Randomized trial of a leadership and organizational change strategy to improve the implementation and sustainment of digital measurement-based care in youth mental health services

对领导和组织变革策略进行随机试验，以改善青少年心理健康服务中基于数字测量的护理的实施和维持

• 批准号: 10166946
• 负责人: Nathaniel J. Williams
• 金额: $ 76.42万
• 依托单位: BOISE STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-06-01 至 2023-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10166946
• 关键词: Accounting; Address; Administrator; Adopted; Age; Algorithms; Big Data; Caring; Child Mental Health; Childhood; Climate; Clinic; Clinical; Clinical Research; Communities; Computer software; Consultations; Country; Data; Diagnosis; Electronic Health Record; Evidence based practice; Exhibits; Expenditure; Feedback; Funding; Health Services; Health Technology; Health system; Impairment; Income; Infrastructure; Intervention; Investments; Leadership; Link; Measurement; Mediating; Medical; Mental Health; Mental Health Services; Mental disorders; Modality; Motivation; Organizational Change; Outcome; Outpatients; Patient-Focused Outcomes; Patients; Pattern; Personal Satisfaction; Phase; Protocols documentation; Provider; Psychotherapy; Randomized Controlled Trials; Recommendation; Research; Research Personnel; Scientist; Service setting; Services; Social Environment; Symptoms; System; Testing; Time; Training; Training Programs; Treatment outcome; United States National Institutes of Health; Youth; base; behavior change; behavioral health; burden of illness; care systems; career; community setting; digital; digital health; disability; effective intervention; evidence base; experience; implementation efforts; implementation intervention; implementation strategy; improved; improved outcome; leadership development; mortality; organizational climate; provider behavior; randomized trial; social; social organization; symptomatic improvement; theories; Accounting; Address; Administrator; Adopted; Age; Algorithms; Big Data; Caring; Child Mental Health; Childhood; Climate; Clinic; Clinical; Clinical Research; Communities; Computer software; Consultations; Country; Data; Diagnosis; Electronic Health Record; Evidence based practice; Exhibits; Expenditure; Feedback; Funding; Health Services; Health Technology; Health system; Impairment; Income; Infrastructure; Intervention; Investments; Leadership; Link; Measurement; Mediating; Medical; Mental Health; Mental Health Services; Mental disorders; Modality; Motivation; Organizational Change; Outcome; Outpatients; Patient-Focused Outcomes; Patients; Pattern; Personal Satisfaction; Phase; Protocols documentation; Provider; Psychotherapy; Randomized Controlled Trials; Recommendation; Research; Research Personnel; Scientist; Service setting; Services; Social Environment; Symptoms; System; Testing; Time; Training; Training Programs; Treatment outcome; United States National Institutes of Health; Youth; base; behavior change; behavioral health; burden of illness; care systems; career; community setting; digital; digital health; disability; effective intervention; evidence base; experience; implementation efforts; implementation intervention; implementation strategy; improved; improved outcome; leadership development; mortality; organizational climate; provider behavior; randomized trial; social; social organization; symptomatic improvement; theories

