Jennifer K Coury, Jennifer L Schneider, Beverly B Green, Laura-Mae Baldwin, Amanda F Petrik, Jennifer S Rivelli, Malaika R Schwartz, & Gloria D Coronado
University of Washington affiliated authors are displayed in bold.
Published: February 2020
Krysttel Stryczek, Colby Lea, Chris Gillespie, George Sayre, Scott Wanner, Seppo T. Rinne, Renda Soylemez Wiener, Laura Feemster, Edmunds Udris, David H. Au, & Christian D. Helfrich
University of Washington affiliated authors are displayed in bold.
Published: January 2020
Amritha Bhat, Ian M. Bennett, Amy M. Bauer, Rinad S. Beidas, Whitney Eriksen, Frances K. Barg, Rachel Gold, Jürgen Unützer
University of Washington affiliated authors are displayed in bold.
Published: January 2020
The collaborative care model (CoCM) is a multicomponent, team-based integrated behavioral health framework. Its effectiveness in the treatment of perinatal depression is established, but implementation has been limited. The authors used longitudinal remote coaching (LRC) as a novel implementation strategy to support systematic case review in a multistate cluster-randomized trial of CoCM for perinatal depression. They describe LRC for perinatal CoCM in three clinics and use of a mixed-methods analysis of data from LRC feedback forms and interviews with participants. LRC is a scalable implementation strategy with potential to support complex models of integrated behavioral health, such as perinatal CoCM.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
Michael L. Parchman, Brooke Ike, Katherine P. Osterhage, Laura-Mae Baldwin, Kari A. Stephens and Sarah Sutton
University of Washington affiliated authors are displayed in bold.
Published: January 2020
Christine M. Khosropour, Kandis V. Backus, Arianna R. Means, Laura Beauchamps, Kendra Johnson, Matthew R. Golden, and Leandro Mena
University of Washington affiliated authors are displayed in bold.
Published: January 2020
Noah S. Triplett, Georganna Sedlar, Lucy Berliner, Nathaniel Jungbluth, Meredith Boyd, & Shannon Dorsey
University of Washington affiliated authors are displayed in bold.
Published: January 2020
Jill Locke, Christina Kang-Yi, Lindsay Frederick, David S Mandell
University of Washington affiliated authors are displayed in bold.
Published: December 2019
Anjuli D. Wagner, Sarah Gimbel, Kristjana H. Ásbjörnsdóttir, Peter Cherutich, Joana Coutinho, Jonny Crocker, Emiliae Cruz, Fatima Cuembelo, Vasco Cumbe, McKenna Eastment, Jennifer Einberg, Florencia Floriano, Douglas Gaitho, Brandon L. Guthrie, Grace John-Stewart, Alex H. Kral, Barrot H. Lambdin, Shan Liu, Martin Bcom Maina, Nelia Manaca, Mika Matsuzaki, Loris Mattox, Nancy Mburu, R. Scott McClelland, Mark A. Micek, Ana Olga Mocumbi, Albertoe Muanido, Ruth Nduati, Irene N. Njuguna, Geoffrey Oluoch, Laura B. Oyiengo, Keshet Ronen, Caroline Soi, Bradley H. Wagenaar, George Wanje, Lynn D. Wenger, and Kenneth Sherr
University of Washington affiliated authors are displayed in bold.
Published: December 2019
Andrea L. Nevedal, Eleanor T. Lewis, Justina Wu, Josephine Jacobs, Jeffrey G. Jarvik, Roger Chou, & Paul G. Barnett
University of Washington affiliated authors are displayed in bold.
Published: December 2019
Clinical practice guidelines suggest that magnetic resonance imaging of the lumbar spine (LS-MRI) is unneeded during the first 6 weeks of acute, uncomplicated low-back pain. Unneeded LS-MRIs do not improve patient outcomes, lead to unnecessary surgeries and procedures, and cost the US healthcare system about $300 million dollars per year. However, why primary care providers (PCPs) order unneeded LS-MRI for acute, uncomplicated low-back pain is poorly understood.
To characterize and explain the factors contributing to PCPs ordering unneeded LS-MRI for acute, uncomplicated low-back pain.
Qualitative study using semi-structured interviews.
Veterans Affairs PCPs identified from administrative data as having high or low rates of guideline-concordant LS-MRI ordering in 2016.
Providers were interviewed about their use of LS-MRI for acute, uncomplicated low-back pain and factors contributing to their decision-making. Directed content analysis of transcripts was conducted to identify and compare environmental-, patient-, and provider-level factors contributing to unneeded LS-MRI.
Fifty-five PCPs participated (8.6% response rate). Both low (n = 33) and high (n = 22) guideline-concordant providers reported that LS-MRIs were required for specialty care referrals, but they differed in how other environmental factors (stringency of radiology utilization review, management of patient travel burden, and time constraints) contributed to LS-MRI ordering patterns. Low- and high-guideline-concordant providers reported similar patient factors (beliefs in value of imaging and pressure on providers). However, provider groups differed in how provider-level factors (guideline familiarity and agreement, the extent to which they acquiesced to patients, and belief in the value of LS-MRI) contributed to LS-MRI ordering patterns.
Results describe how diverse environmental, patient, and provider factors contribute to unneeded LS-MRI for acute, uncomplicated low-back pain. Prior research using a single intervention to reduce unneeded LS-MRI has been ineffective. Results suggest that multifaceted de-implementation strategies may be required to reduce unneeded LS-MRI.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
Mona J. Ritchie, JoAnn E. Kirchner, James C. Townsend, Jeffery A. Pitcock, Katherine M. Dollar, & Chuan-Fen Liu
University of Washington affiliated authors are displayed in bold.
Published: December 2019
Integrating mental health services into primary care settings is complex and challenging. Although facilitation strategies have successfully supported implementation of primary care mental health integration and other complex innovations, we know little about the time required or its cost.
To examine the time and organizational cost of facilitating implementation of primary care mental health integration.
Descriptive analysis.
One expert external facilitator and two internal regional facilitators who helped healthcare system stakeholders, e.g., leaders, managers, clinicians, and non-clinical staff, implement primary care mental health integration at eight clinics.
Implementation facilitation tailored to the needs and resources of the setting and its stakeholders.
We documented facilitators’ and stakeholders’ time and types of activities using a structured spreadsheet collected from facilitators on a weekly basis. We obtained travel costs and salary information. We conducted descriptive analysis of time data and estimated organizational cost.
The external facilitator devoted 263 h (0.09 FTE), including travel, across all 8 clinics over 28 months. Internal facilitator time varied across networks (1792 h versus 1169 h), as well as clinics. Stakeholder participation time was similar across networks (1280.6 versus 1363.4 person hours) but the number of stakeholders varied (133 versus 199 stakeholders). The organizational cost of providing implementation facilitation also varied across networks ($263,490 versus $258,127). Stakeholder participation accounted for 35% of the cost of facilitation activities in one network and 47% of the cost in the other.
Although facilitation can improve implementation of primary care mental health integration, it requires substantial organizational investments that may vary by site and implementation effort. Furthermore, the cost of using an external expert to transfer facilitation skills and build capacity for implementation efforts appears to be minimal.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**