title: Use of a learning collaborative to support implementation of integrated care for smoking cessation for veterans with posttraumatic stress disorder.
abstract: OBJECTIVE
  We evaluated the feasibility of incorporating integrated care (IC) for smoking cessation into routine treatment for posttraumatic stress disorder (PTSD) at Department of Veterans Affairs (VA) Medical Centers and the utility of the Learning Collaborative (LC) model in facilitating implementation.
  
  
  METHODS
  We conducted 2 LCs aimed at implementing IC for smoking cessation using multidisciplinary teams comprising 70 staff members from 12 VA PTSD clinics. Using questionnaires, we evaluated providers' perceptions of the LC methodology and the effectiveness and feasibility of routine IC delivery. We assessed number of providers delivering and patients receiving IC using medical record data.
  
  
  RESULTS
  More than 85% of participating VA staff considered the LC to be an effective training and implementation platform. The majority thought IC effectively addressed an important need and could be delivered in routine PTSD care. All LC participants who planned to deliver IC did so (n=52). Within 12 months of initial training, an additional 46 locally trained providers delivered IC and 395 veterans received IC.
  
  
  CONCLUSIONS
  The LC model effectively facilitated rapid and broad implementation of IC. Facilitators and barriers to sustained use of IC are unknown and should be identified to understand how best to promote ongoing access to evidence-based treatment for smoking cessation in mental health populations.
authors.affiliation: Lori Ebert is with the Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC. Carol Malte is with the Center of Excellence in Substance Abuse Treatment and Education, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA. Kim Hamlett-Berry is with Clinical Public Health, Department of Veterans Affairs, Washington, DC. Jean Beckham is with the VA Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham. Miles McFall and Andrew Saxon are with the VA Puget Sound Health Care System, Seattle.
authors.forename: Lori
authors.initials: L
authors.lastname: Ebert
authors.forename: Carol
authors.initials: C
authors.lastname: Malte
authors.forename: Kim
authors.initials: K
authors.lastname: Hamlett-Berry
authors.forename: Jean
authors.initials: J
authors.lastname: Beckham
authors.forename: Miles
authors.initials: M
authors.lastname: McFall
authors.forename: Andrew
authors.initials: A
authors.lastname: Saxon
mesh_terms: D000328:Adult; D003299:Cooperative Behavior; D005260:Female; D006801:Humans; D008297:Male; D010348:Patient Care Team / Q000458:organization & administration*; D016540:Smoking Cessation / Q000379:methods*; D013313:Stress Disorders, Post-Traumatic / Q000628:therapy*; D011795:Surveys and Questionnaires; D014029:Tobacco Use Disorder / Q000628:therapy*; D014481:United States; D014728:Veterans