Figure 3

Level of use of telemedicine-based collaborative-care management. The Level of Use interview measured sustained use of the program and was administered approximately a year after the last CBOC enrolled its first patient into the telemedicine-based CCM program, when research funds were no longer supporting the salary of clinical personnel. Level of Use was measured using key informant interviews with the Medical Directors of each of the 11 CBOCs and the Chief of Mental Health or Chief of Primary Care at the VAMC (depending on which service line operated the program). Using a structured interview guide and inductive questioning, the Level of Use framework classified the CBOCs into eight ranked levels of adoption according to their adoption behaviors. The first three levels distinguish between stages of nonuse (nonuse, orientation, and preparation). The next five levels distinguish between stages of use (mechanical, routine, refinement, integration, renewal), and these distinctions are made based on the type of adaptations or refinements that are being made to the innovation.