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Pittman JOE, Lindamer L, Afari N, Depp C, Villodas M, Hamilton A, Kim B, Mor MK, Almklov E, Gault J, Rabin B. Implementing eScreening for suicide prevention in VA post-9/11 transition programs using a stepped-wedge, mixed-method, hybrid type-II implementation trial: a study protocol. Implement Sci Commun 2021; 2:46. [PMID: 33926577 PMCID: PMC8082763 DOI: 10.1186/s43058-021-00142-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 03/25/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Post-9/11 veterans who enroll in VA health care frequently present with suicidal ideation and/or recent suicidal behavior. Most of these veterans are not screened on their day of enrollment and their risk goes undetected. Screening for suicide risk, and associated mental health factors, can lead to early detection and referral to effective treatment, thereby decreasing suicide risk. eScreening is an innovative Gold Standard Practice with evidence to support its effectiveness and implementation potential in transition and care management (TCM) programs. We will evaluate the impact of eScreening to improve the rate and speed of suicide risk screening and referral to mental health care compared to current screening methods used by transition care managers. We will also evaluate the impact of an innovative, multicomponent implementation strategy (MCIS) on the reach, adoption, implementation, and sustained use of eScreening. METHODS This is an eight-site 4-year, stepped-wedge, mixed-method, hybrid type-II implementation trial comparing eScreening to screening as usual while also evaluating the potential impact of the MCIS focusing on external facilitation and Lean/SixSigma rapid process improvement workshops in TCM. The aims will address: 1) whether using eScreening compared to oral and/or paper-based methods in TCM programs is associated with improved rates and speed of PTSD, depression, alcohol, and suicide screening & evaluation, and increased referral to mental health treatment; 2) whether and to what degree our MCIS is feasible, acceptable, and has the potential to impact adoption, implementation, and maintenance of eScreening; and 3) how contextual factors influence the implementation of eScreening between high- and low-eScreening adopting sites. We will use a mixed methods approach guided by the RE-AIM outcomes of the Practical Robust Implementation and Sustainability Model (PRISM). Data to address Aim 1 will be collected via medical record query while data for Aims 2 and 3 will be collected from TCM staff questionnaires and qualitative interviews. DISCUSSION The results of this study will help identify best practices for screening in suicide prevention for Post-9/11 veterans enrolling in VA health care and will provide information on how best to implement technology-based screening into real-world clinical care programs. TRIAL REGISTRATION ClinicalTrials.gov : NCT04506164; date registered: August 20, 2020; retrospectively registered.
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Affiliation(s)
- James O E Pittman
- VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA, USA.
- VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, USA.
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, USA.
| | - Laurie Lindamer
- VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA, USA
- VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, USA
| | - Niloofar Afari
- VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA, USA
- VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, USA
| | - Colin Depp
- VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA, USA
- VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, USA
| | - Miguel Villodas
- San Diego State University, 5500 Campanile Dr, San Diego, CA, USA
| | - Alison Hamilton
- VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA, USA
| | - Bo Kim
- HSR&D Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA, USA
| | - Maria K Mor
- VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- VA Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Erin Almklov
- VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA, USA
- VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, USA
| | - John Gault
- VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA, USA
- VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, USA
| | - Borsika Rabin
- VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA, USA
- UC San Diego Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, USA
- UC San Diego Dissemination and Implementation Science Center, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, USA
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Pittman JOE, Rabin B, Almklov E, Afari N, Floto E, Rodriguez E, Lindamer L. Adaptation of a quality improvement approach to implement eScreening in VHA healthcare settings: innovative use of the Lean Six Sigma Rapid Process Improvement Workshop. Implement Sci Commun 2021; 2:37. [PMID: 33827705 PMCID: PMC8028199 DOI: 10.1186/s43058-021-00132-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 03/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Veterans Health Administration (VHA) developed a comprehensive mobile screening technology (eScreening) that provides customized and automated self-report health screening via mobile tablet for veterans seen in VHA settings. There is agreement about the value of health technology, but limited knowledge of how best to broadly implement and scale up health technologies. Quality improvement (QI) methods may offer solutions to overcome barriers related to broad scale implementation of technology in health systems. We aimed to develop a process guide for eScreening implementation in VHA clinics to automate self-report screening of mental health symptoms and psychosocial challenges. METHODS This was a two-phase, mixed methods implementation project building on an adapted quality improvement method. In phase one, we adapted and conducted an RPIW to develop a generalizable process guide for eScreening implementation (eScreening Playbook). In phase two, we integrated the eScreening Playbook and RPIW with additional strategies of training and facilitation to create a multicomponent implementation strategy (MCIS) for eScreening. We then piloted the MCIS in two VHA sites. Quantitative eScreening pre-implementation survey data and qualitative implementation process "mini interviews" were collected from individuals at each of the two sites who participated in the implementation process. Survey data were characterized using descriptive statistics, and interview data were independently coded using a rapid qualitative analytic approach. RESULTS Pilot data showed overall satisfaction and usefulness of our MCIS approach and identified some challenges, solutions, and potential adaptations across sites. Both sites used the components of the MCIS, but site 2 elected not to include the RPIW. Survey data revealed positive responses related to eScreening from staff at both sites. Interview data exposed implementation challenges related to the technology, support, and education at both sites. Workflow and staffing resource challenges were only reported by site 2. CONCLUSIONS Our use of RPIW and other QI methods to both develop a playbook and an implementation strategy for eScreening has created a testable implementation process to employ automated, patient-facing assessment. The efficient collection and communication of patient information have the potential to greatly improve access to and quality of healthcare.
