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Health Services Research & Development

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2005 HSR&D National Meeting Abstract

3019 — Assessing VISN-Level Mental Health Service Lines in a Multi-Site Implementation Study

Author List:
Smith JL (Mental Health QUERI)
Owen RR (Mental Health QUERI)
Mukherjee S (Mental Health QUERI)
Curran GM (Mental Health QUERI)

The organization of mental health services in Veterans Integrated Service Networks (VISNs) may influence the adoption and sustained implementation of evidence-based practices. As part of a multi-site study to evaluate the effectiveness of interventions to improve antipsychotic medication management for veterans with schizophrenia, this abstract describes a collaborative process to develop a strategy for assessing mental health service line implementation at the VISN level, in terms of structure and operational authority of network leadership.

In collaboration with organizational researchers at the Management Decision and Research Center (MDRC), a semi-structured qualitative interview guide was adapted for use to collect information about the structure and operation of mental heath service lines at the VISN level. Data on populations of patients with schizophrenia and VA medical center performance on indicators of high quality antipsychotic prescribing from the Northeast Program Evaluation Center were reviewed to identify eligible VISNs (N=15). The designated mental health leader for each of the fifteen VISNs was contacted by telephone to complete the qualitative interview (100% response rate). Interview responses were used to classify VISN mental health service lines into one of nine organizational configurations, which characterize service line implementation along a continuum from relatively weak to strong structures.

Most of the VISNs were organized into task force models of mental health service line implementation (8/15; 53.3%). Other service line implementation models observed were multidisciplinary teams (3/15; 20.0%), matrix models (3/15; 20.0%), and a division model (1/15; 6.7%). Almost all respondents reported that the network service line monitored performance measures and worked to promote improvement in performance measures when needed (14/15; 83.3%).

Although a variety of organizational forms characterize VISN mental health service line implementation in the VA, the majority of VISNs assessed in this study are organized into relatively weak structures in comparison to models where network mental health leaders have budget and/or supervisory authority.

Potential effects of service line structure/operation on the implementation of quality improvement interventions for schizophrenia will be assessed as the study progresses.

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