Remote Supervision for Implementing Collaborative Care for Perinatal Depression

远程监督对围产期抑郁症实施协作护理

基本信息

批准号：
9256545
负责人：
IAN Moore BENNETT
金额：
$ 86.73万
依托单位：
UNIVERSITY OF WASHINGTON
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-04-08 至 2021-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9256545
关键词：
Address Affect Birth Caring Clinical Cluster randomized trial Complex Consultations Cost Analysis Disease Electronic Health Record Elements Evaluation Evidence based practice Family Federally Qualified Health Center Feedback General Practices Health Health Benefit Healthcare Hybrids Individual Infant Intervention Knowledge Link Low income Mental Depression Mental Health Mental Health Services Mental disorders Modeling Outcome Patient-Focused Outcomes Patients Penetration Perinatal Disorder Population Pregnancy Pregnant Women Prenatal care Primary Health Care Process Provider Public Health Randomized Remote Consultation Research Support Resources Services Site Supervision Technology Testing Time Training Variant Vulnerable Populations Woman Work base clinical practice collaborative care cost cost effectiveness depression model design disability disparity reduction effective therapy effectiveness trial efficacy trial evidence base experience health care disparity improved innovation member peripartum depression pragmatic trial prospective public health relevance racial minority research to practice safety net scale up skills success symposium theories tool

项目摘要

DESCRIPTION (provided by applicant): Depression is a common and serious disorder among pregnant women but few from low income groups receive effective treatment. The highly evidence based collaborative care (CC) model for depression has been shown to work for women in pregnancy but has not been widely implemented. In cases where large scale pragmatic implementation of this innovation has been attempted there has been great variation in the success at individual health centers. A major obstacle to achieving the same success in large scale efforts to implement this care innovation as is seen in more controlled effectiveness trials is the limit of resources available to support the staff members carrying out this care. Although ongoing support in the form of training, technical assistance, quality improvement, and tools has been found to improve implementation and patient outcomes through longitudinal consultation by content experts in the health innovation being implemented most implementation efforts rely primarily on brief intensive training for staff. These content experts are complementary but distinct from general practice facilitators that address general processes that are applicable to implementation of any innovation. In order to achieve the potential public health benefits of CC an efficient and scalable model of longitudinal consultation may be needed to facilitate its effective implementation. We propose a pragmatic cluster randomized trial of longitudinal remote consultation (LRC) utilizing video conferencing to efficiently link providers to consultants who provide timely feedback and training. We plan to use a Hybrid Type III implementation design with a focus on implementation outcomes but also clinical outcomes. The proposed study will involve twenty federally qualified health centers (FQHCs) providing prenatal care and which are part of the national OCHIN Network with a shared electronic health record. All sites will receive a standard multifaceted approach to implementation used in many current broad implementation efforts. After pre-implementation training ten of the sites will be randomly selected to receive the LRC. Implementation and clinical outcomes as well as costs will be compared between the study conditions after a 12 month implementation period and a 13-21 month sustainment period. The results of the proposed study will provide critical generalizable knowledge regarding the benefits of ongoing consultation for implementation of complex interventions like collaborative care.

描述（由申请人提供）：抑郁症是孕妇中常见且严重的疾病，但低收入群体中很少有人得到有效的治疗。基于高度证据的抑郁症协作护理（CC）模式已被证明对怀孕期妇女有效，但效果不佳。在尝试大规模务实实施这项创新的情况下，各个卫生中心的成功程度存在很大差异，这是大规模实施这项护理创新的主要障碍。在更多受控有效性试验中看到的是极限尽管通过内容专家在正在实施的健康创新方面的纵向咨询，发现以培训、技术援助、质量改进和工具等形式提供的持续支持可以改善实施和患者结果。大多数实施工作主要依赖于对员工进行简短的强化培训。这些内容专家是互补的，但与一般实践促进者不同，后者解决适用于任何创新的一般流程，以实现 CC 的潜在公共健康效益。可能需要可扩展的纵向协商模型以促进其有效性我们提出了一项实用的纵向远程咨询 (LRC) 集群随机试验，利用视频会议有效地将提供者与提供及时反馈和培训的顾问联系起来。我们计划使用混合型 III 实施设计，重点关注实施结果，但也关注实施结果。拟议的研究将涉及 20 个提供产前护理的联邦合格健康中心 (FQHC)，这些中心是具有共享电子健康记录的国家 OCHIN 网络的一部分，所有地点都将接受当前广泛使用的标准多方面实施方法。实施力度。实施前培训后，将随机选择 10 个地点接受 LRC。将在 12 个月的实施期和 13-21 个月的维持期后对研究条件的实施结果和成本进行比较。拟议研究的一部分将提供关于持续咨询对实施协作护理等复杂干预措施的好处的重要的普遍知识。