Conclusions: Enhanced REP was associated with greater Re-Engage program uptake (completed contacts) among sites not responding to a standard implementation strategy. Further research is needed to determine whether national implementation of Facilitation results in tangible changes in patient-level outcomes.

Isrctn: ISRCTN21059161.

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Figures

Figure 1
Figure 1
CONSORT diagram for cluster randomized trial of an adaptive implementation strategy.
Figure 2
Figure 2
Re-Engage program uptake over the 12-month period comparing adaptive implementation strategies (immediate versus delayed Enhanced REP).
See this image and copyright information in PMC

References

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