ArticleImplementation science : IS2024
Sustaining the collaborative chronic care model in outpatient mental health: a matrixed multiple case study.
Article in Implementation science : IS, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed, 11 citations in OpenAlex.
- Applying system support mapping combined with the matrixed multiple case study approach to identify and analyse implementation determinants: lessons from a multi-site implementation study in German neonatal intensive care units.BMC health services research · 2026Trial
- What Matters in Sustaining Peer Support for Adults in Mental Health Services? Exploring the Perceptions of Diverse Actors.Community mental health journal · 2026Article
- Implementing the collaborative chronic care model for mental health: a nonrandomized clinical trial.Implementation science communications · 2026Article
- A practice-based implementation strategy bundle for integrating behavioral health in primary care: a matrixed multiple case study.Implementation science communications · 2026Article
- Streamlining surgical instrument counting: a matrixed multiple case study on the fidelity of weighing systems in the operating room.Implementation science communications · 2025Article
- Inter-organizational alignment and implementation outcomes in integrated mental healthcare for children and adolescents: a cross-sectional observational study.Implementation science : IS · 2024Observational
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Authors and funding
9 authors at 6 institutions in 1 country.
Funding
Abstract
backgroundSustaining evidence-based practices (EBPs) is crucial to ensuring care quality and addressing health disparities. Approaches to identifying factors related to sustainability are critically needed. One such approach is Matrixed Multiple Case Study (MMCS), which identifies factors and their combinations that influence implementation. We applied MMCS to identify factors related to the sustainability of the evidence-based Collaborative Chronic Care Model (CCM) at nine Department of Veterans Affairs (VA) outpatient mental health clinics, 3-4 years after implementation support had concluded.
methodsWe conducted a directed content analysis of 30 provider interviews, using 6 CCM elements and 4 Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) domains as codes. Based on CCM code summaries, we designated each site as high/medium/low sustainability. We used i-PARIHS code summaries to identify relevant factors for each site, the extent of their presence, and the type of influence they had on sustainability (enabling/neutral/hindering/unclear). We organized these data into a sortable matrix and assessed sustainability-related cross-site trends.
resultsCCM sustainability status was distributed among the sites, with three sites each being high, medium, and low. Twenty-five factors were identified from the i-PARIHS code summaries, of which 3 exhibited strong trends by sustainability status (relevant i-PARIHS domain in square brackets): "Collaborativeness/Teamwork [Recipients]," "Staff/Leadership turnover [Recipients]," and "Having a consistent/strong internal facilitator [Facilitation]" during and after active implementation. At most high-sustainability sites only, (i) "Having a knowledgeable/helpful external facilitator [Facilitation]" was variably present and enabled sustainability when present, while (ii) "Clarity about what CCM comprises [Innovation]," "Interdisciplinary coordination [Recipients]," and "Adequate clinic space for CCM team members [Context]" were somewhat or less present with mixed influences on sustainability.
conclusionsMMCS revealed that CCM sustainability in VA outpatient mental health clinics may be related most strongly to provider collaboration, knowledge retention during staff/leadership transitions, and availability of skilled internal facilitators. These findings have informed a subsequent CCM implementation trial that prospectively examines whether enhancing the above-mentioned factors within implementation facilitation improves sustainability. MMCS is a systematic approach to multi-site examination that can be used to investigate sustainability-related factors applicable to other EBPs and across multiple contexts.
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