Adaptive Implementation Intervention for VA Suicide Risk Identification Strategy

VA Office of Research and Development

Status: Completed

Conditions: Suicide

Treatments: Behavioral: Audit and Feedback; Behavioral: External Facilitation

Study type: Interventional

Funder types: Other U.S. Federal agency

Identifiers

NCT04243330

PEC 19-303 (Other Grant/Funding Number)

PEX 19-005

Details and patient eligibility

About

The overall objective of this national quality improvement project is to develop an adaptive implementation strategy to improve the implementation of suicide risk screening and evaluation in Veterans Health Administration ambulatory care settings (i.e., VA Risk ID).

Full description

VA Risk ID is the largest implementation of population-based suicide risk screening and evaluation in any United States healthcare system to date. Given the considerable scope of this initiative, several strategies have been employed to support national implementation. To facilitate continuous quality improvement, ongoing evaluation of VA Risk ID and interventions to improve implementation of the three-stage screening and evaluation process are needed. This project is intended to help VHA facilities address challenges to implementing VA Risk ID to fidelity using a sequence of evidence-based implementation strategies (audit and feedback followed by audit and feedback plus external facilitation). By doing so, it will ensure that more Veterans are screened and evaluated for suicide risk, which is the basis of effective, patient-centered suicide risk management. By adapting the implementation intervention "dose" based on facility performance and monitoring implementation over time, this project will allow the program office to focus resources where and when needed the most.

Enrollment: 138 patients

Sex: All

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• Intervention occurs at the site/facility level. Up to 140 VHA facilities across the country will participate in the project. Sites will be allocated to various interventions based on performance (i.e., pre-determined benchmarks for adequate implementation).

Exclusion criteria

• This is a national quality improvement project. Sites that are randomized to different intervention arms based on performance may refuse to participate in the implementation interventions.

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Sequential Assignment

Masking: None (Open label)

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138 participants in 3 patient groups

Implementation as Usual

No Intervention group

Description:

Implementation support consisting of clinical decision support tools, trainings, technical assistance and quality assurance to support implementation of VA Suicide Risk Identification Strategy. Available to all facilities.

Audit and Feedback

Experimental group

Description:

Audit and Feedback will serve as the first stage implementation intervention for sites that do not meet the benchmark for adequate implementation following 9 months of implementation as usual.

Treatment:

Behavioral: Audit and Feedback

External Facilitation

Experimental group

Description:

Audit and Feedback plus External Facilitation will serve as the second stage implementation intervention for sites that still do not meet the benchmark for adequate implementation following 9 months of implementation as usual plus audit and feedback.

Treatment:

Behavioral: Audit and Feedback

Behavioral: External Facilitation