This article is part of a series on U.S. Department of Veterans Affairs Quality Enhancement Research Initiative (QUERI), edited by (Internal Series) Cheryl B Stetler, Brian S Mittman, Joseph Francis. (Journal Series) Martin P Eccles, Ian Graham .

Research article

Developing a national dissemination plan for collaborative care for depression: QUERI Series

Jeffrey L Smith¹ , John W Williams Jr² , Richard R Owen¹ , Lisa V Rubenstein³ and Edmund Chaney⁴

¹  VA Mental Health Quality Enhancement Research Initiative, Central Arkansas Veterans Healthcare System, 2200 Fort Roots Drive, Building 58 (152/NLR), North Little Rock, Arkansas, 72114, USA

²  Durham VA Medical Center HSR&D, 508 Fulton Street (Building 16), Durham, North Carolina, 27705, USA

³  VA HSR&D Center for the Study of Healthcare Provider Behavior, VA Greater Los Angeles Healthcare System, 16111 Plummer Street (Building 25), Sepulveda, California, 91343, USA

⁴  VA HSR&D Center of Excellence, VA Puget Sound Healthcare System, 1100 Olive Way, Suite 1400, Seattle, Washington 98101, USA

author email corresponding author email

Implementation Science 2008, 3:59doi:10.1186/1748-5908-3-59

Published:	31 December 2008

Abstract

Background

Little is known about effective strategies for disseminating and implementing complex clinical innovations across large healthcare systems. This paper describes processes undertaken and tools developed by the U.S. Department of Veterans Affairs (VA) Mental Health Quality Enhancement Research Initiative (MH-QUERI) to guide its efforts to partner with clinical leaders to prepare for national dissemination and implementation of collaborative care for depression.

Methods

An evidence-based quality improvement (EBQI) process was used to develop an initial set of goals to prepare the VA for national dissemination and implementation of collaborative care. The resulting product of the EBQI process is referred to herein as a "National Dissemination Plan" (NDP). EBQI participants included: a) researchers with expertise on the collaborative care model for depression, clinical quality improvement, and implementation science, and b) VA clinical and administrative leaders with experience and expertise on how to adapt research evidence to organizational needs, resources and capacity. Based on EBQI participant feedback, drafts of the NDP were revised and refined over multiple iterations before a final version was approved by MH-QUERI leadership. 'Action Teams' were created to address each goal. A formative evaluation framework and related tools were developed to document processes, monitor progress, and identify and act upon barriers and facilitators in addressing NDP goals.

Results

The National Dissemination Plan suggests that effectively disseminating collaborative care for depression in the VA will likely require attention to: Guidelines and Quality Indicators (4 goals), Training in Clinical Processes and Evidence-based Quality Improvement (6 goals), Marketing (7 goals), and Informatics Support (1 goal). Action Teams are using the NDP as a blueprint for developing infrastructure to support system-wide adoption and sustained implementation of collaborative care for depression. To date, accomplishments include but are not limited to: conduct of a systematic review of the literature to update VA depression treatment guidelines to include the latest evidence on collaborative care for depression; training for clinical staff on TIDES (Translating Initiatives for Depression into Effective Solutions project) care; spread of TIDES care to new VA facilities; and integration of TIDES depression assessment tools into a planned update of software used in delivery of VA mental health services. Thus far, common barriers encountered by Action Teams in addressing NDP goals include: a) limited time to address goals due to competing tasks/priorities, b) frequent turnover of key organizational leaders/stakeholders, c) limited skills and training among team members for addressing NDP goals, and d) difficulty coordinating activities across Action Teams on related goals.

Conclusion

MH-QUERI has partnered with VA organizational leaders to develop a focused yet flexible plan to address key factors to prepare for national dissemination and implementation of collaborative care for depression. Early indications suggest that the plan is laying an important foundation that will enhance the likelihood of successful implementation and spread across the VA healthcare system.