Implementing and Evaluating Computer-Based Interventions for Mental Health

实施和评估基于计算机的心理健康干预措施

• 批准号: 10186481
• 负责人: ERIC HERMES
• 金额: --
• 依托单位: VA CONNECTICUT HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-07-01 至 2021-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10186481
• 关键词: Accountability; Administrator; Adoption; Affect; Algorithms; Ambulatory Care; Anxiety; Caring; Chronic Insomnia; Clinic; Clinical; Computerized Medical Record; Computers; Congresses; Connecticut; Data Set; Development; Diffusion; Disease; Documentation; Education; Effectiveness; Evaluation; Evidence based intervention; Evidence based treatment; Face; Focus Groups; Future; Grant; Health; Health Services; Health Services Research; Healthcare; Healthcare Systems; Hybrids; Improve Access; Individual; Informatics; Information Retrieval; Intervention; Interview; Leadership; Medical Records; Mental Depression; Mental Health; Mental disorders; Methods; Natural Language Processing; Outcome; Patient Education; Patient-Focused Outcomes; Patients; Personal Satisfaction; Pharmaceutical Preparations; Pilot Projects; Policy Maker; Population; Preparation; Primary Health Care; Process; Productivity; Provider; Psyche structure; Psychiatrist; Randomized Controlled Trials; Research; Research Personnel; Risk; Self Efficacy; Site; Sleeplessness; Structure; Testing; United States National Institutes of Health; Veterans; Work; barrier to care; base; care providers; career; common treatment; effective therapy; effectiveness implementation trial; effectiveness testing; evidence base; health care quality; hypnotic; implementation strategy; improved; interest; member; multi-site trial; patient engagement; primary care services; programs; sedative; self help; treatment guidelines; treatment program; trial design

Background. Computer-based interventions (CBIs) provide a potentially effective platform for increasing Veteran access to evidence-based treatment for disorders common in primary care such as depression, anxiety, and insomnia. Because of their advantages, Congress mandated that VA implement CBIs via the Veterans' Mental Health and Other Care Improvements Act of 2008.3 However, efforts to evaluate strategies for CBI implementation in VA primary care have been limited. The Supported-CBI Implementation Strategy was developed to implement a range of mental health CBIs in primary care and consists of four components: (1) a clinical intermediary for patient support, (2) provider/staff facilitation and education, (3) patient education, and (4) stepped-care for those requiring additional treatment. A recent pilot study at VACT demonstrated the feasibility of a CBI for insomnia in VA outpatient care when implemented via Supported-CBI. Objectives. The focus of this work will be on using CBIs as intervention platforms and not a specific program or disorder. However, the RESTORETM program for the treatment of insomnia, will be used for testing. There are three objectives: (1) adapt Supported-CBI to current VA primary care organizations, (2) test the effectiveness of Supported-CBI and the clinical outcomes of RESTORETM in VACT primary care, and (3) explore the development of informatics-based processes to track the diffusion of CBI use throughout VA. Hypotheses. 1. Supported-CBI can be modified for use in VA primary care by identifying barriers/facilitators revealed by national and local primary care providers and administrators. 2. Supported-CBI, relative to a control implementation strategy, will demonstrate superior rates of (a) CBI engagement by patients, (b) provider adoption through referral to the CBI, and (c) patient completion of the CBI, as well as (d) improved patient insomnia outcomes. 3. VA organizations/providers who are early- and non-adopters of CBI use can be identified from VA medical record documentation. Once identified, interviews will validate informatics findings, identify additional barriers/facilitators, and reveal sites interested in a multi-site trial of Supported-CBI. Methods. Barriers/facilitators to Supported-CBI implementation will be identified through the qualitative analysis of semi-structured interviews and focus groups with VA-wide primary care leadership and members of local VACT primary care teams. The preliminary effectiveness of Supported-CBI and clinical outcomes of RESTORETM (compared to a low-intensity [control] strategy) will be evaluated in a hybrid type 3 implementation-effectiveness trial. Summative and process-level implementation outcomes as well as clinical insomnia outcomes will be evaluated over a six-month period and the sustainment of implementation over an additional year. The diffusion of CBI use across VA will be evaluated using information retrieval from a national dataset of VA clinical notes to identify instances of CBI use and to target semi-structured interviews of VA providers who are early- and non-adopters of CBIs. Impact. This research will modify and test a strategy for CBI implementation in VA primary care, which can be used by VA providers, administrators, and policy makers to increase access to evidence-based mental healthcare, decrease barriers to care, and increase clinic productivity. This research will directly impact VA providers by expanding efficacious, non-pharmacologic alternatives for treating mild to moderate mental health problems. This research will impact Veteran health by increasing access to mental healthcare, particularly in the early stages of disorders common in primary care treatment. Veteran well-being will be improved through intervention-related improvements in health outcomes and self-efficacy. Risk to Veterans may also lessen through the decreased use of potentially harmful psychotropic medications.

