Dynamic diffusion network QUERI Program: evaluating strategies to support successful spread of integrated mental health and chaplain moral injury groups across the Veterans Health Administration
| ISRCTN | ISRCTN28160036 |
|---|---|
| DOI | https://doi.org/10.1186/ISRCTN28160036 |
| Sponsor | United States Department of Veterans Affairs |
| Funder | Quality Enhancement Research Initiative |
- Submission date
- 29/05/2026
- Registration date
- 30/06/2026
- Last edited
- 11/06/2026
- Recruitment status
- No longer recruiting
- Overall study status
- Ongoing
- Condition category
- Other
Plain English summary of protocol
Background and study aims
Many successful evidence-based practices (EBPs) within the VA system reach an inflection point between early implementation and broad dissemination. These EBPs face the challenge of simultaneously supporting continued spread to new sites/facilities (i.e., Rogers Diffusion of Innovations early and late majority sites) and sustainment at existing early adopter sites. Given that over half of implemented innovations are not sustained over the long term, Aarons et al. describe the need to study sustainment as “critical,” and “as important as the study of implementation” – without sustainment, “time and fiscal investments in implementation are wasted and public health impact is limited.” Our group’s prior examination of EBPs though the VA Innovation Ecosystem revealed that initial implementation outcomes often do not predict long-term sustainment among successful EBPs, further emphasizing the need for regular assessments of sustainment. Unfortunately, based on a VA Evidence Synthesis Program review, there has been little research examining national spread and sustainment of successful EBPs.
The Veterans Affairs (VA) Dynamic Diffusion Network (DDN) QUERI Program is designed to support quality improvement efforts and provide information to VA to continue to better understand different implementation support strategies, especially for spreading and sustaining complex clinical EBPs beyond successful earlier adopters across the VA healthcare system.
Specific aims for Moral Injury Groups will focus on measurements in the areas of implementation effectiveness, fidelity and improvement efforts, clinical effectiveness, and implementation costs to deliver moral injury groups.
Who can participate?
Facilities in the United States Veterans Health Administration (VHA) who are seeking to implement moral injury groups co-led by healthcare chaplains and mental health providers as part of a quality improvement program.
What does the study involve?
Participating facilities that are offering, or will be offering, collaborative (mental health and healthcare chaplain co-led) moral injury groups will be assigned to one of two implementation support strategies – community of practice or network-based facilitated implementation (DDN). The Dynamic Diffusion Network was developed as a method for implementing and adapting complex clinical interventions. It is designed to enhance the evidence-based implementation of clinical EBPs that utilize existing structures within facilities. The DDN recognizes the need to: 1) have engaged facilities; 2) plan to link quality goals and EBP components to the workflow; 3) facilitate rapid cycle quality improvement and 4) plan for sustainment and further spread. The DDN QUERI Program will evaluate these strategies with selected VA facilities.
What are the possible benefits and risks of participating?
This non-research quality improvement project seeks to understand how to help VA facilities improve the quality of care provided to Veterans who are experiencing moral injury.
Where is the study run from?
The Durham Veterans Affairs Health Care System
When is the study starting and how long is it expected to run for?
April 2026 to June 2028
Who is funding the study?
United States Veterans Affairs Quality Enhancement Research Initiative
Who is the main contact?
George L. Jackson, PhD MHA
George.Jackson3@va.gov
Contact information
Principal investigator
Health Services Research (152)
