Cargando…

A Hybrid III stepped wedge cluster randomized trial testing an implementation strategy to facilitate the use of an evidence-based practice in VA Homeless Primary Care Treatment Programs

BACKGROUND: Homeless veterans often have multiple health care and psychosocial needs, including assistance with access to housing and health care, as well as support for ongoing treatment engagement. The Department of Veterans Affairs (VA) developed specialized Homeless Patient Alignment Care Teams...

Descripción completa

Detalles Bibliográficos
Autores principales: Simmons, Molly M., Gabrielian, Sonya, Byrne, Thomas, McCullough, Megan B., Smith, Jeffery L., Taylor, Thom J., O’Toole, Tom P., Kane, Vincent, Yakovchenko, Vera, McInnes, D. Keith, Smelson, David A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5379611/
https://www.ncbi.nlm.nih.gov/pubmed/28376839
http://dx.doi.org/10.1186/s13012-017-0563-2
_version_ 1782519639902781440
author Simmons, Molly M.
Gabrielian, Sonya
Byrne, Thomas
McCullough, Megan B.
Smith, Jeffery L.
Taylor, Thom J.
O’Toole, Tom P.
Kane, Vincent
Yakovchenko, Vera
McInnes, D. Keith
Smelson, David A.
author_facet Simmons, Molly M.
Gabrielian, Sonya
Byrne, Thomas
McCullough, Megan B.
Smith, Jeffery L.
Taylor, Thom J.
O’Toole, Tom P.
Kane, Vincent
Yakovchenko, Vera
McInnes, D. Keith
Smelson, David A.
author_sort Simmons, Molly M.
collection PubMed
description BACKGROUND: Homeless veterans often have multiple health care and psychosocial needs, including assistance with access to housing and health care, as well as support for ongoing treatment engagement. The Department of Veterans Affairs (VA) developed specialized Homeless Patient Alignment Care Teams (HPACT) with the goal of offering an integrated, “one-stop program” to address housing and health care needs of homeless veterans. However, while 70% of HPACT’s veteran enrollees have co-occurring mental health and substance use disorders, HPACT does not have a uniform, embedded treatment protocol for this subpopulation. One wraparound intervention designed to address the needs of homeless veterans with co-occurring mental health and substance use disorders which is suitable to be integrated into HPACT clinic sites is the evidence-based practice called Maintaining Independence and Sobriety through Systems Integration, Outreach, and Networking-Veterans Edition, or MISSION-Vet. Despite the promise of MISSION-Vet within HPACT clinics, implementation of an evidence-based intervention within a busy program like HPACT can be difficult. The current study is being undertaken to identify an appropriate implementation strategy for MISSION-Vet within HPACT. The study will test the implementation platform called Facilitation and compared to implementation as usual (IU). The aims of this study are as follows: (1) Compare the extent to which IU or Facilitation strategies achieve fidelity to the MISSION-Vet intervention as delivered by HPACT homeless provider staff. (2) Compare the effects of Facilitation and IU strategies on the National HPACT Performance Measures. (3) Compare the effects of IU and Facilitation on the permanent housing status. (4) Identify and describe key stakeholders’ (patients, providers, staff) experiences with, and perspectives on, the barriers to, and facilitators of implementing MISSION. DESIGN: Type III Hybrid modified stepped wedge implementation comparing IU to Facilitation across seven HPACT teams in three sites in the greater Los Angeles VA system. This is a cluster randomized trial. DISCUSSION: Integrating MISSION-Vet within HPACT has the potential to improve the health of thousands of veterans, but it is crucial to implement the intervention appropriately in order for it to succeed. The lessons learned in this protocol could assist with a larger roll-out of MISSION within HPACT. This protocol is registered with clinicaltrials.gov and was assigned the number NCT 02942979.
