title: Enhancing outreach for persons with serious mental illness: 12-month results from a cluster randomized trial of an adaptive implementation strategy.
abstract: BACKGROUND
  Few implementation strategies have been empirically tested for their effectiveness in improving uptake of evidence-based treatments or programs. This study compared the effectiveness of an immediate versus delayed enhanced implementation strategy (Enhanced Replicating Effective Programs (REP)) for providers at Veterans Health Administration (VA) outpatient facilities (sites) on improved uptake of an outreach program (Re-Engage) among sites not initially responding to a standard implementation strategy.
  
  
  METHODS
  One mental health provider from each U.S. VA site (N = 158) was initially given a REP-based package and training program in Re-Engage. The Re-Engage program involved giving each site provider a list of patients with serious mental illness who had not been seen at their facility for at least a year, requesting that providers contact these patients, assessing patient clinical status, and where appropriate, facilitating appointments to VA health services. At month 6, sites considered non-responsive (N = 89, total of 3,075 patients), defined as providers updating documentation for less than <80% of patients on their list, were randomized to two adaptive implementation interventions: Enhanced REP (provider coaching; N = 40 sites) for 6 months followed by Standard REP for 6 months; versus continued Standard REP (N = 49 sites) for 6 months followed by 6 months of Enhanced REP for sites still not responding. Outcomes included patient-level Re-Engage implementation and utilization.
  
  
  RESULTS
  Patients from sites that were randomized to receive Enhanced REP immediately compared to Standard REP were more likely to have a completed contact (adjusted OR = 2.13; 95% CI: 1.09-4.19, P = 0.02). There were no differences in patient-level utilization between Enhanced and Standard REP sites.
  
  
  CONCLUSIONS
  Enhanced REP was associated with greater Re-Engage program uptake (completed contacts) among sites not responding to a standard implementation strategy. Further research is needed to determine whether national implementation of Facilitation results in tangible changes in patient-level outcomes.
  
  
  BACKGROUND
  
  ISRCTN21059161.
authors.affiliation: VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Mailstop 152, Ann Arbor, MI, 48105, USA. amykilbo@umich.edu.|Department of Psychiatry, University of Michigan Medical School, North Campus Research Complex, 2800 Plymouth Road, Building 16, Ann Arbor, MI, 48109-2800, USA. amykilbo@umich.edu.
authors.forename: Amy M
authors.initials: AM
authors.lastname: Kilbourne
authors.affiliation: Institute for Social Research, University of Michigan, 426 Thompson Street, Ann Arbor, MI, 48104-2321, USA. dalmiral@umich.edu.
authors.forename: Daniel
authors.initials: D
authors.lastname: Almirall
authors.affiliation: VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Mailstop 152, Ann Arbor, MI, 48105, USA. David.goodrich2@va.gov.|Department of Psychiatry, University of Michigan Medical School, North Campus Research Complex, 2800 Plymouth Road, Building 16, Ann Arbor, MI, 48109-2800, USA. David.goodrich2@va.gov.
authors.forename: David E
authors.initials: DE
authors.lastname: Goodrich
authors.affiliation: VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Mailstop 152, Ann Arbor, MI, 48105, USA. Zongshan.lai@va.gov.|Department of Psychiatry, University of Michigan Medical School, North Campus Research Complex, 2800 Plymouth Road, Building 16, Ann Arbor, MI, 48109-2800, USA. Zongshan.lai@va.gov.
authors.forename: Zongshan
authors.initials: Z
authors.lastname: Lai
authors.affiliation: VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Mailstop 152, Ann Arbor, MI, 48105, USA. abrahakm@udmercy.edu.|University of Detroit Mercy, 4001 West McNichols Road, Detroit, MI, 48221-3038, USA. abrahakm@udmercy.edu.
authors.forename: Kristen M
authors.initials: KM
authors.lastname: Abraham
authors.affiliation: VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Mailstop 152, Ann Arbor, MI, 48105, USA. Kristina.nord@va.gov.|Department of Psychiatry, University of Michigan Medical School, North Campus Research Complex, 2800 Plymouth Road, Building 16, Ann Arbor, MI, 48109-2800, USA. Kristina.nord@va.gov.
authors.forename: Kristina M
authors.initials: KM
authors.lastname: Nord
authors.affiliation: VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Mailstop 152, Ann Arbor, MI, 48105, USA. Nicholas.Bowersox@va.gov.|Department of Psychiatry, University of Michigan Medical School, North Campus Research Complex, 2800 Plymouth Road, Building 16, Ann Arbor, MI, 48109-2800, USA. Nicholas.Bowersox@va.gov.
authors.forename: Nicholas W
authors.initials: NW
authors.lastname: Bowersox
mesh_terms: D000553:Ambulatory Care / Q000458:organization & administration*; D016000:Cluster Analysis; D003156:Community Mental Health Services / Q000458:organization & administration; D019317:Evidence-Based Medicine / Q000458:organization & administration*; D006284:Health Plan Implementation / Q000458:organization & administration*; D006801:Humans; D001523:Mental Disorders / Q000534:rehabilitation*; D017063:Outcome Assessment, Health Care; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration*