Suicidal Self-directed Violence, Suicidal Preparatory Behavior
Conditions
Keywords
implementation science, implementation strategy, suicide prevention, academic detailing, quality improvement
Brief summary
Scientific advances are constantly leading to better treatments. However, it is quite challenging for healthcare systems, including VA, to ask very busy providers to change the way they practice. The MIDAS QUERI program helps providers improve the way they treat VA patients. This project will focus on increasing referrals to the Suicide Prevention 2.0 Clinical Telehealth (SP 2.0) initiative through the delivery of Academic Detailing and LEAP (a team-based quality improvement program). SP 2.0 provides accessible, evidence-based suicide prevention treatment to all Veterans with a history of suicidal self-directed violence or preparatory behaviors in the past 12 months.
Detailed description
Sustained integration of evidence-based practices (EBPs) is a challenge within many healthcare systems, especially in settings that have already strived but failed to achieve longer-term goals. The Veterans Affairs (VA) Maintaining Implementation through Dynamic Adaptations (MIDAS) Quality Enhancement Research Initiative (QUERI) program was funded as a series of trials to test multi-component implementation strategies to sustain optimal use of EBPs. The current project focuses on increasing referrals to the Suicide Prevention 2.0 Clinical Telehealth (SP 2.0) initiative. The investigators have recruited 4 sites for this non-randomized intervention project. Sites have agreed to participate in pre-implementation interviews to gather information regarding barriers and facilitators to use of the SP 2.0 initiative. Sites will then be provided with tailored feedback regarding interview findings and potential use of Academic Detailing and LEAP to address these. Sites may then select to receive either Academic Detailing and/or LEAP which will be provided by MIDAS QUERI. Primary outcome will be rate of SP 2.0 referral adjusted for pre-intervention rate.
Interventions
BEHAVIORALAcademic Detailing (AD)
The National Resource Center for Academic Detailing (NaRCAD) describes AD as an innovative, one-on-one outreach education technique that helps clinicians provide evidence-based care to their patients. Using an accurate, up-to-date synthesis of the best clinical evidence in an engaging format, academic detailers ignite clinician behavior change, ultimately improving patient health. A successful AD visit is highly interactive, always a dialogue, and assesses a clinician's individual needs, beliefs, attitudes, issues, and concerns in order to promote better \[practice\].
BEHAVIORALLEAP
Learn. Engage. Act. Process (LEAP) program is a structured 6-month core curriculum plus 6 monthly collaborative sessions. The LEAP quality improvement program engages frontline teams in sustained incremental improvements of EBPs over a six-month period, allowing space for busy clinicians to learn and immediately apply fundamental QI skills. LEAP encompasses: 1) a structured, accessible curriculum based on the Institute for Healthcare Improvement's (IHI) Model for Improvement and Plan-Do-Study-Act cycles of change; 2) team-based, hands-on learning, and 3) coaching support and a QI network to enhance learning and accountability.
Sponsors
VA Office of Research and Development
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Intervention model description
A multi-faceted implementation intervention including qualitative interviews and feedback and optional delivery of Academic Detailing and/or LEAP.
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
Note- the investigators are recruiting clinics/medical centers - not individual patients. Prior to implementation, the investigators will work with sites to ensure they have met the preconditions necessary to begin sustained optimization of the EBP: * 1\) a team leader or champion * 2\) an identified department with service leadership buy-in and control over the processes/practices impacted by the implementation * 3\) readily accessible data to measure process and impact of the implementation and use of the EBP * 4\) availability of required resources
Exclusion criteria
* N/A
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| SP2Clin Metric | Baseline to 12-months post-baseline | The quarterly SP2Clin metric data is reported and available on a VA national dashboard. The SP2Clin metric is calculated by the number of suicide prevention telehealth consults submitted among those with a suicide behavior event. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Number of Consults to SP 2.0 Clinic | Baseline to 12-months post-baseline | Change in number of telehealth consults to the Suicide Prevention 2.0 Clinical Telehealth (SP 2.0) initiative. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Change in Quality Improvement Skills Application | Baseline to 12-months post-baseline | 16-item measure of change in quality improvement skills application. Values 1 to 4 where higher values indicate more frequent use of quality improvement skills. |
| Provider Satisfaction With Academic Detailing | Post-first Academic Detailing session | 7-items measuring satisfaction with Academic Detailing. Each response option uses a Likert-type scale with values 1 to 5 where higher values indicate higher satisfaction. |
| Change in Provider Satisfaction With LEAP | Baseline to 12-months post-baseline | 6-item measure of satisfaction with LEAP. Values 1 to 5 where higher values indicate higher satisfaction. |
Countries
United States
Participant flow
Recruitment details
VA medical centers were recruited through Veterans Integrated Service Network (VISN) ICC calls and presentations to interested sites from November 2022 through May 2023. VISNs of interest were identified based on sites within that VISN having documented gaps in referring to the program.
Pre-assignment details
13 sites within VISNs of interest were approached directly. Following introductory presentations, 4 sites agreed to participate in the intervention arm. Four non-enrolled control sites were matched to the intervention arm sites based on size and baseline referral rates.
Participants by arm
| Arm | Count |
|---|---|
| Intervention A multi-faceted implementation intervention including qualitative interviews and feedback and optional delivery of Academic Detailing and/or LEAP.
Academic Detailing (AD): The National Resource Center for Academic Detailing (NaRCAD) describes AD as an innovative, one-on-one outreach education technique that helps clinicians provide evidence-based care to their patients. Using an accurate, up-to-date synthesis of the best clinical evidence in an engaging format, academic detailers ignite clinician behavior change, ultimately improving patient health. A successful AD visit is highly interactive, always a dialogue, and assesses a clinician's individual needs, beliefs, attitudes, issues, and concerns in order to promote better \[practice\].
