3008 — An Implementation Planning Tool for Depression Care Management

Pyne JM (Mental Health QUERI), Fortney JC (Mental Health QUERI)

Objectives:
VA leadership has committed to widespread implementation of the depression care management model throughout the VA healthcare system. Numerous effectiveness studies have demonstrated that depression care management improves outcomes for primary care patients treated for depression. However, fidelity to the evidence base has been mixed during implementation studies. To maintain fidelity to the evidence base during implementation, we developed an implementation planning tool that outlines the decisions and steps needed to tailor depression care management implementation to local needs, resources, and priorities while maintaining fidelity to the evidence base.

Methods:
A 14-step implementation planning tool was developed based on organizational theory and lessons learned from two concurrent VA multi-site implementation studies. The concurrent studies were conducted in two different clinical (general primary care clinics and HIV clinics), organizational (community-based outpatient clinics and parent VAMC-based clinics), and geographic contexts (Mid-South and Southwest). In addition, multiple QUERIs collaborated during these implementation efforts (Mental Health, HIV/HCV, and Substance Use Disorders).

Results:
The 14-step implementation planning tool describes in detail the steps and action items needed to adapt an evidence-based collaborative care program for depression to local context while maintaining high fidelity to the research evidence base. The planning tool also identifies other implementation tools (e.g., decision support systems, suicide risk assessments) and resources (e.g., training materials) that can support implementation efforts. Specific examples of how the 14 steps were operationalized in the two multi-site studies will be provided along with the advantages and disadvantages of different approaches associated with each step.

Implications:
This 14-step implementation tool should help clinicians and administrators develop successful strategies for rolling out collaborative care for depression interventions. These steps were consistent with the evidence base for organizational theory and depression collaborative care and flexible enough to be applicable to different depression treatment contexts.

Impacts:
Implementation efforts are accelerating throughout VA. Implementation efforts are expensive. This 14-step implementation planning tool may provide a cost-effective approach to implementation efforts. Although we focused on the collaborative care model for depression, the same basic steps would be needed to implement collaborative care efforts for other disorders.