Positive Effect of Collaborative Chronic Care Model on VA Mental Health

April 22, 2020

Takeaway: A partnership between QUERI and VA’s Office of Mental Health and Suicide Prevention resulted in the implementation of a Collaborative Chronic Care Model that incorporated Behavioral Health Interdisciplinary Program teams to treat Veterans with mental health conditions. This intervention led to significantly decreased mental health hospitalizations for Veterans and, with the collaboration of the Office of Veterans Access to Care, has been spread to 21 additional VA healthcare facilities.

Beginning in 2010, there was a multistage effort by QUERI investigators that evolved over eight years to move the Collaborative Chronic Care Model (CCM) – an adaptation of the Chronic Care Model – into broad use for Veterans with mental health conditions treated in the VA healthcare system.¹ This journey started with an evidence synthesis of randomized controlled trials of CCMs for any mental health condition – and demonstrated the effectiveness of CCM across mental health conditions (i.e., depression, bipolar disorder, and anxiety disorders) for individuals treated in mental health clinics as well as primary care settings.

Policy Impact

In 2013, VA’s Office of Mental Health and Suicide Prevention (OMHSP) began a high-priority effort to enhance care coordination in general mental health clinics by establishing interdisciplinary teams (called Behavioral Health Interdisciplinary Program, or BHIP, teams) in each VA medical center nationally. OMHSP became aware of the evidence synthesis, and in 2015 adopted the CCM as the model for their outpatient mental health teams. In addition, OMHSP collaborated with study investigators to develop CCM training materials and implementation support methods to augment pre-existing BHIP guidance.

Implementation Trial

From February 2016 through February 2018, QUERI investigators again partnered with OMHSP to conduct one of the first studies to evaluate CCM implementation for individuals treated in mental health clinics.² Funded through QUERI, this randomized trial established CCM-based teams in nine outpatient general mental health clinics. The study included 5,596 Veterans treated in mental health clinic BHIP teams (excluding Veterans with dementia) and 62 VA providers on those BHIP teams. Findings showed that mental health hospitalizations decreased significantly for Veterans treated by facilitated BHIP teams compared to Veterans treated in other mental health clinics in those facilities. Further, although no improvement in population-level Veteran self-ratings of health status was seen, in post-hoc analyses mental health status improved in Veterans with >3 treated mental health diagnoses versus others.

This experience highlights the synergy possible among research, policymaking, program development, and implementation – and the benefits of working within a learning health care system.

For more information about this research, please contact Mark Bauer, MD, part of the Team-Based Behavioral Health QUERI National Program and HSR&D’s Center for Healthcare Organization and Implementation Research (CHOIR) at Mark.Bauer@va.gov .

References

1. Bauer M, Weaver K, Kim B, et al. The Collaborative Chronic Care Model for mental health conditions: From evidence synthesis to policy impact to scale-up and spread. Medical Care. 2019;57:S221-S227.
2. Bauer M, Miller C, Kim B, et al. Effectiveness of implementing a Collaborative Care Model for clinician teams on patient outcomes and health status in mental health: A randomized clinical trial. JAMA Network Open. March 1, 2019;2(3):e190230.