Abstract for: Synthesizing Stakeholder Engagement, Electronic Health Records and Simulation for Timely, High-Quality VA Mental Health Care

There is a significant gap between scientific consensus regarding “evidence-based practices” (EBPs) and their routine use in healthcare systems. Using best practices for participatory system dynamics (PSD), we are synthesizing local staff expertise and health system operations data to select strategies to improve EBP reach in the US Veterans Health Administration (VA). Our team worked with Veteran patients, local leadership, psychiatrists, psychologists, social workers, nurses and clerks to develop a system dynamics model of VA outpatient mental health care. PSD models were developed in Vensim DSS. We conducted qualitative group modeling to develop the model structure, reviewed data inputs for validity, and conducted model calibration checks against the historical behavior of the clinical system. Stakeholders provided a list of restructuring scenarios intended to improve EBP reach for evaluation via simulation. Stakeholders valued the use of simulation to better understand and address the complexity of day-to-day decision-making. PSD modeling process and tools led to changes in scheduling practices to ensure an adequate supply of high-value care appointments, new data captured in the electronic health record and de-implementation of ineffective referral and care coordination practices.