format Online
Article
Text
id pubmed-5379611
institution National Center for Biotechnology Information
language English
publishDate 2017
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-53796112017-04-07 A Hybrid III stepped wedge cluster randomized trial testing an implementation strategy to facilitate the use of an evidence-based practice in VA Homeless Primary Care Treatment Programs Simmons, Molly M. Gabrielian, Sonya Byrne, Thomas McCullough, Megan B. Smith, Jeffery L. Taylor, Thom J. O’Toole, Tom P. Kane, Vincent Yakovchenko, Vera McInnes, D. Keith Smelson, David A. Implement Sci Study Protocol BACKGROUND: Homeless veterans often have multiple health care and psychosocial needs, including assistance with access to housing and health care, as well as support for ongoing treatment engagement. The Department of Veterans Affairs (VA) developed specialized Homeless Patient Alignment Care Teams (HPACT) with the goal of offering an integrated, “one-stop program” to address housing and health care needs of homeless veterans. However, while 70% of HPACT’s veteran enrollees have co-occurring mental health and substance use disorders, HPACT does not have a uniform, embedded treatment protocol for this subpopulation. One wraparound intervention designed to address the needs of homeless veterans with co-occurring mental health and substance use disorders which is suitable to be integrated into HPACT clinic sites is the evidence-based practice called Maintaining Independence and Sobriety through Systems Integration, Outreach, and Networking-Veterans Edition, or MISSION-Vet. Despite the promise of MISSION-Vet within HPACT clinics, implementation of an evidence-based intervention within a busy program like HPACT can be difficult. The current study is being undertaken to identify an appropriate implementation strategy for MISSION-Vet within HPACT. The study will test the implementation platform called Facilitation and compared to implementation as usual (IU). The aims of this study are as follows: (1) Compare the extent to which IU or Facilitation strategies achieve fidelity to the MISSION-Vet intervention as delivered by HPACT homeless provider staff. (2) Compare the effects of Facilitation and IU strategies on the National HPACT Performance Measures. (3) Compare the effects of IU and Facilitation on the permanent housing status. (4) Identify and describe key stakeholders’ (patients, providers, staff) experiences with, and perspectives on, the barriers to, and facilitators of implementing MISSION. DESIGN: Type III Hybrid modified stepped wedge implementation comparing IU to Facilitation across seven HPACT teams in three sites in the greater Los Angeles VA system. This is a cluster randomized trial. DISCUSSION: Integrating MISSION-Vet within HPACT has the potential to improve the health of thousands of veterans, but it is crucial to implement the intervention appropriately in order for it to succeed. The lessons learned in this protocol could assist with a larger roll-out of MISSION within HPACT. This protocol is registered with clinicaltrials.gov and was assigned the number NCT 02942979. BioMed Central 2017-04-04 /pmc/articles/PMC5379611/ /pubmed/28376839 http://dx.doi.org/10.1186/s13012-017-0563-2 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Study Protocol
Simmons, Molly M.
Gabrielian, Sonya
Byrne, Thomas
McCullough, Megan B.
Smith, Jeffery L.
Taylor, Thom J.
O’Toole, Tom P.
Kane, Vincent
Yakovchenko, Vera
McInnes, D. Keith
Smelson, David A.
A Hybrid III stepped wedge cluster randomized trial testing an implementation strategy to facilitate the use of an evidence-based practice in VA Homeless Primary Care Treatment Programs
title A Hybrid III stepped wedge cluster randomized trial testing an implementation strategy to facilitate the use of an evidence-based practice in VA Homeless Primary Care Treatment Programs
title_full A Hybrid III stepped wedge cluster randomized trial testing an implementation strategy to facilitate the use of an evidence-based practice in VA Homeless Primary Care Treatment Programs
title_fullStr A Hybrid III stepped wedge cluster randomized trial testing an implementation strategy to facilitate the use of an evidence-based practice in VA Homeless Primary Care Treatment Programs
title_full_unstemmed A Hybrid III stepped wedge cluster randomized trial testing an implementation strategy to facilitate the use of an evidence-based practice in VA Homeless Primary Care Treatment Programs
