Development of an MI Implementation Intervention in Adolescent HIV Care Settings

在青少年艾滋病毒护理环境中制定 MI 实施干预措施

基本信息

批准号：
8990069
负责人：
Karen MacDonell
金额：
$ 27.83万
依托单位：
WAYNE STATE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-08-20 至 2018-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8990069
关键词：
AIDS/HIV problem Address Adherence Administrator Adolescent Adolescent Medicine Trials Network Adoption Behavior Behavior Therapy Caring Clinic Clinical Clinical Services Code Collaborations Communication Data Development Diagnostic Discipline Effectiveness Elements Empathy Ensure Evaluation Evidence based intervention Evidence based practice Goals Guidelines HIV HIV risk Health Healthcare Hybrids Individual Intervention Intervention Studies Intervention Trial Interview Link Malignant Neoplasms Measurement Measures Medical Methods Modeling NIH Office of AIDS Research Outcome Outcome Measure Patient-Centered Care Patients Phase Phase III Clinical Trials Population Preparation Procedures Process Protocols documentation Provider Research Research Activity Risk Behaviors Risk Reduction Site Slice Strategic Planning Testing Time Training Treatment Protocols United States National Institutes of Health Youth behavior change clinical care clinical practice communication behavior design evidence base implementation science implementation trial improved innovation member motivational enhancement therapy multi-component intervention multi-site trial multidisciplinary patient population primary outcome programs public health relevance quality assurance therapy development uptake

项目摘要

DESCRIPTION (provided by applicant): The goal of this implementation science R34 is to develop an implementation intervention to increase evidence-based patient-provider communication strategies using a Motivational Interviewing (MI) framework, and pilot all evaluation procedures included measurement and the development of a statistical analysis plan. MI is an evidence-based intervention for improving patient-provider relationships and promoting behavior change, and is one of the only interventions to produce change across multiple behaviors in youth with HIV. MI is already embedded in the clinical guidelines for HIV care and HIV risk reduction. However, the inconsistent implementation of clinical guidelines is a constant concern. Fidelity of implementation refers to the degree to which staff members actually implement programs as intended by the developer, or how faithful they are to specification of the evidence-based practice. Several studies suggest that delivering MI with high fidelity can be difficult for many practitioners, but practitioners benefit from carefully designed, multicomponent interventions to help them understand and use evidence-based practices. These implementation interventions consist of a strategy or set of strategies to increase implementation of evidence-based practice. Thus, the primary goal of this proposal is to develop and pilot test a multi-level implementation intervention to increase MI fidelity and improve patient-provider communication in adolescent HIV care settings within the Adolescent Trials Network for HIV/AIDS (ATN). Leading the way in implementation science in health care is the VA's Quality Enhancement Research Initiative (QUERI), created to link research activities to clinical services in "real time" to promote the rapid uptake of best clinical practices and improvement in patient outcomes. Utilizing the QUERI model of implementation intervention development, this proposal will prepare for a full-scale implementation intervention trial with the following aims: 1) To develop a method of measuring MI fidelity to ensure methodological rigor, acceptability and feasibility of administration, and clinical usefulness (Phase 1). We will compare ratings of 200 recordings of full patient-provider interactions with ratings of thin slices (recordng 1 minute every 5 minutes); 2) To conduct evidence-based tailoring of MI training for adolescent HIV care settings (Phase 2a). We will code and utilize sequential analysis of the 200 recordings to identify those specific provider communication behaviors that predict subsequent youth motivational statements; 3) To collaboratively develop the implementation intervention with clinic teams from at least 10 different adolescent HIV clinics (Phase 2b). We will conduct a formative evaluation to provide local diagnostic data regarding barriers and facilitators to adoption and create development panels - local development teams made up of clinicians and administrators from the site, and study staff to address barriers and facilitators from formative evaluation and draft locally-customized clinical care and multi-level implementation strategies with initial sustainability plans; 4) To pilot test the implementation intervention and process/outcome evaluation protocols at two sites (Phase 3) to prepare for a full-scale implementation trial.

描述（由申请人提供）：该实施科学 R34 的目标是开发实施干预措施，以使用动机访谈 (MI) 框架增加基于证据的患者与提供者沟通策略，并试行所有评估程序，包括测量和开发MI 是一项基于证据的干预措施，旨在改善患者与提供者的关系并促进行为改变，并且是唯一能够改变 HIV 感染者多种行为的干预措施之一，已纳入 MI 的临床指南中。艾滋病毒护理和艾滋病毒风险然而，临床指南的实施不一致是一个持续存在的问题。实施的忠实度是指工作人员按照开发者的意图实际实施计划的程度，或者他们对基于证据的实践规范的忠实程度。研究表明，对于许多从业者来说，以高保真度提供 MI 可能很困难，但从业者可以从精心设计的多组件中受益帮助他们理解和使用基于证据的实践的干预措施，这些实施干预措施包括一个或一组促进基于证据的实践的实施的策略。因此，该提案的主要目标是开发和试点测试多层次的实践。 VA 的质量增强研究计划 (QUERI) 在青少年艾滋病毒/艾滋病试验网络 (ATN) 内开展实施干预，以提高 MI 保真度并改善青少年艾滋病毒护理机构中患者与提供者的沟通。创建用于链接研究“实时”临床服务活动，以促进最佳临床实践的快速采用和患者治疗结果的改善，利用实施干预开发的 QUERI 模型，该提案将为全面实施干预试验做好准备。以下目标： 1) 开发一种测量 MI 保真度的方法，以确保方法的严谨性、管理的可接受性和可行性以及临床实用性（我们将进行比较）。 200 个完整患者与提供者互动记录的评分（每 5 分钟记录 1 分钟）； 2) 针对青少年 HIV 护理环境进行基于证据的 MI 培训定制（第 2a 阶段）。对 200 个记录进行顺序分析，以确定预测后续青少年动机陈述的特定提供者沟通行为 3) 与至少 10 个不同青少年艾滋病毒诊所的诊所团队合作制定实施干预措施（阶段） 2b) 我们将进行形成性评估，提供有关采用的障碍和促进因素的本地诊断数据，并创建开发小组 - 由现场主教和管理人员组成的本地开发团队以及研究人员，以解决形成性评估和促进因素。起草本地定制的临床护理和多层次实施策略以及初步的可持续性计划； 4) 在两个地点试点测试实施干预和过程/结果评估方案（第 3 阶段），为全面实施试验做好准备。