An Evidence‐Based Model for Disseminating‐Implementing Coordinated Anxiety Learning and Management in Department of Veterans Affairs’ Community‐Based Outpatient Clinics

2019 ◽  
Vol 36 (3) ◽  
pp. 371-380
Author(s):  
Michael A. Cucciare ◽  
Kathy Marchant ◽  
Jan Lindsay ◽  
Michelle G. Craske ◽  
Anthony Ecker ◽  
...  
Keyword(s):  
Veterans Affairs ◽  
Outpatient Clinics ◽  
Evidence Based ◽  
Department Of Veterans Affairs ◽  
Community Based ◽  
Evidence Based Model

Evaluation of the Department of Veterans Affairs Community-Based Outpatient Clinics

Medical Care ◽  
2002 ◽  
Vol 40 (7) ◽  
pp. 555-560 ◽  
Author(s):  
Michael K. Chapko ◽  
Steven J. Borowsky ◽  
John C. Fortney ◽  
Ashley N. Hedeen ◽  
Marsha Hoegle ◽  
...  
Keyword(s):  
Veterans Affairs ◽  
Outpatient Clinics ◽  
Department Of Veterans Affairs ◽  
Community Based

scholarly journals Adapting Coordinated Anxiety Learning and Management for Veterans Affairs Community-Based Outpatient Clinics: Iterative Approach

10.2196/10277 ◽  
2018 ◽  
Vol 5 (3) ◽  
pp. e10277 ◽  
Author(s):  
Traci H Abraham ◽  
Kathy Marchant-Miros ◽  
Michael B McCarther ◽  
Michelle G Craske ◽  
Geoffrey M Curran ◽  
...  
Keyword(s):  
Mental Health ◽  
Veterans Affairs ◽  
Outpatient Clinics ◽  
Evidence Based ◽  
Mental Health Providers ◽  
Health Providers ◽  
Focus Group Discussions ◽  
Group Discussions ◽  
Community Based ◽  
Computer Based

Background A national priority at the US Department of Veterans Affairs (VA) is to increase the availability and accessibility of evidence-based psychotherapies (EBPs) across all VA medical facilities. Yet many veterans, particularly those who use remote outpatient VA clinics, still do not receive much needed evidence-based treatment. Strategies are needed for supporting mental health providers at rural VA community-based outpatient clinics (CBOCs) as they translate their clinical training to routine practice. The Coordinated Anxiety Learning Management (CALM) program is a computer-delivered program that supports the delivery of cognitive behavioral therapy (CBT) by providers in outpatient settings to patients with depression and anxiety, including posttraumatic stress disorder. Objective The objectives of our study were to (1) adapt an existing computer-based program to rural VA CBOCs through feedback from key stakeholder focus groups; (2) develop a prototype of the adapted program; and (3) determine the adapted program’s acceptability and feasibility. Mental health stakeholders included VA leaders (n=4) in the implementation of EBPs, VA experts (n=4) in CBT, VA CBOC mental health providers (n=8), and veterans (n=8) diagnosed with a mental health condition treated using the CALM program and receiving treatment in a VA CBOC. Methods An iterative approach comprising 3 waves of focus group discussions was used to develop a modified prototype of CALM. Following each wave of focus group discussions, template analysis was used to rapidly communicate stakeholder recommendations and feedback to the design team. The original program was first adapted through a process of data collection, design modification, and product development. Next, a prototype was developed. Finally, the redesigned program was tested for acceptability and feasibility through a live demonstration. Results Key stakeholders suggested modifications to the original CALM program that altered its modules’ appearance by incorporating veteran-centric content. These modifications likely have no impact on the integrity of the original CALM program, but have altered its content to reflect better the demographic characteristics and experiences of rural veterans. Feedback from stakeholder groups indicates that changes will help VA patients identify with the program content, potentially enhancing their treatment engagement. Conclusions The development model was effective for economically gathering actionable recommendations from stakeholders to adapt a computer-based program, and it can result in the development of an acceptable and feasible computer-delivered intervention. Results have implications for developing computer-based programs targeting behavior change more broadly and enhancing engagement in EBP.

scholarly journals Adapting Coordinated Anxiety Learning and Management for Veterans Affairs Community-Based Outpatient Clinics: Iterative Approach (Preprint)

2018 ◽  
Author(s):  
Traci H Abraham ◽  
Kathy Marchant-Miros ◽  
Michael B McCarther ◽  
Michelle G Craske ◽  
Geoffrey M Curran ◽  
...  
Keyword(s):  
Mental Health ◽  
Veterans Affairs ◽  
Outpatient Clinics ◽  
Evidence Based ◽  
Mental Health Providers ◽  
Health Providers ◽  
Focus Group Discussions ◽  
Group Discussions ◽  
Community Based ◽  
Computer Based

