This preprint is under consideration at Implementation Science. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
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Implementation of Peer Specialist Services in VA Primary Care: A Cluster Randomized Trial on the Impact of External Facilitation
Matthew Chinman
VA Pittsburgh Healthcare System
Corresponding Author
ORCiD: https://orcid.org/0000-0001-5390-8723
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background. Over 1100 Veterans work in the Veteran’s Health Administration (VHA) as Peer Specialists (PSs)—those with formal training who support other Veterans with similar diagnoses. A White House Executive Action mandated the pilot reassignment of VHA PSs from their usual placement in mental health to 25 primary care Patient Aligned Care Teams (PACT) in order to broaden the provision of wellness services that can address many chronic illnesses. An evaluation of this initiative was undertaken to assess the impact of outside assistance on the deployment of PS in PACT, as implementation support is often needed to prevent challenges commonly experienced when first deploying PSs in VHA settings.
Methods. This study was a cluster-randomized Hybrid II trial to test the impact of minimal implementation support vs. facilitated implementation on the deployment of VHA PSs in PACT over two years. Twenty-five Veteran’s Affairs Medical Centers (VAMCs) were recruited to reassign a mental health PSs to provide wellness-oriented care in PACT. Sites in three successive cohorts (n=7, 10, 8) over six-month blocks were matched and randomized to each study condition. In facilitated implementation, an outside expert worked with site stakeholders through a site visit and regular calls, and provided performance data to guide the planning and address challenges. Minimal implementation sites received a webinar and access the Office of Mental Health Services work group. The two conditions were compared on PS workload data and Veteran measures of activation, satisfaction and functioning. Qualitative interviews collected information on perceived usefulness of the PS services.
Results. In the first year, sites that received facilitation had higher numbers of unique Veterans served and a higher number of PS visits, although the groups did not differ after the second year. Also, sites receiving external facilitation started delivering PS services more quickly than minimal support sites. All sites in the external facilitation condition continued in the pilot into the second year, whereas two of the sites in the minimal assistance condition dropped out after the first year. There were no differences between groups on Veterans’ outcomes—activation, satisfaction and functioning. Most Veterans were very positive about the help they received as evidenced in the qualitative interviews.
Discussion. These findings demonstrate that external facilitation can be effective in supporting the implementation of PSs in primary care settings. The lack of significant differences across conditions after the second year highlights the positive outcomes associated with active facilitation, while also raising the important question of whether longer-term success may require some level of ongoing facilitation and implementation support.
Trial Registration. This project is registered at ClinicalTrials.gov with number NCT02732600 (URL:https://clinicaltrials.gov/ct2/show/NCT02732600).
Keywords
Peer Specialist, implementation, facilitation, primary care
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CURRENT STATUS: Under Revision
Version 1
Posted 18 Sep, 2020
No community comments so far
Editorial decision: Major revision
On 31 Dec, 2020
Review #2 received
Received 05 Nov, 2020
Review #1 received
Received 05 Nov, 2020
Reviewer #2 agreed
On 14 Oct, 2020
Reviewer #1 agreed
On 30 Sep, 2020
Reviewers invited
Invitations sent on 26 Sep, 2020
Editor assigned
On 14 Sep, 2020
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On 13 Sep, 2020
Editor invited
On 13 Sep, 2020
First submitted
On 11 Sep, 2020
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This preprint is under consideration at Implementation Science. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research
Implementation of Peer Specialist Services in VA Primary Care: A Cluster Randomized Trial on the Impact of External Facilitation
Matthew Chinman
VA Pittsburgh Healthcare System
Corresponding Author
ORCiD: https://orcid.org/0000-0001-5390-8723
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Revision
Version 1
Posted 18 Sep, 2020
No community comments so far
Editorial decision: Major revision
On 31 Dec, 2020
Review #2 received
Received 05 Nov, 2020
Review #1 received
Received 05 Nov, 2020
Reviewer #2 agreed
On 14 Oct, 2020
Reviewer #1 agreed
On 30 Sep, 2020
Reviewers invited
Invitations sent on 26 Sep, 2020
Editor assigned
On 14 Sep, 2020
Submission checks complete
On 13 Sep, 2020
Editor invited
On 13 Sep, 2020
First submitted
On 11 Sep, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background. Over 1100 Veterans work in the Veteran’s Health Administration (VHA) as Peer Specialists (PSs)—those with formal training who support other Veterans with similar diagnoses. A White House Executive Action mandated the pilot reassignment of VHA PSs from their usual placement in mental health to 25 primary care Patient Aligned Care Teams (PACT) in order to broaden the provision of wellness services that can address many chronic illnesses. An evaluation of this initiative was undertaken to assess the impact of outside assistance on the deployment of PS in PACT, as implementation support is often needed to prevent challenges commonly experienced when first deploying PSs in VHA settings.
Methods. This study was a cluster-randomized Hybrid II trial to test the impact of minimal implementation support vs. facilitated implementation on the deployment of VHA PSs in PACT over two years. Twenty-five Veteran’s Affairs Medical Centers (VAMCs) were recruited to reassign a mental health PSs to provide wellness-oriented care in PACT. Sites in three successive cohorts (n=7, 10, 8) over six-month blocks were matched and randomized to each study condition. In facilitated implementation, an outside expert worked with site stakeholders through a site visit and regular calls, and provided performance data to guide the planning and address challenges. Minimal implementation sites received a webinar and access the Office of Mental Health Services work group. The two conditions were compared on PS workload data and Veteran measures of activation, satisfaction and functioning. Qualitative interviews collected information on perceived usefulness of the PS services.
Results. In the first year, sites that received facilitation had higher numbers of unique Veterans served and a higher number of PS visits, although the groups did not differ after the second year. Also, sites receiving external facilitation started delivering PS services more quickly than minimal support sites. All sites in the external facilitation condition continued in the pilot into the second year, whereas two of the sites in the minimal assistance condition dropped out after the first year. There were no differences between groups on Veterans’ outcomes—activation, satisfaction and functioning. Most Veterans were very positive about the help they received as evidenced in the qualitative interviews.
Discussion. These findings demonstrate that external facilitation can be effective in supporting the implementation of PSs in primary care settings. The lack of significant differences across conditions after the second year highlights the positive outcomes associated with active facilitation, while also raising the important question of whether longer-term success may require some level of ongoing facilitation and implementation support.
Trial Registration. This project is registered at ClinicalTrials.gov with number NCT02732600 (URL:https://clinicaltrials.gov/ct2/show/NCT02732600).