Implementing Effective Policy in a National Mental Health Reengagement Program for Veterans.
Policy is a powerful motivator of clinical change, but implementation success can depend on organizational characteristics. This article used validated measures of organizational resources, culture, and climate to predict uptake of a nationwide Veteran's Health Administration (VA) policy aimed at implementing Re-Engage, a brief care management program that reestablishes contact with veterans with serious mental illness lost to care. Patient care databases were used to identify 2738 veterans lost to care. Local recovery coordinators (LRCs) were to update disposition for 2738 veterans at 158 VA facilities and, as appropriate, facilitate a return to care. Multivariable regression was used to assess organizational culture and climate as predictors of early policy compliance (via LRC presence) and uptake at 6 months. Higher composite climate and culture scores were associated with higher odds of having a designated LRC but were not predictive of higher uptake. Sites with LRCs had significantly higher rates of updated documentation than sites without LRCs.
*Department of Internal Medicine, Division of General Medicine; †Institute for Social Research, University of Michigan, Ann Arbor; ‡Department of Pathology, Beaumont Health System, Royal Oak; §VA Center for Clinical Management Research, VA Ann Arbor Healthcare System; ∥Department of Psychiatry, University of Michigan Medical School, Ann Arbor; ¶Department of Psychology, University of Detroit Mercy, Detroit, MI; and #Office of Research and Development, Veterans Health Administration, U.S. Department of Veterans, Washington DC.
Shawna N
SN
Smith
Zongshan
Z
Lai
Daniel
D
Almirall
David E
DE
Goodrich
Kristen M
KM
Abraham
Kristina M
KM
Nord
Amy M
AM
Kilbourne
D006291:Health Policy; D006801:Humans; D001523:Mental Disorders / Q000523:psychology / Q000628:therapy*; D008603:Mental Health; D008605:Mental Health Services; D016730:Program Development; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology*; D058014:Veterans Health
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