Effectiveness and Implementation of eScreening in Post 9/11 Transition Programs

NCT04506164 | Completed Results

• 2 other identifiers: SDR 19-4431I01HX003079-01A1
• Study Type: interventional
• Target: 72
• Locations: 1 country
• Sites: 1

Brief Summary

Electronic screening is effective for timely detection of, and intervention for, suicidal ideation and other mental health symptoms. The VA eScreening program is a patient self-report electronic screening system that has shown promise for the efficient and effective collection of mental and physical health information among Veterans. However, additional effectiveness and implementation research is warranted to evaluate the impact of eScreening within VHA. This study addresses questions of the impact of eScreening compared to screening as usual, while evaluating a multi-component implementation strategy (MCIS) for optimal enterprise rollout of eScreening in VA Transition Care Management clinics.

Conditions

Suicide; Depression; Stress Disorders, Post-Traumatic

Keywords

suicide; mental health; screening; technology; self report; veterans

Outcome Measures

Primary Outcomes (11)

• Compare Rate of PTSD Screening During eScreening Implementation and Sustainment vs. Screening as Usual/Pre-implementation

  Proportion of newly enrolled Veterans who received PTSD screening (i.e., The Primary Care PTSD Screen for DSM-5 \[PC-PTSD-5\]) during the eScreening implementation and sustainment phases compared to the screening as usual/pre-implementation phase. For this outcome, we calculated the rate of screening (i.e., the proportion of Veterans who received the screening measure versus those who did not) during each phase, and then compared the proportion of Veterans who received screening during the eScreening implementation and sustainment phases vs. screening as usual/pre-implementation phase.

  within 30 days of enrollment at the VA study site during each phase

• Compare Rate of Depression (PHQ-2) Screening During eScreening Implementation and Sustainment vs. Screening as Usual/Pre-implementation

  Proportion of newly enrolled Veterans who received depression screening (Patient Health Questionnaire-2; PHQ-2) during the eScreening implementation and sustainment phases compared to the screening as usual/pre-implementation phase. For this outcome, we calculated the rate of screening (i.e., the proportion of Veterans who received the screening measure versus those who did not) during each phase, and then compared the proportion of Veterans who received screening during the eScreening implementation and sustainment phases vs. screening as usual/pre-implementation phase.

  within 30 days of enrollment at the VA study site during each phase

• Compare Rate of Alcohol Screening (AUDIT) During eScreening Implementation and Sustainment vs. Screening as Usual/Pre-implementation

  Proportion of newly enrolled Veterans who received alcohol screening (AUDIT) during the eScreening implementation and sustainment phases compared to the screening as usual/pre-implementation phase. For this outcome, we calculated the rate of screening (i.e., the proportion of Veterans who received the screening measure versus those who did not) during each phase, and then compared the proportion of Veterans who received screening during the eScreening implementation and sustainment phases vs. screening as usual/pre-implementation phase.

  within 30 days of enrollment at the VA study site during each phase

• Compare Rate of Suicide Screening (CSSRS) During eScreening Implementation and Sustainment vs. Screening as Usual/Pre-implementation

  Proportion of newly enrolled Veterans who received suicide screening (Columbia-Suicide Severity Rating Scale; CSSRS) during the eScreening implementation and sustainment phases compared to the screening as usual/pre-implementation phase. For this outcome, we calculated the rate of screening (i.e., the proportion of Veterans who received the screening measure versus those who did not) during each phase, and then compared the proportion of Veterans who received screening during the eScreening implementation and sustainment phases vs. screening as usual/pre-implementation phase.

  within 30 days of enrollment at the VA study site during each phase.

• Time to PTSD Screening (PC-PTSD-5) Completion During eScreening Implementation and Sustainment vs. Screening as Usual/Pre-implementation

  Number of days to receive PTSD screening (PC-PTSD-5) during the eScreening implementation and sustainment phases compared to the screening as usual/pre-implementation phase. For this outcome, we calculated the time to screening (in days) during each phase, and then compared the time to screening for the eScreening implementation and sustainment phases vs. screening as usual/pre-implementation phase.

  within 30 days of enrollment at the VA study site during each phase.

• Time to Depression (PHQ-2) Screening Completion During eScreening Implementation and Sustainment vs. Screening as Usual/Pre-implementation

  Number of days to depression screening (PHQ-2) during the eScreening implementation and sustainment phases compared to the screening as usual/pre-implementation phase. For this outcome, we calculated the time to screening (in days) during each phase, and then compared the time to screening for the eScreening implementation and sustainment phases vs. screening as usual/pre-implementation phase.

  within 30 days of enrollment at the VA study site during each phase.

• Time to Alcohol Screening (AUDIT) Completion During eScreening Implementation and Sustainment vs. Screening as Usual/Pre-implementation

  Number of days to alcohol screening (AUDIT) during the eScreening implementation and sustainment phases compared to the screening as usual/pre-implementation phase. For this outcome, we calculated the time to screening (in days) during each phase, and then compared the time to screening for the eScreening implementation and sustainment phases vs. screening as usual/pre-implementation phase.

  within 30 days of enrollment at the VA study site during each phase.

• Time to Suicide Screening (CSSRS) Completion During eScreening Implementation and Sustainment vs. Screening as Usual/Pre-implementation

  Number of days to suicide screening (CSSRS) during the eScreening implementation and sustainment phases compared to the screening as usual/pre-implementation phase. For this outcome, we calculated the time to screening (in days) during each phase, and then compared the time to screening for the eScreening implementation and sustainment phases vs. screening as usual/pre-implementation phase.

  within 30 days of enrollment at the VA study site during each phase.

