Care Team and Practice Level Implementation Strategies to Optimize Pediatric Collaborative Care: A Cluster-Randomized Trial

优化儿科协作护理的护理团队和实践水平实施策略：整群随机试验

• 批准号: 10531931
• 负责人: DAVID KOLKO
• 金额: $ 80.97万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-01-18 至 2025-11-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10531931
• 关键词: Academy; Acceleration; Address; Adopted; Adult; American; Attention deficit hyperactivity disorder; Attitude; Caregivers; Caring; Case Manager; Child; Child Behavior; Childhood; Clinical; Clinical Trials; Cluster randomized trial; Collection; Competence; Data; Diagnosis; Evidence based practice; Face; Family; Health Personnel; Home; Hybrids; Intervention; Knowledge; Leadership; Learning; Manuals; Measures; Mediating; Mediation; Mediator; Medical; Mental Health; Meta-Analysis; Minority; Modeling; National Institute of Mental Health; Outcome; Patient-Focused Outcomes; Pediatrics; Pennsylvania; Prevalence; Primary Care; Primary Care Physician; Problem Solving; Problem behavior; Protocols documentation; Provider; Psychiatrist; Public Health; Quality of life; Randomized; Replicating Effective Programs; Research; Resources; Sampling; Schedule; Science; Services; Severities; Strategic Planning; Symptoms; System; Teenagers; Testing; Training; Training Programs; Work; behavioral health; behavioral impairment; care providers; chronic care model; collaborative care; comorbidity; design; effectiveness outcome; effectiveness/implementation trial; evidence base; health record; implementation barriers; implementation intervention; implementation outcomes; implementation science; implementation strategy; improved; multidisciplinary; novel; patient centered medical home; pediatric patients; primary care practice; programs; response; scale up; supportive environment; theories; uptake; videoconference

PROJECT SUMMARY/ABSTRACT Chronic care models (CCM) that deliver evidence-based practices (EBP) by multidisciplinary provider teams with primary care physicians (PCP) and behavioral health (BH) providers (as care managers, CM) have improved BH outcomes in adults1-3 and children/teens, but their widespread application is impeded by implementation barriers at multiple levels. As an example, our clinical trials document the benefits of a simplified cross-diagnosis CCM protocol for child behavior problems and ADHD (Doctor Office Collaborative Care; DOCC; MH064372), but DOCC requires targeted implementation support to enhance uptake and address practical barriers at the care team (e.g., low coordination) and practice/leadership levels (e.g., low priority). Further, meta-analyses suggest that science provides few answers for how to overcome such obstacles as trials have not tested implementation strategies to scale-up a pediatric CCM. As a theory-based implementation intervention, Facilitation delivered by an outside expert with providers/teams (external) or practice manager/leaders (internal) has enhanced provider competency to deliver an EBP and leadership or organizational-level commitment to EBP implementation. External facilitation strategies applied to a care team (TEAM) may engage validated targets (i.e., team functioning), whereas internal facilitation strategies applied to leaders (LEAD) may engage practice-level targets (i.e., implementation support) to enhance uptake. They may interact to enhance EBP uptake and patient outcomes. This R01 application proposes a randomized, hybrid type 3 effectiveness-implementation trial to: 1) test the main and interactive effects of TEAM and LEAD facilitation augmentation on provider implementation and clinical outcomes, 2) test for target engagement and mediation at the team and leadership levels, and 3) examine selected practice, provider, and family moderators of implementation. The state-wide sample includes 24 primary care practices from the medical home program of the American Academy of Pediatrics-Pennsylvania Chapter. After standard training in the DOCC EBP, all practices will be randomized to one of four conditions: 1) No TEAM or LEAD; 2) TEAM only; 3) LEAD only, and 4) TEAM+LEAD. TEAM and LEAD facilitation will be delivered via videoconference on a graded schedule over 18 months. Care teams will deliver DOCC to 25 children who meet the clinical cutoff (75th percentile) on the Pediatric Symptom Checklist-17 Externalizing scale and their caregivers. We will collect practice/provider measures from 175 practice staff (0, 6, 12, 18, 24 months) and 600 caregivers (i.e., 0, 3, 6, 12 months) to support all analyses. Collection of generalizable data to routine pediatric practice will yield new knowledge about the impact, mediators, and moderators of CCM implementation. In one of the first large-scale pediatric trials of a service system intervention to address these aims and respond to RFA-MH-18-701 and the NIMH’s Strategic Plan (4.2), this trial will advance the implementation science knowledge needed to refine promising strategies for accelerating the delivery and scale-up of DOCC in a pediatric medical home.

项目摘要/摘要 多学科提供商团队提供基于证据的实践（EBP）的慢性护理模型（CCM） 与初级保健医生（PCP）和行为健康（BH）提供者（作为护理经理，CM）有 成人1-3和儿童/青少年的BH结果改善了，但其宽度应用的应用受到阻碍 实施障碍在多个层面上。例如，我们的临床试验证明了 简化儿童行为问题和多动症的简化跨诊断CCM协议（医生办公室合作 关心; docc; MH064372），但是DOCC需要有针对性的实施支持以增强吸收和 解决护理团队（例如低协调）和实践/领导层的实用障碍（例如 优先事项）。此外，荟萃分析表明，科学为如何克服这种方法提供了很少的答案 作为试验的障碍尚未测试实施策略以扩展小儿CCM。作为基于理论的 实施干预，由提供者/团队（外部）或 实践经理/领导者（内部）提高了提供者的能力来提供EBP和领导或 组织水平对EBP实施的承诺。适用于护理团队的外部设施策略 （团队）可以参与经过验证的目标（即团队功能），而内部设施策略适用于 领导者（领导者）可以聘请实践级别的目标（即实施支持）来增强吸收。他们可能 相互作用以增强EBP摄取和患者预后。此R01应用程序提出了随机的，混合的 3型有效性实施试验至：1）测试团队的主要和交互作用并领导 提供者实施和临床结果的促进，2）目标参与和测试 团队和领导层的调解，以及3）检查选定的实践，提供者和家庭 实施的主持人。全州样本包括医疗的24种初级保健实践 美国儿科学会 - 佩内斯特尼亚分会的家庭计划。经过标准培训 DOCC EBP，所有实践将被随机分配到四个条件之一：1）没有团队或领导； 2）仅限团队； 3） 仅领先，4）团队+领先。团队和领导设施将通过视频会议交付 时间表的分级超过18个月。护理团队将为符合临床临界的25个孩子提供DOCC （第75个百分位数）在小儿症状清单17外部化量表及其护理人员。我们将收集 从175名练习人员（0、6、12、18、24个月）和600名护理人员（即0、3、6，， 12个月）支持所有分析。收集可概括的数据以例行儿科实践将产生新的 有关CCM实施的影响，调解人和主持人的知识。在第一个大型 服务系统干预的儿科试验以解决这些目标并对RFA-MH-18-701和 NIMH的战略计划（4.2），该试验将提高精炼所需的实施科学知识 有希望加速DOCC在儿科医疗之家的交付和扩大规模的有希望的策略。