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Scientific advances are constantly leading to better treatments. However, it is quite challenging for healthcare systems, including VA, to ask very busy providers to change the way they practice. The MIDAS QUERI program helps providers improve the way they treat VA patients. This project will focus on increasing referrals to the Suicide Prevention 2.0 Clinical Telehealth (SP 2.0) initiative through the delivery of Academic Detailing and LEAP (a team-based quality improvement program). SP 2.0 provides accessible, evidence-based suicide prevention treatment to all Veterans with a history of suicidal self-directed violence or preparatory behaviors in the past 12 months.
Sustained integration of evidence-based practices (EBPs) is a challenge within many healthcare systems, especially in settings that have already strived but failed to achieve longer-term goals. The Veterans Affairs (VA) Maintaining Implementation through Dynamic Adaptations (MIDAS) Quality Enhancement Research Initiative (QUERI) program was funded as a series of trials to test multi-component implementation strategies to sustain optimal use of EBPs. The current project focuses on increasing referrals to the Suicide Prevention 2.0 Clinical Telehealth (SP 2.0) initiative.
The investigators have recruited 4 sites for this non-randomized intervention project. Sites have agreed to participate in pre-implementation interviews to gather information regarding barriers and facilitators to use of the SP 2.0 initiative. Sites will then be provided with tailored feedback regarding interview findings and potential use of Academic Detailing and LEAP to address these. Sites may then select to receive either Academic Detailing and/or LEAP which will be provided by MIDAS QUERI. Primary outcome will be rate of SP 2.0 referral adjusted for pre-intervention rate.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Intervention | Experimental | A multi-faceted implementation intervention including qualitative interviews and feedback and optional delivery of Academic Detailing and/or LEAP. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Academic Detailing (AD) | Behavioral | The National Resource Center for Academic Detailing (NaRCAD) describes AD as "an innovative, one-on-one outreach education technique that helps clinicians provide evidence-based care to their patients. Using an accurate, up-to-date synthesis of the best clinical evidence in an engaging format, academic detailers ignite clinician behavior change, ultimately improving patient health. A successful AD visit is highly interactive, always a dialogue, and assesses a clinician's individual needs, beliefs, attitudes, issues, and concerns in order to promote better [practice]." |
| Measure | Description | Time Frame |
|---|---|---|
| SP2Clin Metric | The quarterly SP2Clin metric data is reported and available on a VA national dashboard. The SP2Clin metric is calculated by the number of suicide prevention telehealth consults submitted among those with a suicide behavior event. | Baseline to 12-months post-baseline |
| Measure | Description | Time Frame |
|---|---|---|
| Change in Number of Consults to SP 2.0 Clinic | Change in number of telehealth consults to the Suicide Prevention 2.0 Clinical Telehealth (SP 2.0) initiative. | Baseline to 12-months post-baseline |
| Measure | Description | Time Frame |
|---|---|---|
| Change in Quality Improvement Skills Application | 16-item measure of change in quality improvement skills application. Values 1 to 4 where higher values indicate more frequent use of quality improvement skills. | Baseline to 12-months post-baseline |
| Provider Satisfaction With Academic Detailing |
Inclusion Criteria:
Note- the investigators are recruiting clinics/medical centers - not individual patients. Prior to implementation, the investigators will work with sites to ensure they have met the preconditions necessary to begin sustained optimization of the EBP:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Paul N Pfeiffer, MD MS | VA Ann Arbor Healthcare System, Ann Arbor, MI | Principal Investigator |
| Jacob E Kurlander, MD MS MS | VA Ann Arbor Healthcare System, Ann Arbor, MI | Principal Investigator |
| Jeremy B. Sussman, MD MS | VA Ann Arbor Healthcare System, Ann Arbor, MI | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| VA Ann Arbor Healthcare System, Ann Arbor, MI | Ann Arbor | Michigan | 48105-2303 | United States |
Site-level data that underlie results reported, after de-identification will be available.
For 36 months after article is published.
Upon request by researchers who provide a methodologically sound proposal. Further details will be available.
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13 sites within VISNs of interest were approached directly. Following introductory presentations, 4 sites agreed to participate in the intervention arm. Four non-enrolled control sites were matched to the intervention arm sites based on size and baseline referral rates.