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Affiliation(s)
- James O E Pittman
- VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr., San Diego, CA, USA. .,Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA, USA. .,VA San Diego Healthcare System, 3350 La Jolla Village Dr., San Diego, CA, USA. .,UC San Diego Dissemination and Implementation Science Center, University of California San Diego, 9500 Gilman Dr., La Jolla, CA, USA.
| | - Borsika Rabin
- VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr., San Diego, CA, USA.,UC San Diego Dissemination and Implementation Science Center, University of California San Diego, 9500 Gilman Dr., La Jolla, CA, USA.,Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Dr., La Jolla, CA, USA
| | - Erin Almklov
- VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr., San Diego, CA, USA
| | - Niloofar Afari
- VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr., San Diego, CA, USA.,Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA, USA.,VA San Diego Healthcare System, 3350 La Jolla Village Dr., San Diego, CA, USA
| | - Elizabeth Floto
- VA Roseburg Health Care System, 913 NW Garden Valley Blvd, Roseburg, OR, USA
| | - Eusebio Rodriguez
- VA San Diego Healthcare System, 3350 La Jolla Village Dr., San Diego, CA, USA
| | - Laurie Lindamer
- VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr., San Diego, CA, USA.,Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA, USA.,VA San Diego Healthcare System, 3350 La Jolla Village Dr., San Diego, CA, USA.,UC San Diego Dissemination and Implementation Science Center, University of California San Diego, 9500 Gilman Dr., La Jolla, CA, USA
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Garcia RA, Spitzer ED, Beaudry J, Beck C, Diblasi R, Gilleeny-Blabac M, Haugaard C, Heuschneider S, Kranz BP, McLean K, Morales KL, Owens S, Paciella ME, Torregrosa E. Multidisciplinary team review of best practices for collection and handling of blood cultures to determine effective interventions for increasing the yield of true-positive bacteremias, reducing contamination, and eliminating false-positive central line-associated bloodstream infections. Am J Infect Control 2015; 43:1222-37. [PMID: 26298636 DOI: 10.1016/j.ajic.2015.06.030] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 06/23/2015] [Accepted: 06/29/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND A literature search was conducted using keywords for articles published in English from January 1990 to March 2015. Using criteria related to blood culture collection and handling, the search yielded 101 articles. References used also included Microbiology Laboratory standards, guidelines, and textbook information. RESULTS The literature identified diverse and complex issues surrounding blood culture practices, including the impact of false-positive results, laboratory definition of contamination, effect on central line-associated bloodstream infection (CLABSI) reporting, indications for collecting blood cultures, drawing from venipuncture sites versus intravascular catheters, selection of antiseptics, use of needleless connectors, inoculation of blood culture bottles, and optimizing program management in emergency departments, education, and implementation of bundled practice initiatives. CONCLUSION Hospitals should optimize best practice in the collection, handling, and management of blood culture specimens, an often overlooked but essential component in providing optimal care of patients in all settings and populations, reducing financial burdens, and increasing the accuracy of reportable CLABSI. Although universal concepts exist in blood culture practices, some issues require further research to determine benefit. Institutions undertaking a review of their blood culture programs are encouraged to use a checklist that addresses elements that encompass the research contained in this review.
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