Implementation of Collaborative Care for Depression in VA HIV Clinics

A clinical champion is a local provider who serves as a liaison between local clinics and local or regional leadership or national program offices (e.g., HHRC) and advocates for the HITIDES intervention with their local peers. A clinical champion can provide ongoing promotion of and education about HITIDES and remind care providers of its presence and value either formally (e.g., presentations at staff meetings) or informally (e.g., individual conversations about HITIDES benefits). Clinical champions can also engage middle managers or local leadership to buy in to and support intervention uptake. Clinical champions may also work with Veterans in quality improvement efforts to garner their ideas for how to outreach to other Veteran patients, plan quality improvement cycles, or consult in an advisory capacity. Potential champions will be approached about participation after consultation with site HIV care providers and HHRC.

Learning Collaboratives are groups of providers or provider organizations and foster a collaborative learning environment to improve implementation of the clinical innovation (HITIDES). There are several approaches to this in the literature including peer consultation networks, online communities of practice, quality circles, and learning collaboratives. Groups will meet virtually using a wide variety of media. Participation will be monitored by research staff and recorded by participants in a time-tracking log but not controlled. The learning collaboratives will be comprised of a group of site clinical champions, HIV care providers, and other VHA HIV care representatives, potentially including Veterans who are engaged in implementation activities, to foster a learning environment to improve the implementation of HITIDES through consultation.

. External facilitation will be provided by a trained external facilitator who is given the HITIDES Operations Guide and Consumer Voice tools for Veteran engagement in quality improvement. Facilitation is a process to enable sites to increase uptake of HITIDES through supportive relationships and strategies to navigate the implementation process. Virtual external facilitation is a recognized modality of facilitation delivery in VHA. The external facilitator will work with the clinical champion, site personnel, and Veterans-not conducting research activities but engaging in quality improvement processes with these individuals. The addition of a facilitator allows problem identification and problem-solving, using processes based on supportive relationships.