Design and Setting
WEST
We conducted a cluster randomized controlled pragmatic trial at the VA Portland Health Care System, which cares for approximately 85,000 patients across Oregon and southwest Washington, including two medical centers (Portland and Vancouver) and six satellite clinics (Hillsboro, Fairview, West Linn, Salem, Bend, and North Coast).Pragmatic trial features included broad eligibility criteria, intervention implementation integrated with usual care, usual care as the comparison condition, and outcome assessment using electronic health record data.For inclusion, outpatient appointments had to be as follows: (1) in either primary care or mental health; and (2) scheduled at least 2 weeks before the appointment date (the minimum length of time used to determine whether an appointment reminder is mailed). We used “stop codes,” 3-digit identifiers used within VA,