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2019 HSR&D/QUERI National Conference Abstract

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1119 — Evaluating facilitated implementation: Peer Specialists in patient aligned care teams

Lead/Presenter: Richard Goldberg,  VISN 5 MIRECC
All Authors: Goldberg RG (VISN 5 Mental Illness Research, Education, and Clinical Center), Chinman, M (VISN 4 Mental Illness Research, Education, and Clinical Center; Center for Health Equity Research and Promotion), Peeples, AD (VISN 5 Mental Illness Research, Education, and Clinical Center) McCarthy, SA (VISN 4 Mental Illness Research, Education, and Clinical Center; Center for Health Equity Research and Promotion) Daniels, KS (Center for Health Equity Research and Promotion) Vineyard, NS (Research Compliance Office, Washington DC VA Medical Center)

Increasing access to primary care remains a priority in VA. As part of the QUERI for Team Based Behavioral Health, we are evaluating the impact of providing facilitated implementation (external coaching, data feedback on service delivery to stimulate quality improvement) to 12 of the 25 VA sites that, in response to the 2014 White House Executive Action, deployed Peer Specialists (PSs) into primary care to provide health coaching and engage patients into care.

Preliminary analysis of administrative data was run to characterize the level and reach of PS services delivered across the 25 participating sites. Qualitative interviews with 25 PSs and 27 of their supervisors were analyzed to examine the barriers encountered by sites with and without implementation facilitation. Twelve interviews with implementation facilitators were also reviewed to detail how facilitation can best address implementation challenges.

Across all sites to date, PSs have delivered approximately 16,700 encounters to 5,750 unique Veterans. Similar barriers, including low provider buy-in, lack of role clarity, and difficulty securing funding or protected time for PSs in primary care, were reported by sites both with and without facilitated implementation. However, sites receiving facilitation reported that such support was helpful in overcoming these barriers, as facilitators provided a neutral outsider perspective and help solving problems.

The delivery of services to thousands of unique Veterans nationwide confirms that PSs can play an important role in engaging Veterans in primary care settings. Qualitative results describe predictable initial barriers for PSs working in a new health care setting, and facilitator data provide insight into how implementation strategies can contribute to overcoming these barriers.

Given that PSs have not previously been widely deployed in primary care, recruiting 25 sites to participate represents a significant policy impact. Methods and findings from the current evaluation will inform and enhance capacity to implement Section 506 of the MISSION ACT that requires deployment of PSs in PACT teams at 30 VA medical centers within two years. Finally, qualitative findings will inform the development and dissemination of implementation toolkits to help sustain and expand PS deployment in primary care.