Recovery Bridge: A Peer Facilitated Intervention to help bridge the transition from psychiatric inpatient hospitalization to living in the community

康复桥梁：同伴协助干预，帮助弥合从精神病住院到社区生活的过渡

• 批准号: 10637987
• 负责人: RICHARD Warren GOLDBERG
• 金额: --
• 依托单位: BALTIMORE VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-01 至 2025-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10637987
• 关键词: Acute; Address; Advocacy; Ambulatory Care; Anxiety; Area; Benchmarking; Caring; Clinical; Clinical Trials; Communities; Compensation; Control Groups; Crisis Intervention; Data; Development; Dissemination and Implementation; Effectiveness; Elements; Emotional; Evaluation; Future; Health; Health Services Accessibility; Homelessness; Hospitalization; Hospitals; Hybrids; Individual; Infrastructure; Inpatients; Internet; Intervention; Intervention Trial; Investigation; Knowledge; Manuals; Measures; Mental Depression; Mental Health; Mental Health Services; Methodology; Methods; Outcome; Outpatients; Patients; Play; Positioning Attribute; Provider; Psychiatric Hospitals; Quality of life; Recovery; Recovery Support; Research; Resources; Role; Scientific Advances and Accomplishments; Services; Source; Specialist; Specific qualifier value; Structure; Subcategory; Substance abuse problem; Suicide; Suicide prevention; Systems Integration; Technology; Testing; Time; Veterans; Vocational rehabilitation; Work; acceptability and feasibility; clinical practice; community living; design; effectiveness evaluation; effectiveness trial; effectiveness/implementation trial; empowerment; experience; functional outcomes; high risk; hospital readmission; implementation intervention; improved; innovation; inpatient service; intervention participants; military veteran; outpatient programs; peer; peer support; pilot trial; prevent; programs; psychoeducation; psychoeducational; readmission rates; severe mental illness; social; sound; tool

Background: The time following discharge from psychiatric hospitalization is a high-risk period and has been associated with a range of negative outcomes, including high rates of hospital readmission and suicide (1). Because the evidence for transitional discharge interventions with bridging components is mixed and limited in terms of how Peer Specialists (PS) can help support such interventions, additional research is needed. Our proposal calls for the development and preliminary evaluation of a PS facilitated technology-supported intervention based on the existing and frequently used My Recovery Plan program. However, to date, no studies have examined use of this tool to improve post-hospital discharge outcomes. Given the importance of the problem for the VA, and the fact that the VA has both a large PS infrastructure that is valued by both professional providers and Veterans, our work offers sound justification and the unique opportunity to test the proposed intervention in a single integrated system of inpatient and outpatient services. Significance: The significance of this project lies in its ability to actively address an important gap in the research, namely PS interventions focused on reducing readmission and supporting recovery-oriented outcomes in Veterans. Further relating to important HSR&D priorities the project is designed to advance scientific knowledge and clinical practice in the areas of access to care, mental health, and suicide prevention. Innovation and Impact: A key innovation of the proposed research is the potential to efficiently optimize existing resources to target the widespread challenges associated with transitioning out of acute inpatient settings and effectively connect Veterans to preferred services (in this case peer support) in order to prevent re-admission, and improve utilization of VA outpatient mental health services. Finally, in relationship to impact, Recovery Bridge has potential to result in improvement across multiple clinical and functional outcomes that are applicable to a broad Veteran population (rather than only in small select diagnostically specific subpopulations). Specific Aim 1: Integrate the My Recovery Plan tool and existing PS tools and strategies to develop a manualized intervention called Recovery Bridge for use by VA PS working to help Veterans make the transition from acute inpatient psychiatric hospitalization to community living. Specific Aim 2: Complete an open pilot trial (n=15) to examine the feasibility, fidelity, and acceptability of the Recovery Bridge intervention in relation to well specified benchmarks supporting continued and expanded investigation. [Specific Aim 3: As part of the open pilot trial: 1) explore the impact of the intervention on readmission rates (at 30 and 90 days), and connection to outpatient care compared to a control group (n=15) identified from administrative data, and; 2) explore the change in recovery and Quality of Life measures over time in the intervention participants]. Methodology: Source documents described in the proposal will be used to create the Recovery Bridge intervention (as Specified in Aim 1). Quantitative, qualitative, and administrative services data we will be used to complete an open trial of the intervention (as specified in Aim 2 and Aim 3). Next Steps: Benchmarks across the domains of feasibility, fidelity, and acceptability; as well as exploratory outcomes specified in Aim 3, will be used to inform next steps including a larger effectiveness trial followed by a possible hybrid-I effectiveness/implementation trial to inform future dissemination and implementation of the intervention more broadly across the VA.

背景：从精神病院出院后的时间是一个高风险期，并且已被 与一系列负面结果相关，包括高再入院率和自杀率 (1)。 因为使用桥接成分进行过渡性出院干预的证据是混杂的且有限 关于同行专家 (PS) 如何帮助支持此类干预措施，还需要进行更多研究。我们的 提案要求开发和初步评估 PS 促进的技术支持 基于现有且常用的“我的恢复计划”程序的干预。然而，迄今为止，还没有 研究检验了使用该工具来改善出院后的结果。鉴于重要性 VA 面临的问题，以及 VA 拥有双方都重视的大型 PS 基础设施这一事实 专业提供者和退伍军人，我们的工作提供了充分的理由和独特的机会来测试 建议对住院和门诊服务的单一综合系统进行干预。 意义：该项目的意义在于它能够积极解决一个重要的差距 研究，即 PS 干预措施的重点是减少再入院和支持康复导向 退伍军人的结果。进一步与重要的 HSR&D 优先事项相关，该项目旨在推进 获得护理、心理健康和自杀预防领域的科学知识和临床实践。 创新和影响：拟议研究的一个关键创新是有效优化现有研究的潜力 资源，以应对与摆脱急性住院环境相关的广泛挑战，以及 有效地将退伍军人与首选服务联系起来（在本例中为同伴支持），以防止重新入院， 提高退伍军人管理局门诊心理健康服务的利用率。最后，关于影响，恢复 Bridge 有可能改善多种临床和功能结果， 适用于广泛的退伍军人群体（而不是仅适用于少数特定诊断的群体） 亚人群）。 具体目标 1：整合“我的恢复计划”工具和现有的 PS 工具和策略，以开发一个 名为“恢复桥”的手动干预措施，供 VA PS 使用，帮助退伍军人实现过渡 从急性住院精神科住院到社区生活。 具体目标 2：完成公开试点试验（n=15），以检验该方案的可行性、保真度和可接受性 恢复桥干预与明确指定的基准相关，支持持续和扩展 调查。 [具体目标 3：作为开放试点试验的一部分：1) 探索干预措施对再入院率的影响 （第 30 天和 90 天）以及与门诊护理的联系，与对照组 (n=15) 进行比较 行政数据，以及； 2) 探索恢复和生活质量指标随时间的变化 干预参与者]。 方法：提案中描述的源文档将用于创建恢复桥 干预（如目标 1 中指定）。我们将使用的定量、定性和行政服务数据 完成干预的公开试验（如目标 2 和目标 3 中指定）。 后续步骤：可行性、保真度和可接受性领域的基准；以及探索性的 目标 3 中指定的结果将用于指导后续步骤，包括进行更大规模的有效性试验，然后进行 可能的混合 I 有效性/实施试验，为未来的传播和实施提供信息 在整个退伍军人事务部进行更广泛的干预。