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Sustaining the collaborative chronic care model in outpatient mental health: a matrixed multiple case study
Bo Kim1,2, Jennifer L Sullivan3,4, Madisen E Brown5
1Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA, 02130, USA. bo.kim@va.gov.
Implementation Science : IS
|February 19, 2024
Summary
Sustaining evidence-based practices like the Collaborative Chronic Care Model (CCM) depends on provider collaboration, knowledge retention during staff turnover, and strong internal facilitators. These factors are key for long-term success in healthcare settings.
Area of Science:
- Implementation Science
- Healthcare Management
- Health Services Research
Background:
- Sustaining evidence-based practices (EBPs) is vital for quality care and health equity.
- Identifying factors influencing EBP sustainability is a critical research need.
- Matrixed Multiple Case Study (MMCS) is an approach to identify implementation factors and their combinations.
Purpose of the Study:
- To apply MMCS to identify factors influencing the sustainability of the Collaborative Chronic Care Model (CCM) in VA outpatient mental health clinics.
- To assess sustainability 3-4 years after implementation support concluded.
Main Methods:
- Directed content analysis of 30 provider interviews.
- Used Collaborative Chronic Care Model (CCM) elements and Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) domains as codes.
- Categorized sites by sustainability (high/medium/low) and analyzed influencing factors using i-PARIHS domains.
Main Results:
- CCM sustainability varied across the nine VA clinics.
- Three key factors strongly trended with sustainability: "Collaborativeness/Teamwork," "Staff/Leadership turnover," and "Internal facilitator" presence.
- External facilitators, clarity of the model, interdisciplinary coordination, and clinic space also influenced sustainability to varying degrees.
Conclusions:
- CCM sustainability in VA mental health clinics is strongly linked to provider collaboration, knowledge retention during transitions, and skilled internal facilitators.
- Findings inform future trials to enhance implementation facilitation for improved sustainability.
- MMCS offers a systematic method for investigating sustainability factors across different EBPs and contexts.
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