• Change in Rate of Referral to Mental Health Care Following Positive PTSD Screen (PC-PTSD-5) During eScreening Implementation and Sustainment vs. Screening as Usual/Pre-implementation.

  Change in rate of referral to mental health follow up care (BHIP) following a positive PTSD screen (PC-PTSD-5) during the eScreening implementation and sustainment phases compared to the screening as usual/pre-implementation phase.

  30 days from the date the screener was administered during each phase.

• Change in Rate of Referral to Mental Health Care Following Positive Depression Screen (PHQ-2) During eScreening Implementation and Sustainment vs. Screening as Usual/Pre-implementation

  change in rate of referral to mental health follow up care (BHIP) following a positive depression (PHQ-2) screen during the eScreening implementation and sustainment phases compared to the screening as usual/pre-implementation phase.

  30 days from the date the screener was administered during each phase.

• Change in Rate of Referral to Substance Use Treatment Following Positive Alcohol Screen (AUDIT) During eScreening Implementation and Sustainment vs. Screening as Usual/Pre-implementation

  change in rate of referral to substance use treatment following a positive alcohol screen (AUDIT) during the eScreening implementation and sustainment phases compared to the screening as usual/pre-implementation phase.

  30 days from the date the screener was administered during each phase

Secondary Outcomes (1)

• PRISM Contextual Survey Instrument (PCSI)

  Surveys were administered within 60 days of initiating each phase: pre-implementation, implementation, and sustainment

Study Arms (2)

Screening As Usual/Pre-implementation

ACTIVE COMPARATOR

During this 3 month pre-implementation period, usual screening methods were used (i.e., verbal and paper-based screening).

Other: Screening As Usual

eScreening Implementation

EXPERIMENTAL

During this 9 month active implementation phase, eScreening was implemented using the MCIS.

Other: eScreening

Interventions

eScreening OTHER

eScreening is a clinical patient self report system that allows Veterans to complete self report screens, including assessments of depression, PTSD and alcohol use, using a secure connection from any internet connected device.

eScreening Implementation

Screening As Usual OTHER

Assessment of depression, PTSD and alcohol use using verbal and paper-based screening methods.

Screening As Usual/Pre-implementation

Eligibility Criteria

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

You may qualify if:

• Direct or indirect involvement with implementation of eScreening at the site
• Capable of informed consent

You may not qualify if:

• Not involved in or directly impacted by eScreening involvement at each site

Sponsors & Collaborators

• VA Office of Research and Development: lead

Study Sites (1)

VA San Diego Healthcare System, San Diego, CA

San Diego, California, 92161-0002, United States

Location

Related Publications (1)

• Pittman JOE, Lindamer L, Afari N, Depp C, Villodas M, Hamilton A, Kim B, Mor MK, Almklov E, Gault J, Rabin B. Implementing eScreening for suicide prevention in VA post-9/11 transition programs using a stepped-wedge, mixed-method, hybrid type-II implementation trial: a study protocol. Implement Sci Commun. 2021 Apr 29;2(1):46. doi: 10.1186/s43058-021-00142-9.

  PMID: 33926577 RESULT

MeSH Terms

Conditions

Depression; Stress Disorders, Post-Traumatic; Suicide; Psychological Well-Being

Interventions

Mass Screening

Condition Hierarchy (Ancestors)

Behavioral Symptoms; Behavior; Stress Disorders, Traumatic; Trauma and Stressor Related Disorders; Mental Disorders; Self-Injurious Behavior; Personal Satisfaction

Intervention Hierarchy (Ancestors)

Diagnostic Techniques and Procedures; Diagnosis; Health Surveys; Surveys and Questionnaires; Data Collection; Epidemiologic Methods; Investigative Techniques; Diagnostic Services; Preventive Health Services; Health Services; Health Care Facilities Workforce and Services; Health Care Evaluation Mechanisms; Quality of Health Care; Health Care Quality, Access, and Evaluation; Public Health; Environment and Public Health; Public Health Practice

Results Point of Contact

• Title: James Pittman, PhD
• Organization: VA San Diego Healthcare System

James.pittman@va.gov

858-552-8585

Study Officials

• James Pittman, PhD MSW

  VA San Diego Healthcare System, San Diego, CA

  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: CROSSOVER
• Sponsor Type: FED
• Responsible Party: SPONSOR

Model Details: This project primarily examined the effectiveness of an electronic health screening technology (eScreening) compared to Screening As Usual (paper/verbal screening) in eight VHA sites. eScreening was implemented at each site using a multicomponent implementation strategy (MCIS) composed of software provisioning, a 3-day Lean Six Sigma Rapid Process Improvement Workshop (RPIW), user training, and ongoing facilitation. We evaluated the impact of eScreening on the proportion of newly enrolling Veterans being screened, time from enrollment to screening, and referral to needed care by comparing data collected during the pre-implementation Screening As Usual phase with data collected during the eScreening implementation.

Study Record Dates

• First Submitted: August 5, 2020
• First Posted: August 10, 2020
• Study Start: June 18, 2021
• Primary Completion: December 29, 2023
• Study Completion: December 31, 2024
• Last Updated: February 17, 2026
• Results First Posted: February 17, 2026

Record last verified: 2026-01

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)