A Hybrid Effectiveness-Implementation Trial of a Wellness Self-Management Program

健康自我管理计划的混合有效性实施试验

• 批准号: 8397119
• 负责人: RICHARD Warren GOLDBERG
• 金额: --
• 依托单位: BALTIMORE VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-04-01 至 2017-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8397119
• 关键词: Accident and Emergency department; Address; Adoption; Adult; Attention; Attitude; Behavior; Behavioral; Caring; Categories; Chronic; Chronic Care; Chronic Disease; Complement; Cost Analysis; Data; Disease; Education; Effectiveness; Effectiveness of Interventions; Emotional; Evaluation; Feedback; Future; General Population; Health; Health Status; Health system; Healthcare; Hybrids; Intervention; Knowledge; Life; Maintenance; Mediating; Medical; Mental Health; Methods; Modeling; Outcome; Patients; Personal Satisfaction; Physical Function; Population Study; Problem Solving; Process; Public Health; Qualitative Methods; Quality of life; Randomized; Recovery; Risk; Schizophrenia; Self Efficacy; Self Management; Services; Specialist; Specific qualifier value; Speed; Stream; Support Groups; System; Training; Veterans; Visit; base; care systems; contextual factors; cost; design; disability; effectiveness trial; evidence base; functional outcomes; group intervention; health related quality of life; implementation trial; improved; innovation; intervention effect; mental health center; mortality; peer; post intervention; programs; service utilization; severe mental illness; trial comparing; uptake

DESCRIPTION (provided by applicant): Background: Veterans with schizophrenia and other serious mental illnesses (SMI) are at elevated risk for co-occurring chronic medical conditions resulting in increased risk of disability high health care spending, reduced quality of life and early mortality. Physical wellness is increasingly recognized as a key component of the VA's commitment to developing recovery-oriented and veteran-centered mental health treatment. There is also growing recognition of the value of interventions that promote and improve patient self-management of chronic medical conditions. Building on the established efficacy of consumer facilitated medical illness self- management programming used in the general population and two recent adaptations for use with SMI adults in the public health sector (including our own evaluation of an intervention called Living Well), we propose to complete a randomized controlled effectiveness trial of our Living Well intervention and simultaneously conduct a well specified process evaluation to optimize knowledge accrual regarding important factors that may improve future adoption, implementation and sustainability of the Living Well intervention in the VA system of care. Aims: Primary AIM 1: Complete a randomized controlled effectiveness trial of our Living Well intervention with 250 veterans with SMI and at least one co-occurring chronic medical condition and evaluate the intervention's effects on functional and service related outcomes. We hypothesize that those randomized to the Living Well intervention will, in comparison to those randomized to a medical illness education and support group, demonstrate improved general health functioning including physical and emotional functioning as well as reduced rates of medical emergency room visits. We will also evaluate intervention effects on more proximal attitudinal and behavioral outcomes and assess how these factors mediate improvement in the functional and services related outcomes. Primary AIM 2: Complete a well specified process evaluation based on the RE-AIM evaluation framework to better understand contextual factors that can improve the Reach, Effectiveness, Adoption, Implementation and Maintenance which together determine the potential public health impact of the Living Well intervention. Methods: A mix of temporally overlapping quantitative and qualitative methods will be used to maximize integration and synthesis of data streams across the two aims to optimize knowledge accrual. Impact: Despite the growing recognition that self-management strategies hold enormous promise for improving quality and outcomes of care for chronic medical illnesses, and the fact that self-management is gaining prominence as a mental health recovery oriented treatment focus, there are currently no evidence-based peer facilitated medical illness self-management interventions available for dissemination within the VA mental health system. Our proposed study is designed to both generate evidence supporting the effectiveness of a peer co-facilitated intervention and to help speed throughput to public health impact by collecting important contextual information about factors that may improve future dissemination and implementation efforts.

描述（由申请人提供）： 背景：患有精神分裂症和其他严重精神疾病 (SMI) 的退伍军人同时发生慢性疾病的风险较高，导致残疾风险增加、医疗保健支出较高、生活质量下降和过早死亡。身体健康越来越被认为是退伍军人管理局致力于发展以康复为导向和以退伍军人为中心的心理健康治疗的关键组成部分。人们也越来越认识到促进和改善慢性病患者自我管理的干预措施的价值。建立在普通人群中使用的消费者促进的医疗疾病自我管理计划的既定功效以及公共卫生部门最近对 SMI 成人使用的两项调整（包括我们自己对称为 Living Well），我们建议完成一项关于我们的 Living Well 干预措施的随机对照有效性试验，并同时进行明确的流程评估，以优化有关重要因素的知识积累，这些因素可能会改善 VA 未来的 Living Well 干预措施的采用、实施和可持续性护理系统。目标： 主要目标 1：完成一项对 250 名患有 SMI 和至少一种并发慢性疾病的退伍军人进行的 Living Well 干预措施的随机对照有效性试验，并评估干预措施对功能和服务相关结果的影响。我们假设，与随机分配到医疗疾病教育和支持组的那些人相比，那些随机分配到“健康生活”干预组的人将表现出总体健康功能的改善，包括身体和情感功能，以及医疗急诊室就诊率的降低。我们还将评估干预措施对更近端的态度和行为结果的影响，并评估这些因素如何介导功能和服务相关结果的改善。主要目标 2：根据 RE-AIM 评估框架完成明确的流程评估，以更好地了解可以提高影响范围、有效性、采用、实施和维护的背景因素，这些因素共同决定了“健康生活”干预措施的潜在公共卫生影响。方法：将使用时间重叠的定量和定性方法的组合来最大限度地整合和综合这两个目标的数据流，以优化知识积累。影响：尽管人们越来越认识到自我管理策略对于提高慢性疾病护理的质量和结果具有巨大的希望，并且事实上自我管理作为以心理健康恢复为导向的治疗重点越来越受到重视，但目前没有证据表明基于同伴的医疗疾病自我管理干预措施可在退伍军人管理局心理健康系统内传播。我们提出的研究旨在生成支持同行共同促进干预措施有效性的证据，并通过收集有关可能改善未来传播和实施工作的因素的重要背景信息，帮助加快对公共卫生影响的产出。