Enhancing outreach for persons with serious mental illness: 12-month results from a cluster randomized trial of an adaptive implementation strategyReport as inadecuate

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Implementation Science

, 9:163

First Online: 28 December 2014Received: 02 July 2014Accepted: 21 October 2014DOI: 10.1186-s13012-014-0163-3

Cite this article as: Kilbourne, A.M., Almirall, D., Goodrich, D.E. et al. Implementation Sci 2014 9: 163. doi:10.1186-s13012-014-0163-3


BackgroundFew implementation strategies have been empirically tested for their effectiveness in improving uptake of evidence-based treatments or programs. This study compared the effectiveness of an immediate versus delayed enhanced implementation strategy Enhanced Replicating Effective Programs REP for providers at Veterans Health Administration VA outpatient facilities sites on improved uptake of an outreach program Re-Engage among sites not initially responding to a standard implementation strategy.

MethodsOne mental health provider from each U.S. VA site N = 158 was initially given a REP-based package and training program in Re-Engage. The Re-Engage program involved giving each site provider a list of patients with serious mental illness who had not been seen at their facility for at least a year, requesting that providers contact these patients, assessing patient clinical status, and where appropriate, facilitating appointments to VA health services. At month 6, sites considered non-responsive N = 89, total of 3,075 patients, defined as providers updating documentation for less than <80% of patients on their list, were randomized to two adaptive implementation interventions: Enhanced REP provider coaching; N = 40 sites for 6 months followed by Standard REP for 6 months; versus continued Standard REP N = 49 sites for 6 months followed by 6 months of Enhanced REP for sites still not responding. Outcomes included patient-level Re-Engage implementation and utilization.

ResultsPatients from sites that were randomized to receive Enhanced REP immediately compared to Standard REP were more likely to have a completed contact adjusted OR = 2.13; 95% CI: 1.09–4.19, P = 0.02. There were no differences in patient-level utilization between Enhanced and Standard REP sites.

ConclusionsEnhanced REP was associated with greater Re-Engage program uptake completed contacts among sites not responding to a standard implementation strategy. Further research is needed to determine whether national implementation of Facilitation results in tangible changes in patient-level outcomes.

Trial registrationISRCTN: ISRCTN21059161

KeywordsMental disorders Implementation science Population health AbbreviationsREPReplicating Effective Programs framework

PARiHSPromoting Action on Research Implementation in Health Services framework

SMISerious mental illness

VAVeterans Health Administration

ICD-9-CMInternational Classification of Diseases

Ninth RevisionClinical Modification

VISNVA integrated service network

Electronic supplementary materialThe online version of this article doi:10.1186-s13012-014-0163-3 contains supplementary material, which is available to authorized users.

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