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)
基本信息
- 批准号:9837042
- 负责人:
- 金额:--
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 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:
- 关键词:AddressAddressAdherenceAdherenceAdoptionAdoptionAnti-Retroviral AgentsAnti-Retroviral AgentsAreaAreaBisexualBisexualBudgetsCaringCaringCharacteristicsCharacteristicsClinicClinicClinicalClinicalCost SavingsCost SavingsCoupledCoupledDataDataDepression screenDepression screenDiagnosisDiagnosisEconomicsEconomicsEffectivenessEffectivenessEffectiveness of InterventionsEffectiveness of InterventionsEquilibriumEquilibriumEvaluationEvaluationFeeling suicidalFeeling suicidalFutureFutureGaysGaysGoalsGoalsHIVHIVHIV SeropositivityHIV SeropositivityHealth PromotionHealth PromotionHealth Services AccessibilityHealth Services AccessibilityHealthcareHealthcareHealthcare SystemsHealthcare SystemsHepatitis CHepatitis CHybridsHybridsImmune systemImmune systemImpairmentImpairmentImprove AccessImprove AccessInterventionInterventionInvestigator-Initiated ResearchInvestigator-Initiated ResearchLeadershipLeadershipLearningLearningLow incomeLow incomeMediatingMediatingMedicalMedicalMental DepressionMental DepressionMental HealthMental HealthMental disordersMental disordersMethodologyMethodologyNatureNatureOutcomeOutcomePatient CarePatient CarePatient-Focused OutcomesPatient-Focused OutcomesPatientsPatientsPersonsPersonsPopulationPopulationPrimary Health CarePrimary Health CareProviderProviderQuality of CareQuality of CareRaceRaceRandomizedRandomizedRandomized Controlled TrialsRandomized Controlled TrialsRecommendationRecommendationResearchResearchResearch DesignResearch DesignResourcesResourcesRestRestServicesServicesSiteSiteSuicideSuicideTarget PopulationsTarget PopulationsTestingTestingTimeTimeTranslatingTranslatingUpdateUpdateVeteransVeteransVeterans Health AdministrationVulnerable PopulationsVulnerable PopulationsWorkWorkarmarmbasebasebudget impactcare providerscare providersclinical data warehouseclinical data warehousecollaborative carecollaborative carecostcostcost effectivecost effectivedepression modeldepression modeldepressive symptomsdepressive symptomsdesigndesigneconomic evaluationeffectiveness implementation trialeffectiveness outcomeefficacious treatmentethnic minority populationethnic minority populationevidence baseevidence baseexperienceexperiencehealth administrationhealth care disparityhealth care disparityhealth disparityhealth disparityhealth equityhealth equityhigh riskhigh riskhigh standardhigh standardimplementation facilitationimplementation interventionimplementation outcomesimplementation strategyimplementation strategyimplementation trialimprovedimprovedinnovationinnovationmenmenmortalitymortalitymultidisciplinarymultidisciplinarymultimodalitymultimodalitynovelnovelpatient populationpatient populationpeerpeerprimary care settingprimary care settingprogramsprogramsprovider networksprovider networksracial and ethnicracial and ethnicracial minorityracial minorityrecruitrecruitrelative costrelative costrelative effectivenessrelative effectivenesssexual minoritysexual minoritystandard of carestandard of caresuccesssuccesssuicide ratesuicide ratetooltooltreatment as usualtreatment as usualtrial designtrial design
项目摘要
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。
项目成果
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