VA medical centers were recruited through Veterans Integrated Service Network (VISN) ICC calls and presentations to interested sites from November 2022 through May 2023. VISNs of interest were identified based on sites within that VISN having documented gaps in referring to the program.
| ID | Title | Description |
|---|---|---|
| FG000 | Intervention | A multi-faceted implementation intervention including qualitative interviews and feedback and optional delivery of Academic Detailing and/or LEAP. Academic Detailing (AD): The National Resource Center for Academic Detailing (NaRCAD) describes AD as "an innovative, one-on-one outreach education technique that helps clinicians provide evidence-based care to their patients. Using an accurate, up-to-date synthesis of the best clinical evidence in an engaging format, academic detailers ignite clinician behavior change, ultimately improving patient health. A successful AD visit is highly interactive, always a dialogue, and assesses a clinician's individual needs, beliefs, attitudes, issues, and concerns in order to promote better [practice]." LEAP: Learn. Engage. Act. Process (LEAP) program is a structured 6-month core curriculum plus 6 monthly collaborative sessions. The LEAP quality improvement program engages frontline teams in sustained incremental improvements of EBPs over a six-month period, allowing space for busy clinicians to learn and immediately apply fundamental QI skills. LEAP encompasses: 1) a structured, accessible curriculum based on the Institute for Healthcare Improvement's (IHI) Model for Improvement and Plan-Do-Study-Act cycles of change; 2) team-based, hands-on learning, and 3) coaching support and a QI network to enhance learning and accountability. |
| FG001 | Control | To examine the effect of engagement in quality improvement activity on referral to the SP2.0 program, we compared participating sites with similar non-participating sites. Four non-participating sites were selected as matched controls, one for each participating site. Control sites were matched to participating sites on number of suicide behavior events and prevalence of Suicide Prevention Telehealth Program consults submitted at baseline. |
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
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The data came from a dashboard provided by an operational office and did not include demographics.
| ID | Title | Description |
|---|---|---|
| BG000 | Intervention | A multi-faceted implementation intervention including qualitative interviews and feedback and optional delivery of Academic Detailing and/or LEAP. Academic Detailing (AD): The National Resource Center for Academic Detailing (NaRCAD) describes AD as "an innovative, one-on-one outreach education technique that helps clinicians provide evidence-based care to their patients. Using an accurate, up-to-date synthesis of the best clinical evidence in an engaging format, academic detailers ignite clinician behavior change, ultimately improving patient health. A successful AD visit is highly interactive, always a dialogue, and assesses a clinician's individual needs, beliefs, attitudes, issues, and concerns in order to promote better [practice]." LEAP: Learn. Engage. Act. Process (LEAP) program is a structured 6-month core curriculum plus 6 monthly collaborative sessions. The LEAP quality improvement program engages frontline teams in sustained incremental improvements of EBPs over a six-month period, allowing space for busy clinicians to learn and immediately apply fundamental QI skills. LEAP encompasses: 1) a structured, accessible curriculum based on the Institute for Healthcare Improvement's (IHI) Model for Improvement and Plan-Do-Study-Act cycles of change; 2) team-based, hands-on learning, and 3) coaching support and a QI network to enhance learning and accountability. |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Categorical | Data on age was not collected nor was it available at the medical center level from our data source. |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | SP2Clin Metric | The quarterly SP2Clin metric data is reported and available on a VA national dashboard. The SP2Clin metric is calculated by the number of suicide prevention telehealth consults submitted among those with a suicide behavior event. | Participants are not enrolled in this study. All enrollment and analysis were conducted at the VAMC level. | Posted | Mean | Standard Deviation | telehealth consults | Baseline to 12-months post-baseline | VA Medical Centers | VA Medical Centers |
|
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Adverse events were not monitored
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Intervention | A multi-faceted implementation intervention including qualitative interviews and feedback and optional delivery of Academic Detailing and/or LEAP. Academic Detailing (AD): The National Resource Center for Academic Detailing (NaRCAD) describes AD as "an innovative, one-on-one outreach education technique that helps clinicians provide evidence-based care to their patients. Using an accurate, up-to-date synthesis of the best clinical evidence in an engaging format, academic detailers ignite clinician behavior change, ultimately improving patient health. A successful AD visit is highly interactive, always a dialogue, and assesses a clinician's individual needs, beliefs, attitudes, issues, and concerns in order to promote better [practice]." LEAP: Learn. Engage. Act. Process (LEAP) program is a structured 6-month core curriculum plus 6 monthly collaborative sessions. The LEAP quality improvement program engages frontline teams in sustained incremental improvements of EBPs over a six-month period, allowing space for busy clinicians to learn and immediately apply fundamental QI skills. LEAP encompasses: 1) a structured, accessible curriculum based on the Institute for Healthcare Improvement's (IHI) Model for Improvement and Plan-Do-Study-Act cycles of change; 2) team-based, hands-on learning, and 3) coaching support and a QI network to enhance learning and accountability. |
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Site-level engagement in the intervention components was limited across sites.
| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Paul Pfeiffer, MD, MS, Corresponding Principal Investigator | VA Ann Arbor Health Care System | N/A | paul.pfeiffer@va.gov |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Oct 24, 2025 | Oct 24, 2025 | Prot_SAP_000.pdf |
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| ID | Term |
|---|---|
| D000092864 | Suicide Prevention |
| ID | Term |
|---|---|
| D013405 | Suicide |
| D016728 | Self-Injurious Behavior |
| D001526 | Behavioral Symptoms |
| D001519 | Behavior |
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A multi-faceted implementation intervention including qualitative interviews and feedback and optional delivery of Academic Detailing and/or LEAP.
