Implementing mHealth for Schizophrenia in Community Mental Health Settings

在社区心理健康环境中实施精神分裂症移动医疗

基本信息

批准号：
10063048
负责人：
Dror Ben-Zeev
金额：
$ 82.77万
依托单位：
UNIVERSITY OF WASHINGTON
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-01-04 至 2023-11-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10063048
关键词：
Address Administrator Adopted Affect Caring Characteristics Clinic Clinical Clinical Trials Communities Community Mental Health Centers Community Practice Data Collection Development Diffusion Ensure Evaluation Evidence based intervention Evidence based practice Funding Health Personnel Health Resources Health Sciences Healthcare Homelessness Hospitalization Hybrids Imprisonment Individual Intervention Investigational Therapies Lead Measures Mediating Mediator of activation protein Medicaid Mental Depression Mental Health Mental disorders Mobile Health Application Modeling National Institute of Mental Health Organizational Culture Outcome Participant Patient-Focused Outcomes Patients Penetration Population Provider Psyche structure Psychopathology Public Health Randomized Readiness Recovery Regimen Research Research Design Research Personnel Resources Rewards Rural Schizophrenia Self-Injurious Behavior Series Services Severities Severity of illness Site Societies Specialist Suicide System Testing Time Unemployment Victimization Washington clinical care clinical effect comparative effectiveness comparative effectiveness trial cost effectiveness design digital health digital intervention eHealth effectiveness implementation study effectiveness implementation trial evidence base experience handheld mobile device head-to-head comparison health practice implementation facilitation implementation outcomes implementation strategy improved improved outcome innovation insight interest mHealth member mobile computing model design novel patient engagement prospective psychiatric symptom research study rural setting satisfaction schizophrenia-spectrum disorder skills societal costs success therapy design tool treatment organization uptake

项目摘要

PROJECT SUMMARY Schizophrenia spectrum disorders (SSD) are a major public health concern. Evidence-based illness management interventions can extend the recovery periods and improve the outcomes of people with SSD but these are seldom available at community mental health clinics (CMHCs) where the majority of individuals with SSD receive care. Widely available mobile technologies can help overcome the capacity constraints of CMHCs, expand the reach of evidence-based mental healthcare, and provide much needed illness management skills and resources for people with SSD, wherever they may be. FOCUS is a Mobile Health (mHealth) illness-management system specifically designed for people with SSD. A series of studies conducted with over 500 participants with SSD across ten states has shown that FOCUS is feasible, usable, engaging, and effective. CMHC clinicians and administrators express a strong interest in integrating FOCUS into their offerings and workflow. While FOCUS is well-poised for deployment, how best to implement mHealth interventions in real-world community care settings is unclear. Two Practice Facilitation strategies may be suitable for implementation of FOCUS in CMHCs: External Facilitation (EF) and Internal Facilitation (IF) approaches. We propose to conduct a comparative effectiveness prospective cluster randomized hybrid type 3 trial to compare EF vs. IF implementation of the FOCUS intervention in 20 CMHCs in Washington State. Specifically, we aim to 1. Evaluate and compare implementation outcomes; 2. Examine moderators (i.e., readiness for change, culture, urban vs. rural status) and mediators (absorptive capacity) of implementation effects; and 3. Evaluate and compare patient outcomes, including evaluation of intervention mechanism of action. We will examine whether the implementation strategies differentially affect patient engagement, psychiatric symptom severity, and illness management capacity. The project addresses several NIMH strategic priorities and is highly innovative in its objectives, composition of the investigative team, data collection strategy, intervention and implementation models, and study design. The study adopts the NIMH experimental therapeutics approach and evaluates proposed mechanisms of action for both implementation and patient outcomes. At a micro-level, the study will help determine which strategies may facilitate, enhance, or hinder the uptake and clinical effects of FOCUS. At a macro-level, study findings will have broader implications for successful implementation of mHealth interventions in the years ahead. With multiple NIMH-funded mHealth and eHealth development and clinical trials currently underway, now is the opportune time to examine implementation strategies that will help pave the way for real-world uptake of the digital interventions that emerge as most promising.

项目概要精神分裂症谱系障碍（SSD）是一个主要的公共卫生问题。循证疾病管理干预措施可以延长 SSD 患者的恢复期并改善预后，但社区心理健康诊所 (CMHC) 很少提供这些服务，因为那里的大多数人都患有 SSD受到照顾。广泛使用的移动技术可以帮助克服容量限制 CMHC，扩大循证精神保健的范围，并提供急需的疾病为 SSD 患者提供管理技能和资源，无论他们身在何处。 FOCUS 是一款移动健康 (mHealth) 疾病管理系统，专为患有以下疾病的人而设计固态硬盘。对 10 个州的 500 多名 SSD 参与者进行的一系列研究表明， FOCUS 是可行的、可用的、有吸引力的、有效的。 CMHC 临床医生和管理人员表达了强烈的有兴趣将 FOCUS 集成到他们的产品和工作流程中。虽然 FOCUS 已做好部署准备，如何在现实社区护理环境中最好地实施移动医疗干预措施尚不清楚。两种实践促进策略可能适合在 CMHC 中实施 FOCUS：外部促进（EF）和内部促进（IF）方法。我们建议进行一次有效性比较前瞻性整群随机混合 3 型试验，比较 EF 与 IF 实施 FOCUS 的情况对华盛顿州 20 个 CMHC 进行干预。具体来说，我们的目标是 1. 评估和比较实施成果； 2. 检查调节因素（即变革准备程度、文化、城市与农村状况）以及实施效果的中介因素（吸收能力）； 3. 评估和比较患者的治疗结果，包括对干预作用机制的评价。我们将审查是否实施策略对患者参与度、精神症状严重程度和疾病管理有不同影响容量。该项目解决了 NIMH 的几个战略重点，其目标具有高度创新性，调查团队的组成、数据收集策略、干预和实施模式，以及研究设计。该研究采用 NIMH 实验治疗方法并评估所提出的实施和患者结果的行动机制。在微观层面上，这项研究将有助于确定哪些策略可以促进、增强或阻碍 FOCUS 的吸收和临床效果。在一个宏观层面，研究结果将对移动医疗的成功实施产生更广泛的影响未来几年的干预措施。拥有多项 NIMH 资助的移动医疗和电子医疗开发和临床目前正在进行试验，现在是审查实施战略的最佳时机，这将有助于铺平道路现实世界采用最有前途的数字干预措施的方式。