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Articles   |    
A Literature Review of Learning Collaboratives in Mental Health Care: Used but Untested
Erum Nadeem, Ph.D.; S. Serene Olin, Ph.D.; Laura Campbell Hill, B.A.; Kimberly Eaton Hoagwood, Ph.D.; Sarah McCue Horwitz, Ph.D.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201300229
View Author and Article Information

Except for Ms. Hill , the authors are with the Department of Child and Adolescent Psychiatry, New York University, New York City (e-mail: erum.nadeem@nyumc.org). Ms. Hill is with the School of General Studies, Columbia University, New York City.

Copyright © 2014 by the American Psychiatric Association

Abstract

Objective  Policy makers have increasingly turned to learning collaboratives (LCs) as a strategy for improving usual care through the dissemination of evidence-based practices. The purpose of this review was to characterize the state of the evidence for use of LCs in mental health care.

Methods  A systematic search of major academic databases for peer-reviewed articles on LCs in mental health care generated 421 unique articles across a range of disciplines; 28 mental health articles were selected for full-text review, and 20 articles representing 16 distinct studies met criteria for final inclusion. Articles were coded to identify the LC components reported, the focus of the research, and key findings.

Results  Most of the articles included assessments of provider- or patient-level variables at baseline and post-LC. Only one study included a comparison condition. LC targets ranged widely, from use of a depression screening tool to implementation of evidence-based treatments. Fourteen crosscutting LC components (for example, in-person learning sessions, phone meetings, data reporting, leadership involvement, and training in quality improvement methods) were identified. The LCs reviewed reported including, on average, seven components, most commonly in-person learning sessions, plan-do-study-act cycles, multidisciplinary quality improvement teams, and data collection for quality improvement.

Conclusions  LCs are being used widely in mental health care, although there is minimal evidence of their effectiveness and unclear reporting in regard to specific components. Rigorous observational and controlled research studies on the impact of LCs on targeted provider- and patient-level outcomes are greatly needed.

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Table 1Twenty articles representing 16 studies of learning collaboratives (LCs) included in the reviewa
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a Articles are in alphabetical order by author name and grouped by study.

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b BTS, Breakthrough Series; CCM, chronic care model; NIATx, Network for the Improvement of Addiction Treatment; NASBHC, National Assembly on School-Based Health Care

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c ODC, organizations required to demonstrate commitment; PDSAs, plan-do-study-act cycles; QITs, quality improvement teams

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d New QI data, sites collected new data for quality improvement purposes; QI data review, sites reviewed quality improvement data and used feedback

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e Involved leaders, involvement or outreach (or both) to organizational leadership

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f,g,h Articles that share a footnote are based on data from a single study.

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Table 2Definitions of domains and components of learning collaboratives (LCs) in the studies revieweda
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a Table adapted from Nadeem et al. (14) with permission

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b Basic study details highlighted by the published article

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c LC components were compiled through the literature review and explicitly referenced by study authors.

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d Beyond the basic components of the LC, which QI techniques were included in the LC?

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e In theory, LCs enable an organization to enact change at multiple levels within their organizational structure. Did the LC take steps to train or otherwise involve members of the organization who were not directly included in the collaborative?

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Table 3Variables examined by 20 articles on learning collaboratives (LCs) included in the reviewa
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a Articles are organized by author name and grouped by study.

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b,c,d Articles that share a footnote are based on data from a single study.

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