508 Fulton St
Durham
27705
United States of America
 ORCID ID |
0000-0002-1221-647X |
|---|---|
| Phone | +1 9192866936 |
| george.jackson3@va.gov |
Scientific
Durham VA Medical Center (152), VA Mid-Atlantic MIRECC
VA Integrative Mental Health
508 Fulton St.
Durham
27705
United States of America
| ORCID ID |
0000-0003-0856-1913 |
|---|---|
| Phone | +1 919 286 0411 ext. 134048 |
| Jason.Nieuwsma@va.gov |
Public
Health Services Research (152)
508 Fulton St
Durham
27705
United States of America
| Phone | +1 919 286 0411 ext. 174062 |
|---|---|
| brandolyn.white@va.gov |
Study information
| Primary study design | Observational |
|---|---|
| Observational study design | Multicenter hybrid type 3 randomized quality improvement evaluation |
| Scientific title | Dynamic diffusion network QUERI Program: a randomized quality improvement evaluation comparing a high-support vs. lower-support network-based implementation facilitation strategy for mental health and chaplain co-led group-based care for moral injury among veterans receiving care within the Veterans Health Administration |
| Study acronym | DDN QUERI MIG QI Evaluation |
| Study objectives | Guided by the EPIS (exploration, preparation, implementation, sustainment) framework, the objective of this quality improvement evaluation is to compare network-based implementation facilitation strategy (i.e., Dynamic Diffusion Network or DDN) to a Community Practice (COP) among a group of facilities implementing Integrated Mental Health and Chaplaincy (MH&C) Moral Injury Groups. The project will ascertain whether patients in the group receiving DDN support are more likely to attend a greater percentage of group sessions than the COP group. Secondary, clinical impact and group effectiveness on measures of moral injury outcomes, PTSD symptomatology, depressive symptomatology (including suicidality), and mental well-being will be examined. Evidence-based principles of moral injury care (i.e. "core components") and rapid improvement processes will be applied during site implementation. A mixed-methods evaluation of factors influencing outcomes at each EPIS stage based on the Consolidated Framework for Implementation Research (CFIR) will be conducted. |
| Ethics approval(s) | Ethics approval not required |
| Health condition(s) or problem(s) studied | Mental health and chaplain co-led group-based treatment of moral injury in Veterans receiving care in the United States Veterans Health Administration system. |
| Methodology | Enrolled sites will enter an 18-month implementation phase. For the initial 6 months of implementation (implementation phase A), a Community of Practice (COP), lower intensity strategy will be used among both new and sustaining sites to: 1) assess implementation and sustainment needs at both sites (via surveys and semi-structured interviews); and 2) simultaneously support preparation for implementation among new sites and sustainment at existing sites (via facilitated individual and group calls). Following the 6 months, both new and sustaining sites with the lowest pre-specified implementation metrics (conducting moral injury groups and/or reporting needing additional help with implementation) will be randomized in a stratified fashion to receive either: (a) continued COP; or (b) Dynamic Diffusion Network (DDN) facilitation (higher intensity strategy) for months 6-12 (implementation phase B). At the end of the 18-month implementation phase, post-implementation and/or sustainment outcomes will be assessed via surveys and semi-structured interviews. Clinically significant change will be assessed by measures of moral injury outcomes (e.g., PTSD symptomatology, depressive symptomatology including suicidality, and mental well-being) available via patient record data pulls. A small sub-set of patients attending groups will also be interviewed to examine factors associated with patient satisfaction. In support of establishing a business case for implementation of moral injury groups across VHA, implementation costs will be assessed via self-reporting. |
| Intervention type | Other |
| Primary outcome measure(s) |
|
| Key secondary outcome measure(s) |
|
| Completion date | 30/06/2028 |
Eligibility
| Participant type(s) | |
|---|---|
| Age group | Mixed |
| Lower age limit | 0 Years |
| Upper age limit | 1 Year |
| Sex | All |
| Target sample size at registration | 27 |
| Key inclusion criteria | Healthcare facilities in the Veterans Health Administration will be randomly assigned as part of this quality improvement evaluation. The work of these facilities will be led by teams of individuals who are: 1. VHA-employed healthcare chaplain or VHA employed mental health provider 2. Willing and able to co-lead mental health and chaplain co-led collaborative moral injury group(s) for Veterans in VHA setting 3. Willing and able to be randomly assigned to one of two implementation support conditions (community of practice or network-based structured implementation facilitation) 4. Willing and able to obtain facility-level leadership support and approval to participate 5. Invited by DDN QUERI staff to participate in a quality improvement program |
| Key exclusion criteria | Must meet all inclusion criteria noted above, including being invited to participate in QI program by DDN QUERI staff |
| Date of first enrolment | 27/04/2026 |
| Date of final enrolment | 02/06/2026 |
Locations
Countries of recruitment
- United States of America
Study participating centres
Results and Publications
| Individual participant data (IPD) Intention to share | No |
|---|
Editorial Notes
11/06/2026: Trial's existence confirmed by United States Department of Veterans Affairs.
