Implementation of collaborative care for depression in VA HIV clinics: Translating Initiatives for Depression into Effective Solutions (HITIDES)

在 VA HIV 诊所实施抑郁症协作护理：将抑郁症倡议转化为有效解决方案 (HITIDES)

• 批准号: 9837042
• 负责人: Jacob T Painter
• 金额: --
• 依托单位: CENTRAL ARKANSAS VETERANS HLTHCARE SYS
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-01 至 2027-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/9837042
• 关键词: Address; Address; Adherence; Adherence; Adoption; Adoption; Anti-Retroviral Agents; Anti-Retroviral Agents; Area; Area; Bisexual; Bisexual; Budgets; Caring; Caring; Characteristics; Characteristics; Clinic; Clinic; Clinical; Clinical; Cost Savings; Cost Savings; Coupled; Coupled; Data; Data; Depression screen; Depression screen; Diagnosis; Diagnosis; Economics; Economics; Effectiveness; Effectiveness; Effectiveness of Interventions; Effectiveness of Interventions; Equilibrium; Equilibrium; Evaluation; Evaluation; Feeling suicidal; Feeling suicidal; Future; Future; Gays; Gays; Goals; Goals; HIV; HIV; HIV Seropositivity; HIV Seropositivity; Health Promotion; Health Promotion; Health Services Accessibility; Health Services Accessibility; Healthcare; Healthcare; Healthcare Systems; Healthcare Systems; Hepatitis C; Hepatitis C; Hybrids; Hybrids; Immune system; Immune system; Impairment; Impairment; Improve Access; Improve Access; Intervention; Intervention; Investigator-Initiated Research; Investigator-Initiated Research; Leadership; Leadership; Learning; Learning; Low income; Low income; Mediating; Mediating; Medical; Medical; Mental Depression; Mental Depression; Mental Health; Mental Health; Mental disorders; Mental disorders; Methodology; Methodology; Nature; Nature; Outcome; Outcome; Patient Care; Patient Care; Patient-Focused Outcomes; Patient-Focused Outcomes; Patients; Patients; Persons; Persons; Population; Population; Primary Health Care; Primary Health Care; Provider; Provider; Quality of Care; Quality of Care; Race; Race; Randomized; Randomized; Randomized Controlled Trials; Randomized Controlled Trials; Recommendation; Recommendation; Research; Research; Research Design; Research Design; Resources; Resources; Rest; Rest; Services; Services; Site; Site; Suicide; Suicide; Target Populations; Target Populations; Testing; Testing; Time; Time; Translating; Translating; Update; Update; Veterans; Veterans; Veterans Health Administration; Vulnerable Populations; Vulnerable Populations; Work; Work; arm; arm; base; base; budget impact; care providers; care providers; clinical data warehouse; clinical data warehouse; collaborative care; collaborative care; cost; cost; cost effective; cost effective; depression model; depression model; depressive symptoms; depressive symptoms; design; design; economic evaluation; effectiveness implementation trial; effectiveness outcome; efficacious treatment; ethnic minority population; ethnic minority population; evidence base; evidence base; experience; experience; health administration; health care disparity; health care disparity; health disparity; health disparity; health equity; health equity; high risk; high risk; high standard; high standard; implementation facilitation; implementation intervention; implementation outcomes; implementation strategy; implementation strategy; implementation trial; improved; improved; innovation; innovation; men; men; mortality; mortality; multidisciplinary; multidisciplinary; multimodality; multimodality; novel; novel; patient population; patient population; peer; peer; primary care setting; primary care setting; programs; programs; provider networks; provider networks; racial and ethnic; racial and ethnic; racial minority; racial minority; recruit; recruit; relative cost; relative cost; relative effectiveness; relative effectiveness; sexual minority; sexual minority; standard of care; standard of care; success; success; suicide rate; suicide rate; tool; tool; treatment as usual; treatment as usual; trial design; trial design