背景。基于计算机的干预措施（CBI）提供了一个潜在有效的平台，以提高 退伍军人可以获得针对初级保健中常见疾病的循证治疗，例如抑郁症、 焦虑和失眠。由于 CBI 的优势，国会要求 VA 通过以下方式实施 CBI： 2008.3 退伍军人心理健康和其他护理改善法案 然而，评估策略的努力 VA 初级保健中 CBI 的实施受到限制。支持型 CBI 实施策略 旨在在初级保健中实施一系列心理健康 CBI，由四个部分组成： (1) 为患者提供支持的临床中介，(2) 提供者/工作人员的便利和教育，(3) 患者教育， (4) 对需要额外治疗的患者进行分级护理。 VACT 最近的一项试点研究表明 通过 Supported-CBI 实施 CBI 治疗 VA 门诊失眠的可行性。 目标。这项工作的重点是使用 CBI 作为干预平台，而不是特定的计划 或紊乱。不过，用于治疗失眠的RESTORETM程序，将用于测试。那里 是三个目标：(1) 使 Supported-CBI 适应当前 VA 初级保健组织，(2) 测试 Supported-CBI 的有效性和 RESTORETM 在 VACT 初级保健中的临床结果，以及 (3) 探索基于信息学的流程的开发，以跟踪 CBI 在整个 VA 中的使用扩散情况。 假设。 1. 支持 CBI 可以通过识别以下因素揭示的障碍/促进因素进行修改，以用于 VA 初级保健： 国家和地方初级保健提供者和管理人员。 2. 相对于控制实施策略，受支持的 CBI 将表现出 (a) CBI 的优越率 患者的参与，(b) 通过转介至 CBI 来采用提供者，以及 (c) 患者完成 CBI，以及 (d) 改善患者的失眠结果。 3. 早期采用和未采用 CBI 的 VA 组织/提供者可以通过 VA 医疗识别 记录文档。一旦确定，访谈将验证信息学调查结果，确定其他 障碍/促进因素，并揭示对 Supported-CBI 多站点试验感兴趣的站点。 方法。支持 CBI 实施的障碍/促进因素将通过定性分析来确定 对 VA 范围初级保健领导层和成员的半结构化访谈和焦点小组进行分析 当地 VACT 初级保健团队。 Supported-CBI 的初步有效性和临床结果 RESTORETM（与低强度[控制]策略相比）将在混合型 3 中进行评估 实施效果试验。总结性和过程级实施结果以及临床 失眠结果将在六个月内进行评估，并在为期一年的时间内持续实施 额外的一年。 CBI 在 VA 中的使用扩散情况将通过从全国性的信息检索中进行评估 VA 临床记录数据集，用于识别 CBI 使用实例并针对 VA 进行半结构化访谈 早期采用和未采用 CBI 的提供商。 影响。这项研究将修改和测试 VA 初级保健中 CBI 实施的策略，该策略可以 VA 提供者、管理人员和政策制定者使用它来增加获得基于证据的心理信息的机会 医疗保健、减少护理障碍并提高诊所生产力。这项研究将直接影响 VA 通过扩大有效的非药物替代方案来治疗轻度至中度心理健康 问题。这项研究将通过增加获得心理保健的机会来影响退伍军人的健康，特别是在 初级保健治疗中常见疾病的早期阶段。退伍军人的福祉将通过以下方式得到改善 与干预相关的健康结果和自我效能的改善。退伍军人面临的风险也可能减少 通过减少使用潜在有害的精神药物。