Development of an MI Implementation Intervention in Adolescent HIV Care Settings

在青少年艾滋病毒护理环境中制定 MI 实施干预措施

基本信息

批准号：
8990069
负责人：
Karen MacDonell
金额：
$ 27.83万
依托单位：
WAYNE STATE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-08-20 至 2018-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8990069
关键词：
AIDS/HIV problem Address Adherence Administrator Adolescent Adolescent Medicine Trials Network Adoption Behavior Behavior Therapy Caring Clinic Clinical Clinical Services Code Collaborations Communication Data Development Diagnostic Discipline Effectiveness Elements Empathy Ensure Evaluation Evidence based intervention Evidence based practice Goals Guidelines HIV HIV risk Health Healthcare Hybrids Individual Intervention Intervention Studies Intervention Trial Interview Link Malignant Neoplasms Measurement Measures Medical Methods Modeling NIH Office of AIDS Research Outcome Outcome Measure Patient-Centered Care Patients Phase Phase III Clinical Trials Population Preparation Procedures Process Protocols documentation Provider Research Research Activity Risk Behaviors Risk Reduction Site Slice Strategic Planning Testing Time Training Treatment Protocols United States National Institutes of Health Youth behavior change clinical care clinical practice communication behavior design evidence base implementation science implementation trial improved innovation member motivational enhancement therapy multi-component intervention multi-site trial multidisciplinary patient population primary outcome programs public health relevance quality assurance therapy development uptake

项目摘要

DESCRIPTION (provided by applicant): The goal of this implementation science R34 is to develop an implementation intervention to increase evidence-based patient-provider communication strategies using a Motivational Interviewing (MI) framework, and pilot all evaluation procedures included measurement and the development of a statistical analysis plan. MI is an evidence-based intervention for improving patient-provider relationships and promoting behavior change, and is one of the only interventions to produce change across multiple behaviors in youth with HIV. MI is already embedded in the clinical guidelines for HIV care and HIV risk reduction. However, the inconsistent implementation of clinical guidelines is a constant concern. Fidelity of implementation refers to the degree to which staff members actually implement programs as intended by the developer, or how faithful they are to specification of the evidence-based practice. Several studies suggest that delivering MI with high fidelity can be difficult for many practitioners, but practitioners benefit from carefully designed, multicomponent interventions to help them understand and use evidence-based practices. These implementation interventions consist of a strategy or set of strategies to increase implementation of evidence-based practice. Thus, the primary goal of this proposal is to develop and pilot test a multi-level implementation intervention to increase MI fidelity and improve patient-provider communication in adolescent HIV care settings within the Adolescent Trials Network for HIV/AIDS (ATN). Leading the way in implementation science in health care is the VA's Quality Enhancement Research Initiative (QUERI), created to link research activities to clinical services in "real time" to promote the rapid uptake of best clinical practices and improvement in patient outcomes. Utilizing the QUERI model of implementation intervention development, this proposal will prepare for a full-scale implementation intervention trial with the following aims: 1) To develop a method of measuring MI fidelity to ensure methodological rigor, acceptability and feasibility of administration, and clinical usefulness (Phase 1). We will compare ratings of 200 recordings of full patient-provider interactions with ratings of thin slices (recordng 1 minute every 5 minutes); 2) To conduct evidence-based tailoring of MI training for adolescent HIV care settings (Phase 2a). We will code and utilize sequential analysis of the 200 recordings to identify those specific provider communication behaviors that predict subsequent youth motivational statements; 3) To collaboratively develop the implementation intervention with clinic teams from at least 10 different adolescent HIV clinics (Phase 2b). We will conduct a formative evaluation to provide local diagnostic data regarding barriers and facilitators to adoption and create development panels - local development teams made up of clinicians and administrators from the site, and study staff to address barriers and facilitators from formative evaluation and draft locally-customized clinical care and multi-level implementation strategies with initial sustainability plans; 4) To pilot test the implementation intervention and process/outcome evaluation protocols at two sites (Phase 3) to prepare for a full-scale implementation trial.

描述（由应用程序提供）：本实施科学R34的目的是开发一种实施干预措施，以使用动机访谈（MI）框架来增加基于证据的患者支持者的交流策略，而PILOT所有评估程序包括测量和制定统计分析计划。 MI是一种基于证据的干预措施，用于改善患者支持者的关系和促进行为改变，并且是艾滋病毒青年在多种行为中产生变化的唯一干预措施之一。 MI已经嵌入了HIV护理和降低HIV风险的临床指南中。但是，临床准则的实施不一致是一个不断的问题。实施的保真度是指工作人员按照开发商打算实施计划的程度，或者是指他们对循证实践的规定有多忠诚。几项研究表明，对于许多从业者来说，以高忠诚交付MI可能很难干预措施，以帮助他们理解和使用基于证据的实践。这些实施干预措施包括增加循证实践实施的策略或一系列策略。这是该提案的主要目标是开发和试点测试多层实施干预措施，以提高MI保真度并改善青少年HIV艾滋病毒/艾滋病（ATN）的青少年HIV护理环境中的患者培训。弗吉尼亚州的质量增强研究计划（QUERI）领导实施科学的实施科学，该计划旨在将研究活动与“实时”联系起来，以促进最佳临床实践的快速吸收和患者结果的改善。利用实施干预开发的QuERI模型，该提案将为与全面实施干预试验做准备以下目的：1）开发一种测量MI保真度以确保方法论上的严格性，可接受性和可行性以及临床实用性的方法（第1阶段）。我们将比较与薄片的评分（每5分钟1分钟记录）的全部患者相互作用的200记录的评分； 2）为青少年艾滋病毒护理环境（第2A阶段）进行基于证据的MI培训裁缝。我们将编码并利用对200个记录的顺序分析来确定那些预测随后的青年动机陈述的特定提供者的交流行为； 3）与至少10个不同青少年艾滋病毒诊所（第2B期）的诊所团队合作开发实施干预措施。我们将进行一项形成性评估，以提供有关障碍和促进者的本地诊断数据，以采用和创建开发小组 - 由该站点的临床医生和管理人员组成的当地开发团队，并研究人员，以解决形成性评估的障碍和协助者，并在本地固定的临床护理和起草的最初可持续性计划中， 4）试点测试两个站点（第3阶段）的实施干预和过程/结果评估协议，以准备全面实施试验。