Participatory System Dynamics for Evidence-based Addiction and Mental Healthcare

循证成瘾和心理保健的参与系统动力学

• 批准号: 9169543
• 负责人: Lindsey Eileen Zimmerman
• 金额: $ 22.1万
• 依托单位: PALO ALTO VETERANS INSTIT FOR RESEARCH
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-08-01 至 2018-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9169543
• 关键词: Accounting; Address; Adoption; Appointment; Caring; Cessation of life; Chronic; Clinic; Computerized Medical Record; Data; Disease; Dose; Effectiveness; Electronic Health Record; Engineering; Ensure; Evaluation; Evidence based practice; Evidence based treatment; Exhibits; Future; General Practitioners; Goals; Guidelines; Health; Health Services; Health system; Healthcare; Healthcare Systems; Impairment; Information Systems; Intake; Intervention; Investigation; Investments; Lead; Leadership; Measures; Mental Depression; Mental Health; Mental Health Services; Methods; Modeling; Opiates; Outcome; Outpatients; Overdose; Patients; Performance; Pharmacotherapy; Policies; Population; Post-Traumatic Stress Disorders; Procedures; Process; Provider; Psyche structure; Psychotherapy; Relapse; Resources; Risk; Schedule; Scientist; Services; Site; Specific qualifier value; Specificity; Structure; Substance Use Disorder; System; Techniques; Testing; Therapeutic; Time; Translating; Veterans; addiction; alcohol use disorder; base; care seeking; data modeling; dosage; dynamic system; effective therapy; empowered; evidence base; experience; follow-up; health administration; health care quality; implementation science; improved; innovation; medical specialties; meetings; model building; models and simulation; multidisciplinary; patient population; program dissemination; programs; prospective; quality assurance; suicidal morbidity; tool; user-friendly

PROJECT SUMMARY / ABSTRACT Our overarching, long-range goal is to identify rigorous, scaleable implementation innovations that are effective for improving the implementation of evidence-based practices (EBP) in healthcare systems. PTSD, depression and substance use disorders are highly prevalent and debilitating, and are primary reasons Veterans seek care in the Veterans Health Administration (VA). Despite investment in increasing EBP adoption for these disorders among providers, EBPs have wide variability in time-to-receipt and limited reach among the outpatient population. Without improving timely access to high-quality services, Veterans with unmet mental health and addiction needs are at risk for chronic impairment and death. EBPs require multiple appointments coordinated within multidisciplinary service delivery teams and across generalist and specialty programs. Redesigning interdependent processes, such as scheduling practices, referral procedures, patient flows, and staffing allocations must be locally tailored and require considerable stakeholder buy in and support. To advance as a field, implementation science must move beyond descriptions of system barriers and facilitators to address this system complexity. Participatory system dynamics modeling meets this need by triangulating stakeholder perspectives, administrative data and model simulations, conferring rigor and specificity regarding the mechanisms by which EBP implementation is effective or ineffective in local settings. Our short-term objective is to evaluate whether participatory system dynamics modeling helps to improve EBP timing and reach in two VA outpatient systems that were selected due to differences in resources and complexity (high vs. low). VA experts, local leaders and providers, and Veterans with experience as mental health and addiction patients engage in a modeling process to address multidimensional EBP delivery dynamics. Models test stakeholder hypotheses about improvement strategies and formally specify system capacity for implementation alternatives accounting for local constraints. Model simulations evaluate system impacts of new EBP policies or procedures prior to implementation, saving time and resources as compared to trial-and-error approaches. Administrative data is synthesized in models and made newly actionable to stakeholders who develop site-specific restructuring plans. Effectiveness aims test for: 1) increased reach of EBPs among the patient population, and 2) reduced time from intake to EBP, over a 12-month follow-up period, as compared to twelve months before modeling/redesign. Participatory system dynamics modeling holds promise for implementation scientists seeking innovative methods for engaging stakeholders around more precise understandings of EBP delivery dynamics and context to improve implementation outcomes. If shown to be effective, participatory system dynamics modeling can be used to address the critical need for strategies that improve EBP implementation in health service systems, and thereby, help to meet national priorities to ensure timely, high-quality health care.

项目概要/摘要 我们的总体长期目标是确定有效的严格、可扩展的实施创新 改善医疗保健系统中循证实践 (EBP) 的实施。创伤后应激障碍、抑郁症 物质使用障碍非常普遍且令人衰弱，是退伍军人寻求护理的主要原因 在退伍军人健康管理局（VA）。尽管投资增加了这些疾病的 EBP 采用率 在提供者之间，EBP 的接收时间存在很大差异，并且在门诊患者中的覆盖范围有限 人口。如果不能及时改善获得高质量服务的机会，心理健康状况未得到满足的退伍军人和 成瘾需求面临慢性损害和死亡的风险。 EBP 需要协调多个预约 在多学科服务提供团队以及跨通才和专业项目中。重新设计 相互依赖的流程，例如日程安排、转诊程序、患者流程和人员配置 分配必须因地制宜，并需要大量利益相关者的认同和支持。前进作为 领域，实施科学必须超越对系统障碍和促进因素的描述来解决这个问题 系统复杂性。参与式系统动力学建模通过三角测量利益相关者来满足这一需求 观点、管理数据和模型模拟，赋予有关 EBP 实施在当地环境中有效或无效的机制。我们的短期目标 是评估参与式系统动力学建模是否有助于改善 EBP 时机并达到两个目标 由于资源和复杂性的差异（高与低）而选择的 VA 门诊系统。 VA 专家、当地领导人和提供者以及具有心理健康和成瘾患者经验的退伍军人 参与建模过程来解决多维 EBP 交付动态。模型测试利益相关者 关于改进策略的假设并正式指定实施替代方案的系统能力 考虑当地的限制。模型模拟评估新 EBP 政策或程序的系统影响 在实施之前，与试错方法相比，可以节省时间和资源。行政 数据在模型中进行综合，并为开发特定站点的利益相关者提供新的可操作性 重组计划。有效性旨在测试：1) 增加 EBP 在患者群体中的覆盖范围，以及 2) 在 12 个月的随访期内，与之前 12 个月相比，从摄入到 EBP 的时间缩短了 建模/重新设计。参与式系统动力学建模为实施科学家带来了希望 寻求创新方法，让利益相关者更准确地理解 EBP 交付 改善实施成果的动力和背景。如果被证明是有效的，参与系统 动态建模可用于满足改善 EBP 实施策略的迫切需求 卫生服务系统，从而有助于满足国家优先事项，确保及时、高质量的卫生保健。