Project Summary / Abstract Background: HIV Translating Initiatives for Depression into Effective Solutions (HITIDES) is a collaborative care intervention that adapts the primary care collaborative care model for depression treatment to HIV clinics. In a randomized controlled trial, HITIDES significantly improved depression symptoms for Veterans Living with HIV (VLWH) and delivered cost savings. However, no VHA HIV clinics have implemented HITIDES. The goal of this study is to support broad implementation of the HITIDES intervention by testing two appropriate implementation strategies: a clinical champion from each site who, with the help of a learning collaborative of peers, will work with local clinicians and leadership to implement the HITIDES intervention at their site with and without the assistance of external facilitation from an implementation expert. Significance/Impact: Preliminary work has been completed to identify implementation strategies acceptable to VLWH and HIV care providers; however, the relative effectiveness and cost of these implementation strategies is unknown. While the HITIDES depression care team (DCT) is housed off-site and can deliver services consistently with high quality and fidelity, the ability of the DCT to interface and engage with HIV care providers at sites is unknown. Additionally, the mediating effect of site-level implementation outcomes such as reach and adoption on effectiveness of the intervention is unknown. Because the DCT can provide services to multiple HIV clinics, a small-scale rollout of the intervention is needed before considering a national roll out. Innovation: This study employs an innovative hybrid study design to concurrently examine implementation and effectiveness outcomes. The use of implementation success as a mediating factor for intervention effectiveness is also novel. The relative ability of implementation activities to impact care for vulnerable populations is an area of research where little is known. VHA HIV clinics are an ideal test case for examining these questions because VLWH are a group where racial minority, low income, sexual minority Veterans are disproportionately represented. Specific Aims: 1) Determine, through a cluster-randomized controlled trial among VHA HIV clinics, the effect of adding external facilitation to an implementation strategy consisting of a site-level clinical champion and learning collaborative. 2) Determine the impact of HITIDES on changes in depression and suicidal ideation among HIV-positive Veterans receiving the intervention. 3) Estimate the budget impact of HITIDES implementation strategies by calculating the costs of each strategy. Methodology: The use of a hybrid type-3 effectiveness-implementation trial to examine the interaction of implementation and intervention effectiveness is an innovative methodology ideal for situations where the lack of robust evidence of effectiveness is coupled with a cost-saving intervention. This hybrid trial will use a cluster randomization of 8 VHA HIV clinics. These clinics will be chosen for balance and diversity of clinic characteristics and randomly assigned to one of the two implementation arms. Evaluation of each aim will use a mix of primary (e.g., QUERI-developed time-tracking tool) and secondary (e.g., clinical data warehouse) data. We expect the clinical champion, learning collaborative, and external facilitation arm to be associated with greater reach and adoption; however, the clinical champion and learning collaborative alone arm is expected to be less costly. Next steps: The findings from implementation of the HITIDES intervention to 8 VHA HIV clinics will be used to inform selection of implementation strategies for a broad roll out in the future. Findings will be presented in cooperation with our operational partner, VA HIV, Hepatitis C, and Related Condition Program to VACO and VISN leadership.

项目摘要 /摘要 背景：将抑郁症的艾滋病毒转化为有效解决方案（HITIDE）是一项协作 适应HIV诊所的抑郁症治疗的初级保健协作护理模型的护理干预措施。 在一项随机对照试验中，HITIDE可显着改善患有的退伍军人的抑郁症状 艾滋病毒（VLWH）并节省了成本。但是，没有VHA HIV诊所实施了HITIDE。目标 这项研究的是通过测试两个适当的 实施策略：每个网站的临床拥护者 同行，将与当地临床医生和领导人一起在其网站上实施Hitides干预，并 没有实施专家的外部便利协助。 意义/影响：已经完成了初步工作，以确定可接受的实施策略 VLWH和HIV护理提供者；但是，这些实施策略的相对有效性和成本 是未知的。虽然HITIDES抑郁症护理团队（DCT）被安置在现场，并且可以提供服务 DCT互动并与艾滋病毒护理提供者互动并互动的能力始终如一 在站点是未知的。此外，现场实施结果（例如覆盖范围和）的中介作用 采用干预措施的有效性是未知的。因为DCT可以为多个 艾滋病毒诊所是在考虑全国范围内的小型干预措施中的小规模推广。 创新：本研究采用创新的混合研究设计来同时检查实施和 有效性结果。将实施成功用作干预的中介因素 有效性也是新颖的。实施活动影响脆弱的护理的相对能力 人群是一个知名度知之甚少的研究领域。 VHA HIV诊所是检查的理想测试用例 这些问题是因为VLWH是一个种族，低收入，性少数退伍军人的群体 不成比例的代表。 具体目的：1）通过VHA HIV诊所的聚类随机对照试验确定 将外部便利化添加到由现场临床冠军组成的实施策略中 学习协作。 2）确定HIDIDE对抑郁和自杀意念的变化的影响 在接受干预的艾滋病毒阳性退伍军人中。 3）估计速气的预算影响 通过计算每种策略的成本来实施策略。 方法论：使用混合3型有效性实施试验来检查的相互作用 实施和干预有效性是一种创新的方法，非常适合缺乏的情况 强大的有效性证据与节省成本的干预相结合。该混合动力试验将使用一个集群 8 VHA HIV诊所的随机化。这些诊所将被选为诊所的平衡和多样性 特征并随机分配给两个实现组之一。对每个目标的评估将使用 主要（例如，Queri开发的时间跟踪工具）和次级（例如临床数据仓库）的混合 数据。我们希望临床冠军，学习合作和外部促进部门与您相关联 覆盖范围和收养更大；但是，临床冠军和学习合作的手臂是 预计成本较小。 下一步：将HITIDES干预实施到8个VHA HIV诊所的发现将用于 为将来的广泛推广提供实施策略的选择。调查结果将在 与我们的运营伙伴VA HIV，乙型肝炎和与VACO和相关条件计划的合作 VISN领导。