Using NIATx Strategies to Implement Integrated Services in Routine Care

使用 NIATx 策略在日常护理中实施综合服务

基本信息

批准号：
9275460
负责人：
James H Ford
金额：
$ 55.17万
依托单位：
STANFORD 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：
2015-09-30 至 2020-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9275460
关键词：
Address Alcohol or Other Drugs use Alcohols Awareness Clinical Clinical Management Clinical Services Communities Complex Control Groups Cost Analysis County Data Diagnosis Dimensions Drug Use Disorder Drug abuse Economics Effectiveness Engineering Evaluation Evidence based intervention FDA approved Future Goals HIV Health Personnel Health Services Accessibility Health system Healthcare Individual Industrialization Information Management Interdisciplinary Study Intervention Measurable Measures Medical Mental disorders Methodology Modeling Names Outcome Outpatients Pathway interactions Patient Care Patient-Focused Outcomes Patients Penetration Persons Pharmaceutical Preparations Phase Plant Roots Procedures Protocols documentation Provider Psychiatric Social Work Quality of Care Randomized Recovery Research Research Personnel Resources Sampling Self Management Services Severities Taxonomy Testing Universities Variant Waiting Lists Washington Wisconsin addiction base behavioral health care systems cohort comparative cost design dual diagnosis ethnographic method evidence base experience experimental study follow-up health care availability health care delivery health care service heuristics implementation research implementation science improved indexing medical schools multidisciplinary primary outcome programs public health relevance reduce symptoms response routine care screening, brief intervention, referral, and treatment social

项目摘要

DESCRIPTION (provided by applicant): The proposed implementation research addresses a longstanding and vexing problem in behavioral health care: Access to integrated services for persons with co-occurring substance use and mental health disorders. Despite decades of awareness of this problem, at present, less than 10% of treated patients with co-occurring disorders receive evidence-based integrated services. Implementation science holds to key to addressing this persistent gap. The present study unifies and operationalizes three major implementation research heuristics: the Consolidated Framework for Implementation Research, the Stages of Implementation Completion, and the Proctor et al (2011) taxonomy of implementation outcomes. Developed by industrial engineers, a multi-faceted implementation strategy, NIATx, has proven to be effective in implementing and sustaining simple interventions in behavioral health care services. The overarching goal of this project is to test whether NIATx strategies are effective in implementing a complex evidence-based intervention: Integrated services for persons with co-occurring disorders. Promising pilot data suggest that NIATx actually can integrate services, but a more rigorous study is needed. We now take this step and herein propose a cluster randomized wait-list control group design, in which a cohort of 23 agencies receive the active NIATx approach while the other cohort of 23 agencies are waitlisted. In the second phase, the wait-list group of 23 agencies participates in NIATx and the initial group enters a sustainment phase. Hypothesized to install and sustain integrated services, NIATx is examined for effectiveness on two core implementation outcomes: fidelity and penetration, as well as patient care outcomes (psychiatric and substance use symptom reduction). Variation in the extent of and fidelity to which NIATx strategies are delivered are evaluated using the NIATx Fidelity Scale, which embeds the Stages of Implementation Completion measure. Primary outcomes are assessed at pre- implementation, post-implementation and at sustainment follow-up periods. Qualitative and economic analyses augment the quantitative data, and add to the interpretation of organizational and social dynamics, as well as resource costs. We assemble a multi-disciplinary research team with considerable and complementary expertise and experience. Capitalizing on a technically sophisticated clinical management information capacity across a state system of care (Washington), the study engages representative outpatient programs across 20 counties. Consistent with US data, the participating agencies and their key stakeholders are highly motivated to improve services for patients with co-occurring disorders. Practical implementation strategies, including their associated costs, and the measurable impact on services and patient outcomes, will be definitive research products. Findings from this robust study are immediately applicable to improve clinical services, to advance implementation research, and ultimately, to guide future implementations with other behavioral health systems and settings.

描述（由申请人提供）：拟议的实施研究解决了行为保健中长期存在且令人烦恼的问题：为同时发生药物滥用和精神健康障碍的人提供综合服务。尽管几十年来人们已经认识到这个问题，但目前，只有不到 10% 的患有并发疾病的接受治疗的患者接受了基于证据的综合服务。实施科学是解决这一持续差距的关键。本研究统一并实施了三个主要的实施研究启发法：实施研究综合框架、实施完成阶段和 Proctor 等人（2011）实施结果分类法。由工业工程师开发的多方面实施策略 NIATx 已被证明可以有效地实施和维持行为健康护理服务的简单干预措施。该项目的总体目标是测试 NIATx 策略是否有效实施复杂的循证干预措施：为患有共存疾病的人提供综合服务。有希望的试点数据表明 NIATx 实际上可以集成服务，但需要进行更严格的研究。我们现在采取这一步骤，并在此提出一个集群随机等待名单对照组设计，其中一组 23 个机构接受主动 NIATx 方法，而另一组 23 个机构则被列入候补名单。在第二阶段，由 23 个机构组成的等待名单组参与 NIATx，初始组进入维持阶段。假设安装和维持综合服务，NIATx 会检查两个核心实施成果的有效性：保真度和渗透性，以及患者护理成果（精神和药物使用症状减少）。使用 NIATx 保真度量表评估 NIATx 策略交付的程度和保真度的变化，该量表嵌入了实施完成阶段衡量标准。主要成果在实施前、实施后和维持后续阶段进行评估。定性和经济分析增强了定量数据，并增加了对组织和社会动态以及资源成本的解释。我们组建了一支多学科研究团队，拥有丰富且互补的专业知识和经验。该研究利用整个州护理系统（华盛顿）技术先进的临床管理信息能力，参与了 20 个县的代表性门诊项目。与美国的数据一致，参与机构及其主要利益相关者非常积极地改善对并发疾病患者的服务。实际的实施策略，包括其相关成本以及对服务和患者结果的可衡量影响，将成为明确的研究产品。这项强有力的研究结果可立即应用于改善临床服务、推进实施研究，并最终指导其他行为健康系统和环境的未来实施。