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| LEAP | Behavioral | Learn. Engage. Act. Process (LEAP) program is a structured 6-month core curriculum plus 6 monthly collaborative sessions. The LEAP quality improvement program engages frontline teams in sustained incremental improvements of EBPs over a six-month period, allowing space for busy clinicians to learn and immediately apply fundamental QI skills. LEAP encompasses: 1) a structured, accessible curriculum based on the Institute for Healthcare Improvement's (IHI) Model for Improvement and Plan-Do-Study-Act cycles of change; 2) team-based, hands-on learning, and 3) coaching support and a QI network to enhance learning and accountability. |
|
7-items measuring satisfaction with Academic Detailing. Each response option uses a Likert-type scale with values 1 to 5 where higher values indicate higher satisfaction. |
| Post-first Academic Detailing session |
| Change in Provider Satisfaction With LEAP | 6-item measure of satisfaction with LEAP. Values 1 to 5 where higher values indicate higher satisfaction. | Baseline to 12-months post-baseline |
| BG001 | Control | To examine the effect of engagement in quality improvement activity on referral to the SP2.0 program, we compared participating sites with similar non-participating sites. Four non-participating sites were selected as matched controls, one for each participating site. Control sites were matched to participating sites on number of suicide behavior events and prevalence of Suicide Prevention Telehealth Program consults submitted at baseline. |
| BG002 | Total | Total of all reporting groups |
| VA Medical Centers |
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| VA Medical Centers |
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| Sex: Female, Male | Data on sex was not collected nor was it available at the medical center level from our data source. | VA Medical Centers |
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| Race/Ethnicity, Customized | Data on race/ethnicity was not collected nor was it available at the medical center level from our data source. | VA Medical Centers |
| OG001 | Control | To examine the effect of engagement in quality improvement activity on referral to the SP2.0 program, we compared participating sites with similar non-participating sites. Four non-participating sites were selected as matched controls, one for each participating site. Control sites were matched to participating sites on number of suicide behavior events and prevalence of Suicide Prevention Telehealth Program consults submitted at baseline. |
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| Secondary | Change in Number of Consults to SP 2.0 Clinic | Change in number of telehealth consults to the Suicide Prevention 2.0 Clinical Telehealth (SP 2.0) initiative. | Participants are not enrolled in this study. All enrollment and analysis were conducted at the VAMC level. | Posted | Mean | Standard Deviation | telehealth consults | Baseline to 12-months post-baseline | VA Medical Centers | VA Medical Centers |
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| Other Pre-specified | Change in Quality Improvement Skills Application | 16-item measure of change in quality improvement skills application. Values 1 to 4 where higher values indicate more frequent use of quality improvement skills. | This measure is only administered for those who participate in LEAP; this measure was not administered as no sites elected to participate in LEAP. | Posted | Baseline to 12-months post-baseline | VA Medical Centers | VA Medical Centers |
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| Other Pre-specified | Provider Satisfaction With Academic Detailing | 7-items measuring satisfaction with Academic Detailing. Each response option uses a Likert-type scale with values 1 to 5 where higher values indicate higher satisfaction. | Participants were providers at participating sites who had received at least one AD session. AD satisfaction data was collected at the individual level; however, no demographic data was collected. | Posted | Mean | Standard Deviation | Units on a scale | Post-first Academic Detailing session |
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| Other Pre-specified | Change in Provider Satisfaction With LEAP | 6-item measure of satisfaction with LEAP. Values 1 to 5 where higher values indicate higher satisfaction. | This measure is only administered for those who participate in LEAP; this measure was not administered as no sites elected to participate in LEAP. | Posted | Baseline to 12-months post-baseline | VA Medical Centers | VA Medical Centers |
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| EG001 | Control | To examine the effect of engagement in quality improvement activity on referral to the SP2.0 program, we compared participating sites with similar non-participating sites. Four non-participating sites were selected as matched controls, one for each participating site. Control sites were matched to participating sites on number of suicide behavior events and prevalence of Suicide Prevention Telehealth Program consults submitted at baseline. | 0 | 0 | 0 | 0 | 0 | 0 |
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