PROJECT SUMMARY/ ABSTRACT Psychiatric disorders are the leading cause of mortality and disability among youth in high income countries, accounting for 21% of total disease burden, and afflicting 1 in 10 youths in the US with severe impairment. Over 1,200 effective interventions, or evidence-based practices (EBPs), have been shown to improve the well-being of youth with psychiatric disorders. However, despite these advances, less than half of youths treated in community settings experience symptom improvement, a situation largely attributed to the low rates at which community providers adopt EBPs and, even when adopted, the low fidelity with which EBPs are implemented and sustained. Digital measurement-based care (MBC) systems, which collect treatment outcome data from patients and provide clinicians with real-time feedback and recommendations based on ‘big data’ actuarial algorithms, are a high-impact digital health technology EBP shown in 29 RCTs to generate improvements in clinical outcomes (i.e., d=.3-.5) across patient ages, diagnoses, and treatment modalities. Despite this, digital MBC systems are rarely used in community settings for youth, and when they are, fidelity and sustainment are often poor. Recent reviews indicate that many of these implementation and sustainment deficits can be traced to a lack of organization-level ‘social infrastructure’ or social contexts and leadership that do not support and motivate clinicians to adopt and use MBC systems; without this organizational social infrastructure, many implementation efforts fail. These observations are consistent with organizational climate theory and theories of behavior change which we have integrated to generate our primary hypothesis: achieving effective implementation and sustainment of MBC in community settings requires mechanisms of a strong organizational implementation climate and high clinician motivation generated through effective clinic leadership. With NIH support, we have pilot tested a highly transportable implementation strategy called Leadership and Organizational Change for Implementation (LOCI) that targets these mechanisms. Preliminary studies in mental health clinics show that LOCI is feasible, acceptable, and improves implementation leadership and climate. We propose a randomized controlled trial of LOCI in 20 children’s mental health clinics, incorporating 120 clinicians and a total of 720 youth outpatients, to test LOCI’s effects relative to implementation as usual (IAU) on clinician fidelity and youth clinical outcomes of a well-established digital MBC intervention during two phases of initial implementation and sustainment. This project brings together an early career/new investigator (Williams) collaborating with experienced, NIH funded implementation scientists (Aarons, Ehrhart) to advance programmatic research on the leadership, organizational, and clinician mechanisms that improve digital MBC implementation and sustainment. The study will (1) test LOCI’s effects on clinician fidelity to MBC and youth clinical outcomes during initial implementation, and (2) sustainment; and (3) test the multilevel mechanisms that link LOCI to MBC fidelity.

项目摘要/摘要 精神病是高收入中青年死亡和残疾的主要原因 国家，占伯恩疾病总疾病的21％，在美国有十分之一的年轻人中有1个 损害。超过1200多个有效干预措施或基于证据的做法（EBP）已被证明 改善精神疾病青年的福祉。但是，尽管有这些进步，但不到一半 在社区环境中接受治疗的年轻人经历了症状的改善，这种情况主要归因于 社区提供者采用EBP的低利率，即使采用了EBP的低忠诚度 实施和维持。基于数字测量的护理（MBC）系统，收集治疗 来自患者的结果数据，并为临床医生提供基于“大的”的实时反馈和建议 数据的实际算法是29个RCT中显示的高影响力的数字健康技术EBP 跨患者年龄，诊断和治疗方式的临床结局改善（即D = .3-.5）。 尽管如此，数字MBC系统很少在青年社区环境中使用，而当他们是富达时 维持通常很差。最近的评论表明，其中许多实施和维持 缺陷可以追溯到缺乏组织级的“社会基础设施”或社会背景和领导 不支持和动机临床医生采用和使用MBC系统；没有这个组织社会 基础设施，许多实施工作都失败了。这些观察结果与组织氛围一致 我们已经整合为产生主要假设的行为改变的理论和理论： 在社区环境中实现MBC的有效实施和维持需要的机制 通过有效诊所产生的强大组织实施环境和高临床动机 领导。在NIH的支持下，我们已经测试了一种高度可运输的实施策略，称为 实施这些机制的领导和组织变革（LOCI）。初步的 心理健康诊所的研究表明，基因座是可行的，可接受的，并且可以改善实施 领导和气候。我们建议在20个儿童心理健康诊所的Loci进行随机对照试验， 合并120名临床医生和共有720名青年门诊患者，以测试基因座的影响 像往常 在初始实施和维持的两个阶段的干预措施。 该项目汇集了一个早期职业/新调查员（Williams）与经验合作，NIH 资助的实施科学家（Aarons，Ehrhart）推进了有关领导层的计划研究， 组织以及改善数字MBC实施和维持的临床机制。研究 威尔（1）测试基因座对MBC临床保真度的影响以及在最初实施期间的青年临床结果， （2）维持； （3）测试将基因座与MBC保真度联系起来的多级机制。