Improving Measurement-Based Care in Youth Mental Health: A Comparison of Unidimensional and Multidimensional Approaches

改善青少年心理健康中基于测量的护理：单维和多维方法的比较

• 批准号: 9977261
• 负责人: Susan Rae Douglas
• 金额: $ 26.36万
• 依托单位: UNIVERSITY OF MIAMI CORAL GABLES
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-12 至 2022-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9977261
• 关键词: Address; Adolescent; Adult; Algorithms; Assessment tool; Behavior; Caregivers; Caring; Client; Clinic; Clinical; Communities; Complex; Data; Development; Diagnosis; Enrollment; Ensure; Evidence based practice; Feedback; Focus Groups; Future; Goals; Group Interviews; Healthcare; Healthcare Systems; Impairment; Individual; Institutes; Intervention; Measurement; Measures; Mediating; Mental Health; Mental Health Services; Methods; Modeling; Monitor; Names; National Institute of Mental Health; Outcome; Participant; Patient-Focused Outcomes; Patients; Pilot Projects; Population; Procedures; Process; Provider; Psyche structure; Public Health; Quality of Care; Randomized; Randomized Controlled Trials; Research; Research Priority; Research Support; Sequential Multiple Assignment Randomized Trial; Symptoms; System; Theoretical model; Therapeutic; Treatment outcome; Youth; base; care outcomes; clinical decision support; clinical decision-making; comparative effectiveness; control trial; design; effectiveness implementation study; evidence base; implementation strategy; improved; improved outcome; patient oriented; predictive test; programs; standard care; success; theories; treatment planning; trial comparing

Project Summary Data consistently point to a “quality chasm” between routine mental health services and evidence-based practices (EBPs). One approach to improving mental healthcare that holds great potential is measurement- based care (MBC), which is grounded in frequent and systematic use of assessment tools to regularly track the processes and outcomes of care. MBC has broad support as an EBP, particularly for adults. However, MBC implementation is complex and MBC is implemented with high quality in fewer than 20% of community mental health settings. Healthcare systems are in dire need of guidance on how to focus MBC to maximize benefit, and identification of essential MBC components has been named as a key priority for research. These efforts have been hampered by a lack of data on the mechanisms of MBC. This pilot study will use a mechanism- driven approach to compare two models of measurement-based care (MBC) in youth-serving community mental health settings: Multidimensional MBC, which includes measures of multiple domains that are patient- centered, treatment-driven, and symptom-focused, and Unidimensional MBC, which includes symptom measures only. Multidimensional MBC provides feedback on a broader array of process and progress outcomes that may be more relevant to clients and provide more actionable feedback to clinicians, and thus should have a stronger impact on target mechanisms and client outcomes. However, unidimensional MBC is lower burden for patients and providers, so might have more implementation success. The study will employ a Type 1 Effectiveness Implementation Hybrid design to assess the comparative effectiveness of these two approaches in three community mental health clinics serving a diverse client population while gathering data to inform future implementation. The first aim of the study is to conduct preliminary development activities to ensure fit between the two MBC approaches, the measurement of mechanisms, and the clinical context. To accomplish this aim, stakeholder focus groups and interviews will be used to gather perspectives on the two MBC approaches and the proposed research strategies, analyses of existing data will be used to develop algorithms to identify clients whose treatment is on-track (OT) or not-on-track (NOT) for positive treatment outcomes, and a small pre-pilot of study procedures will be conducted with 5 clinicians and 20 adolescent clients. The second aim of the study is to conduct a pilot randomized controlled trial comparing the two MBC approaches. The study will be conducted program-wide as standard care at the participating clinics (N = 900 youth treated by 22 clinicians), with a subset of 400 youth and their caregivers completing additional research measures. Simultaneously, data will be gathered to address the third study aim, which is to conduct a mixed- methods analysis of implementation factors related to multidimensional and unidimensional MBC. If successful, this study will support a future, fully-powered trial that will provide important data regarding MBC mechanisms of action, effective MBC strategies, and successful MBC implementation strategies.

项目概要 数据一致表明，常规心理健康服务与基于证据的服务之间存在“质量鸿沟” 一种具有巨大潜力的改善心理健康的方法是测量—— 基于护理（MBC），其基础是频繁和系统地使用评估工具来定期跟踪 MBC 作为 EBP 得到了广泛的支持，特别是对于成人。 实施过程复杂，MBC 在不到 20% 的社区心理中得到了高质量的实施 医疗保健系统迫切需要关于如何集中 MBC 以实现利益最大化的指导， 确定 MBC 的基本成分已被列为研究的重点。 由于缺乏 MBC 机制的数据而受到阻碍。这项试点研究将使用一种机制—— 比较青年服务社区中两种基于测量的护理 (MBC) 模式的驱动方法 心理健康环境：多维 MBC，包括对患者的多个领域进行测量 以治疗为中心、以治疗为导向、以症状为中心，以及单维MBC，其中包括症状 多维 MBC 只提供有关更广泛的过程和进展的反馈。 结果可能与客户更相关，并为忠诚者提供更具可操作性的反馈，从而 应该对目标机制和客户结果产生更大的影响。然而，单维 MBC 是。 减轻患者和提供者的负担，因此该研究将采用一种更成功的实施方式。 类型 1 有效性实施混合设计来评估这两种方法的比较有效性 三个社区心理健康诊所的方法为不同的客户群体提供服务，同时收集数据 告知今后的实施。 该研究的首要目的是进行初步开发活动，以确保两者之间的契合 MBC 方法、机制测量和临床背景 为了实现这一目标， 将通过利益相关者焦点小组和访谈来收集对两种 MBC 方法的观点，并 拟议的研究策略和对现有数据的分析将用于开发识别客户的算法 其治疗处于正轨 (OT) 或未正轨 (NOT) 以获得积极的治疗结果，并且进行小型预试验 的研究程序将由 5 名牧师和 20 名青少年服务对象进行。 该研究的第二个目的是进行一项随机对照试验，比较两种 MBC 该研究将作为参与诊所的标准护理在整个项目范围内进行（N = 900）。 （22 名青少年），其中 400 名青少年及其照顾者完成了额外的研究 同时，将收集数据以实现第三个研究目标，即进行混合研究。 多维和单维 MBC 相关因素的方法分析 如果成功， 这项研究将支持未来的全动力试验，该试验将提供有关 MBC 机制的重要数据 行动、有效的 MBC 策略以及成功的 MBC 实施策略。