Adaptive Implementation Intervention for VA Suicide Risk Identification Strategy

NCT04243330 | Completed Results

• 2 other identifiers: PEX 19-005PEC 19-303
• Study Type: interventional
• Target: 138
• Locations: 1 country
• Sites: 1

Brief Summary

The overall objective of this national quality improvement project is to develop an adaptive implementation strategy to improve the implementation of suicide risk screening and evaluation in Veterans Health Administration ambulatory care settings (i.e., VA Risk ID).

Conditions

Suicide

Keywords

prevention; implementation science

Outcome Measures

Primary Outcomes (2)

• Change in Columbia Suicide Severity Rating Scale Screener (C-SSRS) Uptake- Phase 1

  C-SSRS uptake is a site level adherence measure of the percentage of patients in ambulatory care who received a timely annual suicide risk screen (i.e., during the first encounter/visit after the annual suicide risk screen reminder was due). Adherence ranges from 0 to 100, higher scores reflect higher adherence. The outcome measure is reported as the change in facility adherence from baseline to month 8 of intervention Phase 1. Higher numbers reflect greater change in adherence from baseline to month 8 of intervention Phase 1.

  Change from baseline and intervention Phase 1 month 8

• Change in Comprehensive Suicide Risk Evaluation (CSRE) Uptake- Phase 1

  CSRE uptake is a site level adherence measure of the percentage of patients in ambulatory care who had a positive C-SSRS screener and received the CSRE as intended (same day and by the appropriate provider). The score is a facility adherence score. Adherence ranges from 0 to 100, higher scores reflect higher adherence. The outcome measure is reported as the change in facility adherence from baseline to month 8 of intervention Phase 1. Higher numbers reflect greater change in adherence from baseline to month 8 of intervention Phase 1.

  Change from baseline and intervention Phase 1 month 8

Secondary Outcomes (4)

• Change in Columbia Suicide Severity Rating Scale Screener (C-SSRS) Uptake- Phase 2a

  Change from month 9 of intervention phase 1 and month 9 of intervention phase 2

• Change in Comprehensive Suicide Risk Evaluation (CSRE) Uptake-Phase 2a

  Change from month 9 of intervention phase 1 and month 9 of intervention phase 2

• Change in Columbia Suicide Severity Rating Scale Screener (C-SSRS) Uptake- Phase 2b

  Change from month 9 of intervention phase 1 and month 9 of intervention phase 2

• Change in Comprehensive Suicide Risk Evaluation (CSRE) Uptake-Phase 2b

  Change from month 9 of intervention phase 1 and month 9 of intervention phase 2

Study Arms (3)

Implementation as Usual

NO INTERVENTION

Implementation support consisting of clinical decision support tools, trainings, technical assistance and quality assurance to support implementation of VA Suicide Risk Identification Strategy. Available to all facilities.

Audit and Feedback

EXPERIMENTAL

Audit and Feedback will serve as the first stage implementation intervention for sites that do not meet the benchmark for adequate implementation following 9 months of implementation as usual.

Behavioral: Audit and Feedback

External Facilitation

EXPERIMENTAL

Audit and Feedback plus External Facilitation will serve as the second stage implementation intervention for sites that still do not meet the benchmark for adequate implementation following 9 months of implementation as usual plus audit and feedback.

Behavioral: Audit and Feedback; Behavioral: External Facilitation

Interventions

Audit and Feedback BEHAVIORAL

The following components will be incorporated into the audit and feedback intervention: i) individualized facility performance data (site level), ii) frequent delivery intervals (monthly), iii) comparisons with other sites, iv) graphical and text form displays of information, v) constructive, non-punitive tone, vi) target performance or benchmark provided, and vii) specific actions or recommendations for meeting the target.

Audit and Feedback; External Facilitation

External Facilitation BEHAVIORAL

Facilitation will be conducted by a team of facilitators who will employ the facilitation process to improve uptake of VA Risk ID. Trained external facilitators will flexibly deliver the facilitation process utilizing an integrated set of implementation strategies (e.g., stakeholder engagement, identification of barriers and facilitators, education, problem solving, the use of formative data, communication, and ongoing support).

External Facilitation

Eligibility Criteria

• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• Intervention occurs at the site/facility level. Up to 140 VHA facilities across the country will participate in the project. Sites will be allocated to various interventions based on performance (i.e., pre-determined benchmarks for adequate implementation).

You may not qualify if:

• This is a national quality improvement project. Sites that are randomized to different intervention arms based on performance may refuse to participate in the implementation interventions.

Sponsors & Collaborators

• VA Office of Research and Development: lead

Study Sites (1)

Rocky Mountain Regional VA Medical Center, Aurora, CO

Aurora, Colorado, 80045, United States

Location

Related Publications (1)

• Bahraini NH, Matarazzo BB, Barry CN, Post EP, Forster JE, Dollar KM, Dobscha SK, Brenner LA. Protocol: examining the effectiveness of an adaptive implementation intervention to improve uptake of the VA suicide risk identification strategy: a sequential multiple assignment randomized trial. Implement Sci. 2020 Jul 22;15(1):58. doi: 10.1186/s13012-020-01019-6.

  PMID: 32698812 DERIVED

Related Links

• Project Description

MeSH Terms

Conditions

Suicide

Condition Hierarchy (Ancestors)

Self-Injurious Behavior; Behavioral Symptoms; Behavior

Limitations and Caveats

Shortened study timeline due to COVID; study phases needed to be shortened potentially limiting ability to detect an impact of phase 1 intervention- audit \& feedback

Results Point of Contact

• Title: Nazanin Bahraini, PhD
• Organization: VA Rocky Mountain MIRECC

Nazanin.Bahraini@va.gov

720-723-6490

Study Officials

• Nazanin H. Bahraini, PhD

  Rocky Mountain Regional VA Medical Center, Aurora, CO

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: Yes

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: SEQUENTIAL
• Sponsor Type: FED
• Responsible Party: SPONSOR

Model Details: Sequential Multiple Assignment Randomized Trial

Study Record Dates

• First Submitted: January 10, 2020
• First Posted: January 28, 2020
• Study Start: April 14, 2021
• Primary Completion: December 31, 2022
• Study Completion: June 15, 2023
• Last Updated: May 20, 2025
• Results First Posted: May 20, 2025

Record last verified: 2025-05

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)