System Dynamics vs Quality Improvement for Mental Health Care

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: VA Office of Research and Development

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?

Evidence-based VA care is best for meeting Veterans' mental health needs, such as depression, PTSD and opioid use disorder, to prevent suicide or overdose. But some key evidence-based practices only reach 3-28% of patients. Participatory system dynamics (PSD) helps improve quality with existing resources, critical in mental health and all VA health care. PSD uses learning simulations to improve staff decisions, showing how goals for quality can best be achieved given local resources and constraints. This study aims to significantly increase the proportion of patients who start and complete evidence-based care, and determine the costs of using PSD for improvement. Empowering frontline staff with PSD simulation encourages safe 'virtual' prototyping of complex changes to scheduling, referrals and staffing, before translating changes to the 'real world.' This study determines if PSD increases Veteran access to the highest quality care, and if PSD better maximizes VA resources when compared against usual trial-and-error approaches to improving quality.

Will I have to stop taking my current medications?

The trial information does not specify whether participants need to stop taking their current medications.

What data supports the effectiveness of the treatment Modeling to Learn (MTL) for mental health care?

System dynamics models have been shown to help improve decision-making and planning in mental health care, such as depression and suicide prevention, by simulating different scenarios and interventions. This approach can enhance the effectiveness of mental health services by informing implementation decisions and improving stakeholder engagement. ^{1 2 3 4 5}

Is the System Dynamics vs Quality Improvement approach safe for mental health care?

The research does not provide specific safety data for the System Dynamics vs Quality Improvement approach in mental health care, but it focuses on improving care processes and outcomes, which generally suggests a focus on safe and effective practices. ^{6 7 8 9 10}

How does the treatment 'Modeling to Learn (MTL)' differ from other mental health treatments?

Modeling to Learn (MTL) is unique because it uses system dynamics (SD) modeling to improve mental health care by simulating and analyzing complex systems, helping to inform decision-making and optimize service delivery, unlike traditional treatments that focus solely on individual patient care. ^{1 2 3 5 11}

Research Team

Lindsey E. Zimmerman, PhD

Principal Investigator

VA Palo Alto Health Care System, Palo Alto, CA

Eligibility Criteria

This trial is for VA divisions and outpatient clinics that are performing below the median in mental health care quality, specifically for depression, PTSD, and opioid use disorder. Clinics must have a multidisciplinary team but can't be part of certain other QI programs or planning to implement a new EHR system during the study.

Inclusion Criteria

VA health care systems are below the median for 24 of 30 VA mental health recommendations for Strategic Analytics for Improvement & Learning (SAIL) and below the median for 3 of 8 VA evidence-based treatment approaches.

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 involved in Office of Veterans Access to Care (OVACS) quality improvement program at baseline

Clinics without an onsite multidisciplinary team of mental health or addiction service providers (minimum required: 1 psychiatrist, 1 psychologist, 1 social worker onsite)

Health care systems functioning above median VA mental health recommendations for Strategic Analytics for Improvement & Learning (SAIL) and below the median for 3 of 8 SAIL evidence-based treatment approaches. Only one health care system can be included per arm - MTL vs QI.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Implementation

Participatory System Dynamics (PSD) and usual Quality Improvement (QI) are implemented in clinics to improve mental health care access

12 months

Regular sessions with multidisciplinary teams

Follow-up

Participants are monitored for effectiveness of PSD and QI interventions

12 months

Evaluation

Evaluation of the effectiveness, scalability, and affordability of PSD compared to usual QI

6 months

Treatment Details

Interventions

• Modeling to Learn (MTL)
• Usual quality improvement (QI)

Trial Overview The trial compares Participatory System Dynamics (PSD), which uses simulations to help staff make better decisions about resource allocation and scheduling, with usual quality improvement methods. It aims to see if PSD can increase patient access to evidence-based mental health care more effectively.

Participant Groups

Group I: Usual quality improvement (QI) Experimental Treatment 1 Intervention

12 clinics randomly assigned to usual QI

Group II: Modeling to Learn (MTL) Experimental Treatment 1 Intervention

12 clinics randomly assigned to MTL

Who Is Running the Clinical Trial?

VA Office of Research and Development

Lead Sponsor

Trials

1,691

Recruited

3,759,000+

References

1. England pubmed.ncbi.nlm.nih.gov

A system dynamics model of clinical decision thresholds for the detection of developmental-behavioral disorders. [2018]

2. England pubmed.ncbi.nlm.nih.gov

System dynamics models of depression at the population level: a scoping review. [2023]

3. United States pubmed.ncbi.nlm.nih.gov

Modeling the Impact of School-Based Universal Depression Screening on Additional Service Capacity Needs: A System Dynamics Approach. [2023]

4. United States pubmed.ncbi.nlm.nih.gov

Participatory System Dynamics Modeling: Increasing Stakeholder Engagement and Precision to Improve Implementation Planning in Systems. [2022]

5. Switzerland pubmed.ncbi.nlm.nih.gov

Sound Decision Making in Uncertain Times: Can Systems Modelling Be Useful for Informing Policy and Planning for Suicide Prevention? [2022]

6. United States pubmed.ncbi.nlm.nih.gov

Using organizational and clinical performance data to increase the value of mental health care. [2018]

7. United States pubmed.ncbi.nlm.nih.gov

Learning health systems: Driving real-world impact in mental health and substance use disorder research. [2022]

8. Switzerland pubmed.ncbi.nlm.nih.gov

The United States must improve its data infrastructure to ensure high-quality mental health care. [2023]

9. United States pubmed.ncbi.nlm.nih.gov

Overcoming obstacles to effective treatment: use of clinical practice improvement methodology. [2015]

10. United States pubmed.ncbi.nlm.nih.gov

Invited Commentary: Baby Steps to a Learning Mental Health-Care System-Can We Do the Work? [2021]

11. United States pubmed.ncbi.nlm.nih.gov

Application of System Dynamics to Inform a Model of Adolescent SBIRT Implementation in Primary Care Settings. [2021]