Achieving Cardiovascular Health Equity in Community Mental Health: Optimizing Implementation Strategies

实现社区心理健康中的心血管健康公平：优化实施策略

• 批准号: 10254410
• 负责人: Gail L. Daumit
• 金额: $ 125.3万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-10 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10254410
• 关键词: Address; Adoption; Affordable Care Act; Behavioral; Blood Pressure; Cardiovascular Diseases; Caring; Cholesterol; Climate; Communities; Community Health; Counseling; Evidence based intervention; Evidence based practice; Foundations; Funding; General Population; Goals; Health; Health Promotion; Health behavior change; Health system; Home; Impaired cognition; Improve Access; Infrastructure; Intervention; Life; Link; Longevity; Maryland; Measures; Medicaid; Mental Health; Michigan; National Heart, Lung, and Blood Institute; National Institute of Mental Health; Outcome; Participant; Persons; Population; Prevalence; Primary Health Care; Proliferating; Provider; Quality of Care; Randomized; Replicating Effective Programs; Risk Behaviors; Risk Factors; Risk Reduction; Self Efficacy; Sequential Multiple Assignment Randomized Trial; Site; Testing; Time; Training; Work; base; behavioral health; cardiovascular disorder risk; cardiovascular health; cardiovascular risk factor; care coordination; clinically significant; community partnership; coping; cost; disease disparity; effective intervention; effectiveness evaluation; effectiveness implementation study; efficacious intervention; experience; group intervention; health equity; health management; implementation fidelity; implementation intervention; implementation science; implementation strategy; implementation study; improved; innovation; medical specialties; mental health organization; mortality; mortality disparity; novel; physical conditioning; population health; prevent; primary care services; primary outcome; programs; provider-level barriers; psychiatric symptom; scale up; screening; secondary outcome; severe mental illness; trial design; uptake; waiver; working group

People with serious mental illness (SMI) comprise 5% of the US population and experience one of the largest CVD-related mortality disparities of any group with rates 2 times higher, and dying 10-20 years earlier, than the overall US population. Underpinning this wide disparity is marked elevation in prevalence of all CVD risk factors in persons with SMI, with low rates of risk factor control. Interventions addressing CVD risk factors require tailoring for persons with SMI who often have substantial barriers related to psychiatric symptoms and cognitive impairment. There is an urgent need for scale-up of efficacious interventions shown to address the high burden of multiple CVD risk factors in SMI, however, organizational and provider-level barriers impede implementation. To improve care of persons with SMI and overcome fragmentation of the US general medical and specialty mental health systems, behavioral health homes, programs where specialty mental health organizations are responsible for coordinating primary care services, have proliferated. While they have shown improved access to primary care and screening for CVD risk factors, to-date behavioral health homes have not resulted in improvement in CVD risk factors, likely because they are not implementing evidence-based interventions. Two effective interventions, the NHLBI-funded IDEAL and NIMH-funded Life Goals interventions, have been shown to reduce CVD risk in persons with SMI. The overarching goal of this UG3/UH3 is to partner with communities in Michigan and Maryland serving persons with SMI to refine, tailor and test provision of different implementation strategies to improve uptake of these evidenced-based practices for reducing CVD risk in SMI in behavioral health homes. Replicating Effective Programs (REP) Framework components (e.g., community working group, packaging, training, technical support) will lay the groundwork for uptake and sustainment, alongside two additional implementation strategies, Coaching and Facilitation, which address provider and organizational barriers, respectively. The Specific Aims are to (1) Establish a highly collaborative and productive partnership with 24 Michigan and Maryland community mental health program sites to tailor IDEAL/Life Goals evidence-based practices and implementation strategies to fit site needs; (2) Determine effectiveness of two implementation strategy augmentations to REP, Coaching and Facilitation, on a) uptake and delivery of IDEAL/Life Goals at 18-months (primary outcome), and b) quality of care for CVD risk factors and CVD risk factors among persons with SMI, (secondary outcomes) and (3) To assess mechanisms (e.g., provider self-efficacy), moderators (e.g., implementation climate), and other relevant measures (e.g., fidelity, costs) to inform an adaptive implementation intervention to further scale up IDEAL/Life Goals in the behavioral health home setting. This innovative work will inform which combination of implementation strategies will lead to optimal uptake of effective interventions to reduce CVD risk among persons with SMI in community-based settings, a critical step in reducing their CVD disparities and achieving health equity.

患有严重精神疾病的人（SMI）占美国人口的5％，并体验最大的人之一 比率高2倍，十年至20年前死亡的任何群体的CVD相关死亡率差异， 美国总体人口。在所有CVD风险的患病率方面，这种广泛的差异的基础是高程 患有SMI的人的因素，风险因素控制率较低。解决CVD风险因素的干预措施 需要针对经常具有与精神症状和精神症状相关的实质性障碍的人的SMI裁缝 认知障碍。迫切需要扩大有效的干预措施，以解决 但是，SMI中多个CVD风险因素的负担很大，但是，组织和提供商级别的障碍阻碍了 执行。改善对SMI的护理并克服美国一般医疗的分裂 以及专业心理卫生系统，行为卫生之家，专业心理健康的计划 组织负责协调初级保健服务，并已激增。当他们显示 改善了获得初级保健和CVD风险因素的筛查，迄今为止的行为健康之家尚未 导致CVD风险因素改善，可能是因为它们没有实施基于证据 干预措施。两种有效的干预措施，由NHLBI资助的理想和NIMH资助的人生目标干预措施， 已显示可降低SMI患者的CVD风险。这个UG3/UH3的总体目标是合作 与密歇根州和马里兰州的社区一起为SMI服务，以完善，裁缝和测试提供 不同的实施策略，以改善这些基于这些有证据的基于CVD的经验的实践 行为卫生之家的SMI风险。复制有效程序（REP）框架组件（例如， 社区工作组，包装，培训，技术支持）将为吸收和 维持辅助策略以及辅导和促进的其他两种实施策略，这些策略解决了 提供者和组织障碍。具体目的是（1）建立高度协作 以及与密歇根州和马里兰州24个社区心理健康计划网站的生产伙伴关系，以量身定制 理想/生活目标基于证据的实践和适合现场需求的实施策略； （2）确定 两种实施策略增强的有效性，以供代表，教练和促进，a）吸收 以及在18个月（主要结果）和b）CVD风险因素的护理质量的实现理想/生活目标（主要结果） SMI（次要结果）和（3）的患者中的CVD风险因素和（3）评估机制（例如， 提供者自我效能感），主持人（例如实施气候）和其他相关措施（例如，忠诚， 成本）为了告知自适应实施干预措施，以进一步扩展行为中的理想/生活目标 卫生家庭环境。这项创新的工作将告知实施策略的哪种组合将领导 最佳采用有效干预措施，以降低基于社区的SMI患者的CVD风险 设置是减少CVD差异并实现健康平等的关键一步。