Mental Health: How a Collaborative Chronic Care Model Helps Improve Outcomes

According to a recent study published online in JAMA Network Open, the use of a collaborative chronic care model (CCM) in general clinical practice settings for individuals with complex mental health conditions can improve overall health outcomes. 

“[CCMs] have extensive randomized clinical trial evidence for effectiveness in serious mental illnesses, but little evidence exists regarding their feasibility or effect in typical practice conditions,” wrote lead study author Mark Bauer, MD, from the Center for Healthcare Organization & Implementation Research at the VA Boston Healthcare System, and colleagues. 

To determine the effectiveness of implementation facilitation in establishing the CCM in mental health teams and the impact on health outcomes of team-treated individuals, Dr Bauer and colleagues conducted a quasi-experimental, randomized,` stepped-wedge implementation trial. The trial was from February 2016 through February 2018 and
was in partnership with the Department of Veteran Affairs (VA) Office of Mental Health and Suicide Prevention. 

The research team enrolled nine facilities from all VA facilities in the United States. These nine facilities received CCM implementation support. Further, veterans treated by designated outpatient general mental health teams were included for hospitalization analyses, and a random sample was identified for health status interviews. Finally, clinicians at each facility were surveyed. The researchers rated site process summaries for concordance with the CCM process. 

The study included 5596 veterans, which included 881 women and the average age was 52.2 years. The random sample selected for health interviews included 1050 participants but was oversampled for women (n=210). 

According to the findings, facilitation was linked with improvements in Team Development Measure subscales for role clarity and team primacy. Further, the CCM-concordant processes achieved varied from 44% to 89%, and no improvement was seen in veteran self-ratings, which included the primary outcome. 

The authors noted that in a post hoc analyses, mental component score improved among veterans with three or more treated mental health diagnoses, and mental health hospitalizations demonstrated a large decrease during facilitation. 

“VA is committed to ensuring veterans receive the best mental health care available,” VA Secretary Robert Wilkie said in a statement. “Combining best practices, such as those identified in the study allows VA to continually refine our mental health services.”—Julie Gould