RCT of a Learning Collaborative to Implement Health Promotion in Mental Health

学习合作在心理健康领域实施健康促进的随机对照试验

• 批准号: 8842717
• 负责人: Stephen J Bartels
• 金额: $ 74.52万
• 依托单位: DARTMOUTH COLLEGE
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-06-01 至 2019-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8842717
• 关键词: Address; Adherence; Adult; Body Weight decreased; Caring; Cluster randomized trial; Communities; Diabetes Mellitus; E-learning; Effectiveness; Enrollment; Evidence based practice; Exercise; Exposure to; General Population; Health; Health Personnel; Health Promotion; Health Services; Healthcare; Individual; Instruction; Intervention; Learning; Life Expectancy; Literature; Measures; Mental Health; Mental disorders; Mentors; Methods; Mission; Modeling; Obesity; Occupations; Organizational Change; Outcome; Outcome Study; Overweight; Participant; Persons; Pharmaceutical Preparations; Physical activity; Population; Problem Solving; Process; Program Sustainability; Provider; Randomized; Research; Resources; Risk Factors; Running; Services; Surveys; Testing; Time; Travel; Use Effectiveness; Wellness Program; Work; behavioral health; compare effectiveness; cost; evidence base; experience; fitness; health disparity; high risk; hypertensive heart disease; implementation research; improved; indexing; meetings; mental health organization; mortality; nutrition; operation; programs; randomized trial; sedentary lifestyle; severe mental illness; uptake; virtual

DESCRIPTION (provided by applicant): People with serious mental illness, about 6% of the US population, have one of the greatest health disparities of any group, with a life expectancy up to 25 years less than the general population. Preventable, obesity- related health conditions due to sedentary lifestyles, poor nutrition, and medications are major causes of this disparity. Despite a variety of evidence-based health promotion practices, we do not know how to effectively transform community mental health organizations to embrace wellness as central to their mission and services. Despite widespread use of Learning Collaboratives and their potential benefits in applying collective problem solving, inclusion of consumer perspective, and quality improvement methods in implementation of evidence- based practices, there have been few (if any) randomized trials evaluating their effectiveness using quantitative outcomes. To our knowledge, the proposed study is among the first to empirically evaluate the effectiveness of a virtual national learning collaborative in implementing a new evidence-based practice. Using an implementation research framework, we propose a cluster-randomized trial of 48 mental health provider organizations to evaluate the effectiveness of two different strategies in the initial implementation of the In SHAPE model of integrated health promotion in mental health organizations. We will test the following study hypotheses: Instruction + Learning Collaborative (I+LC) compared to Instruction Alone (IA) will be associated with: (H1) greater Program Participation (the Primary Service Outcome Study Hypothesis-as measured by the proportion of enrolled individuals who have received an adequate exposure to the intervention defined by attending at least 50% of Health Mentor sessions over 6 months); and (H2) greater Organizational Change supporting health promotion (the Secondary Implementation Outcome Study Hypothesis-as measured by the General Organizational Index adapted for In SHAPE). In addition, we will examine exploratory hypotheses that I+LC vs. IA will be associated with: (E1) more rapid Full Program Operation; (E2) greater Program Uptake and Expansion; (E3) greater Program Fidelity; (E4) greater likelihood of Program Sustainability; and (E5) better Participant Outcomes (physical activity; nutrition and weight loss). Finally, we will document the incremental time and costs associated with the virtual Learning Collaborative, and (E6) explore the effect of Organizational Change supporting health promotion on Program Participation, and of Learning Collaborative Adherence on Program Participation. This study addresses a major gap in the implementation research literature on the effectiveness of Learning Collaboratives compared to usual implementation, including use of virtual (interactive video) as a practical and scalable implementation strategy. Findings from this study may also help inform how to overcome the challenge of implementing a new evidence-based practice demanding organizational transformation among resource-limited providers when the new practice necessitates a shift in mission, scope of practice, type of services delivered, and new financing.

描述（由申请人提供）：患有严重精神疾病的人，约占美国人口的6％，是任何群体中最大的健康差异之一，预期寿命比一般人群少25年。由于久坐的生活方式，营养不良和药物的可预防，与肥胖相关的健康状况是这种差异的主要原因。尽管有各种基于证据的健康促进实践，但我们不知道如何有效地改变社区心理健康组织，以将健康视为其使命和服务的核心。尽管广泛使用学习协作及其在应用集体问题解决，消费者的观点以及质量改进方法中实施基于循证实践时的潜在利益，但使用定量结果来评估其有效性的随机试验（如果有任何随机试验）很少。据我们所知，这项拟议的研究是第一个从经验上评估虚拟国家学习合作组织在实施新的基于循证实践方面的有效性的研究。使用实施研究框架，我们提出了48个心理健康提供者组织的集群随机试验，以评估两种不同策略在最初实施心理健康组织中综合健康促进模型中的有效性。我们将测试以下研究假设：与单独的教学（IA）相比，教学 +学习协作（I + LC）将与：（H1）更大的计划参与（主要服务成果研究假设假设假设 - 按照在至少50％的健康中，以超过6个月份的6个月来衡量的招募个体的比例，这些人的比例为6个月，以6个月的投入到6个月份中。 （H2）更大的组织变革支持健康促进（二级实施结果研究假设假设 - 如适用于形状的一般组织指数所衡量的）。此外，我们将研究I+LC与IA的探索性假设：（E1）更快的完整程序操作； （E2）更大的计划吸收和扩展； （E3）更大的计划保真度； （E4）计划可持续性的可能性更大； （E5）更好的参与者结果（体育活动；营养和体重减轻）。最后，我们将记录与虚拟学习协作相关的增量时间和成本，（E6）探讨支持健康促进对计划参与的组织变革的影响，以及学习协作遵守计划参与的效果。这项研究解决了实施研究文献中有关学习协作有效性与通常实施的有效性的主要差距，包括将虚拟（交互式视频）用作实用且可扩展的实施策略。这项研究的结果还可以帮助告知如何克服新的循证实践的挑战，要求在新实践的转变，实践范围，提供的服务类型和新融资时，要求资源有限的提供商之间的组织转型。