title_short A Hybrid III stepped wedge cluster randomized trial testing an implementation strategy to facilitate the use of an evidence-based practice in VA Homeless Primary Care Treatment Programs
title_sort hybrid iii stepped wedge cluster randomized trial testing an implementation strategy to facilitate the use of an evidence-based practice in va homeless primary care treatment programs
topic Study Protocol
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5379611/
https://www.ncbi.nlm.nih.gov/pubmed/28376839
http://dx.doi.org/10.1186/s13012-017-0563-2
work_keys_str_mv AT simmonsmollym ahybridiiisteppedwedgeclusterrandomizedtrialtestinganimplementationstrategytofacilitatetheuseofanevidencebasedpracticeinvahomelessprimarycaretreatmentprograms
AT gabrieliansonya ahybridiiisteppedwedgeclusterrandomizedtrialtestinganimplementationstrategytofacilitatetheuseofanevidencebasedpracticeinvahomelessprimarycaretreatmentprograms
AT byrnethomas ahybridiiisteppedwedgeclusterrandomizedtrialtestinganimplementationstrategytofacilitatetheuseofanevidencebasedpracticeinvahomelessprimarycaretreatmentprograms
AT mcculloughmeganb ahybridiiisteppedwedgeclusterrandomizedtrialtestinganimplementationstrategytofacilitatetheuseofanevidencebasedpracticeinvahomelessprimarycaretreatmentprograms
AT smithjefferyl ahybridiiisteppedwedgeclusterrandomizedtrialtestinganimplementationstrategytofacilitatetheuseofanevidencebasedpracticeinvahomelessprimarycaretreatmentprograms
AT taylorthomj ahybridiiisteppedwedgeclusterrandomizedtrialtestinganimplementationstrategytofacilitatetheuseofanevidencebasedpracticeinvahomelessprimarycaretreatmentprograms
AT otooletomp ahybridiiisteppedwedgeclusterrandomizedtrialtestinganimplementationstrategytofacilitatetheuseofanevidencebasedpracticeinvahomelessprimarycaretreatmentprograms
AT kanevincent ahybridiiisteppedwedgeclusterrandomizedtrialtestinganimplementationstrategytofacilitatetheuseofanevidencebasedpracticeinvahomelessprimarycaretreatmentprograms
AT yakovchenkovera ahybridiiisteppedwedgeclusterrandomizedtrialtestinganimplementationstrategytofacilitatetheuseofanevidencebasedpracticeinvahomelessprimarycaretreatmentprograms
AT mcinnesdkeith ahybridiiisteppedwedgeclusterrandomizedtrialtestinganimplementationstrategytofacilitatetheuseofanevidencebasedpracticeinvahomelessprimarycaretreatmentprograms
AT smelsondavida ahybridiiisteppedwedgeclusterrandomizedtrialtestinganimplementationstrategytofacilitatetheuseofanevidencebasedpracticeinvahomelessprimarycaretreatmentprograms
AT simmonsmollym hybridiiisteppedwedgeclusterrandomizedtrialtestinganimplementationstrategytofacilitatetheuseofanevidencebasedpracticeinvahomelessprimarycaretreatmentprograms
AT gabrieliansonya hybridiiisteppedwedgeclusterrandomizedtrialtestinganimplementationstrategytofacilitatetheuseofanevidencebasedpracticeinvahomelessprimarycaretreatmentprograms
AT byrnethomas hybridiiisteppedwedgeclusterrandomizedtrialtestinganimplementationstrategytofacilitatetheuseofanevidencebasedpracticeinvahomelessprimarycaretreatmentprograms
AT mcculloughmeganb hybridiiisteppedwedgeclusterrandomizedtrialtestinganimplementationstrategytofacilitatetheuseofanevidencebasedpracticeinvahomelessprimarycaretreatmentprograms
AT smithjefferyl hybridiiisteppedwedgeclusterrandomizedtrialtestinganimplementationstrategytofacilitatetheuseofanevidencebasedpracticeinvahomelessprimarycaretreatmentprograms
AT taylorthomj hybridiiisteppedwedgeclusterrandomizedtrialtestinganimplementationstrategytofacilitatetheuseofanevidencebasedpracticeinvahomelessprimarycaretreatmentprograms
AT otooletomp hybridiiisteppedwedgeclusterrandomizedtrialtestinganimplementationstrategytofacilitatetheuseofanevidencebasedpracticeinvahomelessprimarycaretreatmentprograms
AT kanevincent hybridiiisteppedwedgeclusterrandomizedtrialtestinganimplementationstrategytofacilitatetheuseofanevidencebasedpracticeinvahomelessprimarycaretreatmentprograms
AT yakovchenkovera hybridiiisteppedwedgeclusterrandomizedtrialtestinganimplementationstrategytofacilitatetheuseofanevidencebasedpracticeinvahomelessprimarycaretreatmentprograms
AT mcinnesdkeith hybridiiisteppedwedgeclusterrandomizedtrialtestinganimplementationstrategytofacilitatetheuseofanevidencebasedpracticeinvahomelessprimarycaretreatmentprograms
AT smelsondavida hybridiiisteppedwedgeclusterrandomizedtrialtestinganimplementationstrategytofacilitatetheuseofanevidencebasedpracticeinvahomelessprimarycaretreatmentprograms