LEAP: Learn. Engage. Act. Process (LEAP) program is a structured 6-month core curriculum plus 6 monthly collaborative sessions. The LEAP quality improvement program engages frontline teams in sustained incremental improvements of EBPs over a six-month period, allowing space for busy clinicians to learn and immediately apply fundamental QI skills. LEAP encompasses: 1) a structured, accessible curriculum based on the Institute for Healthcare Improvement's (IHI) Model for Improvement and Plan-Do-Study-Act cycles of change; 2) team-based, hands-on learning, and 3) coaching support and a QI network to enhance learning and accountability. | 0 |
| Intervention A multi-faceted implementation intervention including qualitative interviews and feedback and optional delivery of Academic Detailing and/or LEAP.
Academic Detailing (AD): The National Resource Center for Academic Detailing (NaRCAD) describes AD as an innovative, one-on-one outreach education technique that helps clinicians provide evidence-based care to their patients. Using an accurate, up-to-date synthesis of the best clinical evidence in an engaging format, academic detailers ignite clinician behavior change, ultimately improving patient health. A successful AD visit is highly interactive, always a dialogue, and assesses a clinician's individual needs, beliefs, attitudes, issues, and concerns in order to promote better \[practice\].
LEAP: Learn. Engage. Act. Process (LEAP) program is a structured 6-month core curriculum plus 6 monthly collaborative sessions. The LEAP quality improvement program engages frontline teams in sustained incremental improvements of EBPs over a six-month period, allowing space for busy clinicians to learn and immediately apply fundamental QI skills. LEAP encompasses: 1) a structured, accessible curriculum based on the Institute for Healthcare Improvement's (IHI) Model for Improvement and Plan-Do-Study-Act cycles of change; 2) team-based, hands-on learning, and 3) coaching support and a QI network to enhance learning and accountability. | 0 |
| Control To examine the effect of engagement in quality improvement activity on referral to the SP2.0 program, we compared participating sites with similar non-participating sites. Four non-participating sites were selected as matched controls, one for each participating site. Control sites were matched to participating sites on number of suicide behavior events and prevalence of Suicide Prevention Telehealth Program consults submitted at baseline. | 0 |
| Control To examine the effect of engagement in quality improvement activity on referral to the SP2.0 program, we compared participating sites with similar non-participating sites. Four non-participating sites were selected as matched controls, one for each participating site. Control sites were matched to participating sites on number of suicide behavior events and prevalence of Suicide Prevention Telehealth Program consults submitted at baseline. | 0 |
| Total | 0 |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 0 | 0 / 0 |
| other Total, other adverse events | 0 / 0 | 0 / 0 |
| serious Total, serious adverse events | 0 / 0 | 0 / 0 |
Outcome results
Primary
SP2Clin Metric
The quarterly SP2Clin metric data is reported and available on a VA national dashboard. The SP2Clin metric is calculated by the number of suicide prevention telehealth consults submitted among those with a suicide behavior event.
Time frame: Baseline to 12-months post-baseline
Population: Participants are not enrolled in this study. All enrollment and analysis were conducted at the VAMC level.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Intervention | SP2Clin Metric | 22.6 telehealth consults | Standard Deviation 4.1 |
| Control | SP2Clin Metric | 20.0 telehealth consults | Standard Deviation 3.8 |
Comparison: We compared participating sites with similar non-participating sites. Four non-participating sites were selected as matched controls, one for each participating site. Control sites were matched to participating sites on number of suicide behavior events and prevalence of Suicide Prevention Telehealth Program consults submitted at baseline.p-value: 0.5747t-test, 2 sided
Secondary
Change in Number of Consults to SP 2.0 Clinic
Change in number of telehealth consults to the Suicide Prevention 2.0 Clinical Telehealth (SP 2.0) initiative.
Time frame: Baseline to 12-months post-baseline
Population: Participants are not enrolled in this study. All enrollment and analysis were conducted at the VAMC level.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Intervention | Change in Number of Consults to SP 2.0 Clinic | 289.0 telehealth consults | Standard Deviation 171.3 |
| Control | Change in Number of Consults to SP 2.0 Clinic | 256.0 telehealth consults | Standard Deviation 191.2 |
Comparison: We compared participating sites with similar non-participating sites. Four non-participating sites were selected as matched controls, one for each participating site. Control sites were matched to participating sites on number of suicide behavior events and prevalence of Suicide Prevention Telehealth Program consults submitted at baseline.p-value: 0.8057t-test, 2 sided
Other Pre-specified
Change in Provider Satisfaction With LEAP
6-item measure of satisfaction with LEAP. Values 1 to 5 where higher values indicate higher satisfaction.
Time frame: Baseline to 12-months post-baseline
Population: This measure is only administered for those who participate in LEAP; this measure was not administered as no sites elected to participate in LEAP.
Other Pre-specified
Change in Quality Improvement Skills Application
16-item measure of change in quality improvement skills application. Values 1 to 4 where higher values indicate more frequent use of quality improvement skills.
Time frame: Baseline to 12-months post-baseline
Population: This measure is only administered for those who participate in LEAP; this measure was not administered as no sites elected to participate in LEAP.
Other Pre-specified
Provider Satisfaction With Academic Detailing
7-items measuring satisfaction with Academic Detailing. Each response option uses a Likert-type scale with values 1 to 5 where higher values indicate higher satisfaction.
Time frame: Post-first Academic Detailing session
Population: Participants were providers at participating sites who had received at least one AD session. AD satisfaction data was collected at the individual level; however, no demographic data was collected.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Intervention | Provider Satisfaction With Academic Detailing | 4.75 Units on a scale | Standard Deviation 0.43 |