REACH VET Program Evaluation

Study Overview
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Brief Summary
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The VA's Office of Mental Health and Suicide Prevention is implementing an new program to increase suicide prevention outreach for Veterans at highest risk for suicide. Using a statistical model, REACH VET, short for Recovery Engagement and Coordination for Health - Veterans Enhanced Treatment, uses information from Veterans' health records to identify those who are at a higher risk for suicide, hospitalization, illness, or other negative outcomes. Once a Veteran is identified, his or her VA mental health or primary care provider reaches out to check on the Veteran's well-being and review their treatment plan to determine if enhanced care is needed. The goal of the proposed study is to evaluate the implementation of this program in collaboration with the Partnered Evidence-based Policy Resource Center (PEPReC). The objectives of this evaluation are to evaluate how well this program is put into place using a strategy called virtual external facilitation, and to collect data about the cost of the program and the strategy.

Detailed Description
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The VA's Office of Mental Health and Suicide Prevention is implementing an innovative new program to increase suicide prevention outreach and target Veterans at highest risk for suicide. Using a new predictive model, REACH VET, short for Recovery Engagement and Coordination for Health - Veterans Enhanced Treatment, analyzes existing data from Veterans' health records to identify those who are at a statistically elevated risk for suicide, hospitalization, illness, or other adverse outcomes. Once a Veteran is identified, his or her VA mental health or primary care provider reaches out to check on the Veteran's well-being and review their condition(s) and treatment plans to determine if enhanced care is needed. The goal of the proposed study is to evaluate the implementation of REACH VET in collaboration with the Partnered Evidence-based Policy Resource Center (PEPReC). The objectives of this evaluation are to: evaluate the implementation of REACH VET using virtual external facilitation, and collect preliminary data about the cost and cost offsets. The proposed evaluation will examine the impact of a virtual external facilitation strategy on the implementation of REACH VET in 28 medical facilities across 7 Veteran Integrated Service Networks (VISNs) in a stepped wedge design. Primary implementation outcomes include reach, adoption, and implementation fidelity. Qualitative interviews will be conducted with implementation facilitators, Suicide Prevention Coordinator(s), clinical leadership, and providers to identify barriers and facilitators to implementation of REACH VET and the experience of facilitation. Secondary data will be collected on the cost of the intervention and the cost of implementation strategy.

Official Title
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Risk Stratified Enhancements to Clinical Care: Targeting Care for Patients Identified Through Predictive Modeling as Being at High Risk for Suicide, With the Office of Mental Health Operations

Conditions
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Suicide

Intervention / Treatment
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* Other: External facilitation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: VA employee at a facility receiving virtual external facilitation Involved in REACH VET implementation Exclusion Criteria: Not a VA employee Not employed at a facility receiving virtual external facilitation Not involved in REACH VET implementation
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| VISNs requesting implementation support<br>VA has divided the country into regions of care and these are called Veteran Integrated Service Networks (VISNs). This group consists of VISNs with facilities that need additional implementation support to fully implement REACH VET and that agree to participate. | Other: External facilitation<br>* Facilitation is an evidence-based implementation strategy to support sites that have difficulty implementing innovative programs. Facilitation is a multi-faceted process of interactive problem solving and support that occurs in the context of a recognized need for improvement and a supportive interpersonal relationship (Powell et al., 2015). Facilitation has been used nationally across VA to implement a number of different clinical interventions. The current project will examine this minimally intensive version of implementation facilitation, virtual external facilitation.<br>* Other names: Virtual external facilitation, facilitation, implementation facilitation;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Reach | Reach is the proportion of patients identified at each facility who receive the REACH VET intervention. | 6 months | 
| Adoption | Adoption is the proportion of mental health and primary care providers in each facility that participate. | 6 months | 
| Implementation fidelity | Implementation fidelity is whether facilities implemented all components of the intervention as directed. | 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cost of implementation | Cost of implementation will be estimated by documenting the amount of effort and time needed to offer virtual external facilitation. | weekly through study completion, an average of 2 years | 
| Cost of intervention | Cost of the intervention will be estimated by documenting the amount of effort and time needed to implement REACH VET activities. | up to 6 months | 
| Organizational Readiness for Change survey | The Organizational Readiness for Change survey is a quantitative survey that assesses an organization's culture and readiness for change. | 1 month | 
| Barriers, facilitators, experience of facilitation process | Barriers and facilitators to implementing REACH VET and the experience of the facilitation process will be assessed via qualitative interviews. | 6 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Suicide, Prevention, Implementation, Facilitation