Implementing care for depression and diabetes

实施抑郁症和糖尿病护理

• 批准号: 8302612
• 负责人: HILLARY R BOGNER
• 金额: $ 24万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-05-15 至 2014-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8302612
• 关键词: Academy; Address; Adopted; Adult; American; American College of Physicians; Blood Glucose; Caring; Characteristics; Chronic; Chronic Care; Clinical; Communities; Comorbidity; Development; Diabetes Mellitus; Effectiveness; Environment; Ethnic Origin; Evaluation; Family Physicians; Foundations; Funding; Glycosylated hemoglobin A; Goals; Grant; Health; Home environment; Information Systems; Insurance Carriers; Internist; Intervention; Knowledge; Leadership; Learning; Medical; Mental Depression; Methods; National Institute of Mental Health; Outcome; Patients; Pediatrics; Pennsylvania; Physicians; Primary Health Care; Process; Professional Organizations; Program Evaluation; Provider; Public Health; Qualitative Methods; Questionnaires; Recruitment Activity; Research; Risk; Risk Factors; Rural; Stimulus; Strategic Planning; Support System; Symptoms; Testing; Training; Translational Research; Translations; Wood material; Work; base; blood glucose regulation; chronic care model; comparative efficacy; design; dissemination research; implementation research; improved; innovation; intervention program; meetings; programs; quality assurance; research study; research to practice; response; routine practice; suburb; tool

DESCRIPTION (provided by applicant): This resubmission of a R21 research study will assess how different practices approach implementation of the chronic care model for depression and diabetes with the ultimate goal of developing a tool kit to facilitate implementation. We will relate implementation core components (such as training and coaching activities undertaken by the practices) to patient outcomes (namely, depression improvement in symptoms and blood glucose control). Questions we seek to address include: How can implementation processes are improved? Can implementation processes be "tailored" to practice? The specific aims of this proposal to be carried out in real-world practices are: (1) to assess and compare implementation approaches of the chronic care model across practices mixing both quantitative and qualitative methods; (2) to evaluate the relationship between implementation core components and patient outcomes (depression improvement in symptoms and blood glucose control); and, (3) to develop an implementation tool kit so that implementation strategies can be tailored to the practices, enhancing sustainability of the chronic care model. We will recruit 30 primary care practices in southeastern Pennsylvania involved in the Pennsylvania Primary Care Coalition. With support of this proposal, we seek to describe the practice characteristics associated with implementation and practice change and to develop the components of a tailored approach to implementation based on practice characteristics. The proposed study will directly inform the translation of research to practice by building stakeholder knowledge into the implementation process. Our main patient-level outcomes are depression improvement in symptoms (using the nine-item depression module of the Patient Health Questionnaire (PHQ- 9)) and blood glucose control (using HbA1c). Our goal is to study what implementation core components (facilitative administrative support, selection, preservice training, coaching, staff evaluation, program evaluation, and system support) are adopted and by whom and to develop interventions that are adapted to the practice environment and sustainable. A major goal will be to develop an implementation tool kit consisting of a tailored approach to implementation that will culminate in the submission of an R01 implementation grant. A tailored intervention is more likely to become institutionalized into the routine of the practice than an intervention that imposes upon the practice tools and approaches that were developed elsewhere. If this proposal is funded, we have an opportunity to capitalize on the momentum for innovation in primary care to help close the gap between effectiveness and implementation. The research proposed is consistent with NIMH priorities and directly relevant to objective 4 in the NIMH Strategic Plan; namely, "to help close the gap between the development of new, research-tested interventions and their widespread use by those most in need." This project can have a significant public health impact because efficacious interventions do not improve patient outcomes without good implementation -- both are needed. PUBLIC HEALTH RELEVANCE: This resubmission of a R21 research study will assess how different practices approach implementation of the chronic care model for depression and diabetes with the ultimate goal of developing a toolkit to facilitate implementation. We will relat implementation core components (such as training and coaching activities undertaken by the practices) to patient outcomes (namely, depression improvement in symptoms and blood glucose control). This project can have a significant public health impact because efficacious interventions do not improve patient outcomes without good implementation -- both are needed.

描述（由申请人提供）：R21研究的重新提交将评估不同实践如何实施抑郁症和糖尿病的慢性护理模型，其最终目标是开发工具包以促进实施。我们将将实施核心组成部分（例如，实践进行的培训和教练活动）与患者结局（即症状和血糖控制的抑郁改善）联系起来。我们寻求解决的问题包括：如何改善实施过程？实施过程可以“量身定制”以实践？在现实世界实践中要进行的该提案的具体目的是：（1）评估和比较跨越定量和定性方法的实践的慢性护理模型的实施方法； （2）评估实施核心成分与患者结局之间的关系（症状和血糖控制的抑郁改善）； （3）开发实施工具套件，以便可以根据实践量身定制实施策略，从而增强慢性护理模型的可持续性。我们将在宾夕法尼亚州东南部参与宾夕法尼亚州初级保健联盟的30种初级保健实践。在该建议的支持下，我们试图描述与实施和实践变更相关的实践特征，并根据实践特征开发量身定制的实施方法的组成部分。拟议的研究将直接告知研究将研究转化为实践 将利益相关者的知识纳入实施过程。我们的主要患者水平结果是症状的抑郁症改善（使用患者健康问卷的九个项目抑郁模块（PHQ-9））和血糖控制（使用HBA1C）。我们的目标是研究哪些实施核心组成部分（促进行政支持，选择，职前培训，教练，员工评估，计划评估和系统支持），并通过谁以及制定适合实践环境和可持续性的干预措施。一个主要目标是开发一个实施工具套件，该工具套件由量身定制的实施方法组成，该方法将最终提交R01实施赠款。量身定制的干预措施更有可能将其制度化为实践的常规，而不是强加于其他地方开发的实践工具和方法的干预措施。如果该提案获得资助，我们将有机会利用初级保健创新的势头，以帮助缩小有效性和实施之间的差距。提出的研究与NIMH的优先级是一致的，并且与NIMH战略计划中的目标4直接相关；也就是说，“有助于弥合新的，研究测试的干预措施的发展与最需要的人的广泛使用之间的差距”。该项目可能会产生重大的公共卫生影响，因为有效的干预措施不会在没有良好实施的情况下改善患者的结果 - 两者都需要。 公共卫生相关性：R21研究的重新提交将评估不同实践如何接近抑郁症和糖尿病的慢性护理模型的实施，以开发工具包以促进实施。我们将实施核心组成部分（例如，实践进行的培训和辅导活动）与患者结局（即症状和血糖控制的抑郁症改善）。该项目可能会产生重大的公共卫生影响，因为有效的干预措施不会在没有良好实施的情况下改善患者的结果 - 两者都需要。