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Improving Access to Addiction and Mental Health Care for Veterans

This study is looking at ways to improve how many Veterans with alcohol use disorder, depression, opioid use disorder, or PTSD receive effective treatments. It compares two approaches: Participatory System Dynamics (PSD), which involves staff running simulations to find better ways to provide care, and Audit and Feedback (AF), where staff review data to improve care. The study aims to see if PSD helps more patients get the care they need. To join, your clinic must be a VA division or community-based outpatient clinic (CBOC) that is below the overall VA quality median for certain measures related to addiction and mental health care. Success will be measured by the proportion of patients who start and continue evidence-based treatments and the completion of treatment templates. The current status of this study is unclear.

Study design
This interventional study plans to enroll 720 participants. It compares two different strategies for improving healthcare delivery.
What's involved
Not specified in the trial record.
Compensation
Not stated in the trial record.
Follow-up
The study measures outcomes over a 24-month total observation period, looking at changes over 12-month periods before and after the intervention.

AI-generated from the public study record. Only the study team can confirm whether you're eligible — confirm details with them before making decisions.

NCT04356274

Local Participatory Systems Dynamics to Increase Reach of Evidence Based Addiction and Mental Health Care

Enrolling by Invitation
NAAges 18+InterventionalHealth services
Palo Alto Veterans Institute for Research
~720 participants
Updated 2026-05-04 on ClinicalTrials.gov
What's tested:Participatory System Dynamics (PSD)Audit and Feedback (AF)

At a glance

Recruiting sites
0 of 1 listed site is recruiting right now
RecruitingSuspended, closed, or not yet open
What they're measuring
Proportion of patients diagnosed with alcohol use disorder, depression, opioid use disorder, or PTSD who meet evidence-based psychotherapy and pharmacotherapy initiation and course measures divided by total number of patients with these diagnoses
Measured over Pre-/Post- 12-month period average of evidence-based practice reach (24 months total observation)
+2 more outcomes measured

Conditions

PTSD
Depression
Alcohol Use Disorder
Opioid Use Disorder

Explore related trials

Alcohol use disorderDepressionOpioid Use DisorderPost-Traumatic Stress Disorder

Where it's being run

1 sites across 1 states
California1

Study leadership

  • Lindsey E Zimmerman, PhD · PRINCIPAL_INVESTIGATOR · National Center for PTSD, Dissemination & Training Division

Who to contact

This trial hasn't published a contact. View it on ClinicalTrials.gov

Do you actually qualify for this trial?

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Eligibility criteria

Inclusion

VA divisions and community-based outpatient clinics (CBOCs) or 'clinics' from regional VA health systems
Must be below the overall VA quality median (as assessed by the Strategic Analytics for Improvement and Learning or SAIL), which includes 3 of 8 SAIL measures associated with four evidence-based psychotherapies and three evidence-based pharmacotherapies for depression, PTSD, and opioid use disorder.

Exclusion

clinics with less than 12 months of data in 2018
clinics already involved in Office of Veterans Access to Care (OVACS) quality improvement program at baseline.
clinics where the VA Cerner electronic health record (EHR) implementation rollout will occur during the project period (Veterans Integrated Services Networks (VISNs) 20, 21 ,22, and 7)
clinics who serve less than 122 unique patients each month on average
clinics without an onsite multidisciplinary team of mental health or addiction service providers (minimum required: 1 psychiatrist, 1 psychologist, 1 social worker onsite)

What this trial measures

  • Proportion of patients diagnosed with alcohol use disorder, depression, opioid use disorder, or PTSD who meet evidence-based psychotherapy and pharmacotherapy initiation and course measures divided by total number of patients with these diagnosesPre-/Post- 12-month period average of evidence-based practice reach (24 months total observation)

    Initiation of an evidence-based practice is indicated by an evidence-based psychotherapy template or evidence-based pharmacotherapy prescription after intake. Adequate course is based on receiving an adequate number of evidence-based psychotherapy sessions to be a "completer" (typically 8 sessions) or enough refills for a guideline-recommended adequate trial of each medication (varies by medication). Data is gathered based on electronic health record data from the VA Corporate Data Warehouse (CDW).

  • Proportion of completed evidence-based practice templates during sessions with a relevant CPT codePre-/Post- 12-month period average of evidence-based practice reach (24 months total observation)

    We will study 5 evidence-based psychotherapies: 3 for depression (Cognitive Behavior Therapy (CBT-D), Acceptance and Commitment Therapy (ACT), and Interpersonal Psychotherapy (IPT)) and 2 for PTSD (Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT)). Data is gathered based on electronic health record data from the Corporate Data Warehouse (CDW).

  • Proportion of combination of prescriptions placed with the VA pharmacy and sessions with a relevant CPT codePre-/Post- 12-month period average of evidence-based practice reach (24 months total observation)

    We will study 8 evidence-based pharmacotherapies: 2 for depression (84 and 180 days therapeutic continuity at new antidepressant start), 2 for Opioid Use Disorder (OUD) (methadone and buprenorphine), and 4 for Alcohol Use Disorder (AUD) (Acamprosate, Disulfiram, Naltrexone, and Topiramate). Data is gathered based on electronic health record data from the Corporate Data Warehouse (CDW).