Participatory Systems Engagement for Addiction and Mental Health Care

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Palo Alto Veterans Institute for Research

Disqualifiers: Less than 12 months data, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

720 Participants Needed

Trial Summary

What is the purpose of this trial?

The most common reasons Veterans seek VA addiction and mental health care is for help with opioid and alcohol misuse, depression and PTSD. Research evidence has established highly effective treatments that prevent relapse, overdose and suicide, but even with policy mandates, performance metrics, and electronic health records to fix the problem, these treatments may only reach 3-28% of patients. This study tests participatory business engineering methods (Participatory System Dynamics) that engage patients, providers and policy makers against the status quo approaches, such as data review, and will determine if participatory system dynamics works, why it works, and whether it can be applied in many health care settings to guarantee patient access to the highest quality care and better meet the addiction and mental health needs of Veterans and the U.S. population.

Research Team

Lindsey E Zimmerman, PhD

Principal Investigator

National Center for PTSD, Dissemination & Training Division

Eligibility Criteria

This trial is for VA divisions and outpatient clinics that are below the median in quality for treating depression, PTSD, and opioid use disorder. They must have at least a year's worth of data from 2018 but not be involved in other specific VA improvement programs or scheduled for EHR updates during the study.

Inclusion Criteria

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.

VA divisions and community-based outpatient clinics (CBOCs) or 'clinics' from regional VA health systems

Exclusion Criteria

Clinics with less than 12 months of data in 2018

Clinics already 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)

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Intervention

Participatory System Dynamics (PSD) and Audit and Feedback (AF) interventions are implemented across 24 sites to test effectiveness in improving evidence-based practice reach.

12 months

Follow-up

Participants are monitored for the effectiveness of interventions and data is collected for analysis.

6 months

Treatment Details

Interventions

• Participatory System Dynamics

Trial Overview The trial tests Participatory System Dynamics (PSD), which involves patients, providers, and policymakers to improve care access against standard methods like Audit and Feedback (AF). It aims to see if PSD can enhance treatment reach within veteran healthcare services.

Participant Groups

Group I: Participatory System Dynamics (PSD) Experimental Treatment 1 Intervention

12 clinics assigned to PSD

Group II: Audit and Feedback (AF) Experimental Treatment 1 Intervention

12 clinics assigned to AF

Who Is Running the Clinical Trial?

Palo Alto Veterans Institute for Research

Lead Sponsor

Trials

58

Recruited

8,800+