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.

项目摘要 /摘要 我们的总体，远程目标是确定有效的严格，可扩展的实施创新 用于改善医疗保健系统中循证实践（EBP）的实施。 PTSD，抑郁症 和药物使用障碍非常普遍且令人衰弱，这是退伍军人寻求护理的主要原因 在退伍军人卫生管理局（VA）中。尽管投资增加了这些疾病的EBP采用 在提供商中，EBP的赛车时间差异很大，门诊病人之间有限 人口。不改善及时获得高质量服务，具有未满足心理健康的退伍军人 成瘾需求有慢性损害和死亡的风险。 EBP需要多次约会协调 在多学科服务交付团队以及通才和专业计划中。重新设计 相互依存的过程，例如调度实践，推荐程序，患者流和人员配备 分配必须经过本地量身定制，并且需要大量利益相关者购买和支持。作为一个 现场，实施科学必须超越对系统障碍和促进者的描述，以解决这一问题 系统复杂性。参与性系统动力学建模通过三角策略相关者满足了这一需求 观点，管理数据和模型模拟，赋予有关严格和特殊性 EBP实施在本地环境中有效或无效的机制。我们的短期目标 是评估参与性系统动态建模是否有助于改善EBP时序并达到两个 由于资源和复杂性差异而选择的VA门诊系统（高与低）。 VA 专家，当地领导者和提供者以及具有心理健康和成瘾患者经验的退伍军人 参与建模过程以解决多维EBP交付动力学。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 考虑本地约束。模型模拟评估新的EBP政策或程序的系统影响 在实施之前，与试用和错误方法相比，节省了时间和资源。行政 数据是在模型中合成的，并使开发特定网站的利益相关者新实现 重组计划。有效性针对：1）患者群体中EBP的覆盖范围增加，以及 2）在12个月的随访期内，从摄入到EBP的时间缩短了时间 建模/重新设计。参与性系统动态建模具有实施科学家的希望 寻求创新方法，使利益相关者对EBP交付的更精确理解 改善实施成果的动态和上下文。如果显示有效，参与性系统 动态建模可用于解决对改善EBP实施的策略的关键需求 卫生服务系统，从而有助于满足国家优先事项，以确保及时，高质量的医疗保健。