BACKGROUND A national priority at the US Department of Veterans Affairs (VA) is to increase the availability and accessibility of evidence-based psychotherapies (EBPs) across all VA medical facilities. Yet many veterans, particularly those who use remote outpatient VA clinics, still do not receive much needed evidence-based treatment. Strategies are needed for supporting mental health providers at rural VA community-based outpatient clinics (CBOCs) as they translate their clinical training to routine practice. The Coordinated Anxiety Learning Management (CALM) program is a computer-delivered program that supports the delivery of cognitive behavioral therapy (CBT) by providers in outpatient settings to patients with depression and anxiety, including posttraumatic stress disorder. OBJECTIVE The objectives of our study were to (1) adapt an existing computer-based program to rural VA CBOCs through feedback from key stakeholder focus groups; (2) develop a prototype of the adapted program; and (3) determine the adapted program’s acceptability and feasibility. Mental health stakeholders included VA leaders (n=4) in the implementation of EBPs, VA experts (n=4) in CBT, VA CBOC mental health providers (n=8), and veterans (n=8) diagnosed with a mental health condition treated using the CALM program and receiving treatment in a VA CBOC. METHODS An iterative approach comprising 3 waves of focus group discussions was used to develop a modified prototype of CALM. Following each wave of focus group discussions, template analysis was used to rapidly communicate stakeholder recommendations and feedback to the design team. The original program was first adapted through a process of data collection, design modification, and product development. Next, a prototype was developed. Finally, the redesigned program was tested for acceptability and feasibility through a live demonstration. RESULTS Key stakeholders suggested modifications to the original CALM program that altered its modules’ appearance by incorporating veteran-centric content. These modifications likely have no impact on the integrity of the original CALM program, but have altered its content to reflect better the demographic characteristics and experiences of rural veterans. Feedback from stakeholder groups indicates that changes will help VA patients identify with the program content, potentially enhancing their treatment engagement. CONCLUSIONS The development model was effective for economically gathering actionable recommendations from stakeholders to adapt a computer-based program, and it can result in the development of an acceptable and feasible computer-delivered intervention. Results have implications for developing computer-based programs targeting behavior change more broadly and enhancing engagement in EBP.

scholarly journals Factors Affecting Adoption of Coordinated Anxiety Learning and Management (CALM) in Veterans’ Affairs Community‐Based Outpatient Clinics

2020 ◽  
Author(s):  
Anthony H. Ecker ◽  
Traci H. Abraham ◽  
Lindsey A. Martin ◽  
Kathy Marchant‐Miros ◽  
Michael A. Cucciare
Keyword(s):  
Veterans Affairs ◽  
Outpatient Clinics ◽  
Community Based ◽  
Factors Affecting

scholarly journals Association of VA Payment Reform for Dialysis with Spending, Access to Care, and Outcomes for Veterans with ESKD

2020 ◽  
Vol 15 (11) ◽  
pp. 1631-1639
Author(s):  
Virginia Wang ◽  
Shailender Swaminathan ◽  
Emily A. Corneau ◽  
Matthew L. Maciejewski ◽  
Amal N. Trivedi ◽  
...  
Keyword(s):  
Access To Care ◽  
Veterans Affairs ◽  
Dialysis Access ◽  
Department Of Veterans Affairs ◽  
Health Administration ◽  
Payment Reform ◽  
Community Based ◽  
Time Period ◽  
Community Providers ◽  
Dialysis Facilities

Background and objectivesBecause of the limited capacity of its own dialysis facilities, the Department of Veterans Affairs (VA) Veterans Health Administration routinely outsources dialysis care to community providers. Prior to 2011—when the VA implemented a process of standardizing payments and establishing national contracts for community-based dialysis care—payments to community providers were largely unregulated. This study examined the association of changes in the Department of Veterans Affairs payment policy for community dialysis with temporal trends in VA spending and veterans’ access to dialysis care and mortality.Design, setting, participants, & measurementsAn interrupted time series design and VA, Medicare, and US Renal Data System data were used to identify veterans who received VA–financed dialysis in community-based dialysis facilities before (2006–2008), during (2009–2010), and after the enactment of VA policies to standardize dialysis payments (2011–2016). We used multivariable, differential trend/intercept shift regression models to examine trends in average reimbursement for community-based dialysis, access to quality care (veterans’ distance to community dialysis, number of community dialysis providers, and dialysis facility quality indicators), and 1-year mortality over this time period.ResultsBefore payment reform, the unadjusted average per-treatment reimbursement for non–VA dialysis care varied widely ($47–$1575). After payment reform, there was a 44% reduction ($44–$250) in the adjusted price per dialysis session (P<0.001) and less variation in payments for dialysis ($73–$663). Over the same time period, there was an increase in the number of community dialysis facilities contracting with VA to deliver care to veterans with ESKD from 19 to 37 facilities (per VA hospital), and there were no changes in either the quality of community dialysis facilities or crude 1-year mortality rate of veterans (12% versus 11%).ConclusionsVA policies to standardize payment and establish national dialysis contracts increased the value of VA–financed community dialysis care by reducing reimbursement without compromising access to care or survival.

Sign in / Sign up

Export Citation Format

Share Document