Type III Hybrid Effectiveness-Implementation Trial of a Clinical Decision Support System for the Implementation of Problem Solving Treatment in Community Health Centers

在社区卫生中心实施问题解决治疗的临床决策支持系统的 III 型混合有效性-实施试验

• 批准号: 10621641
• 负责人: IAN Moore BENNETT
• 金额: $ 69.1万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-05-15 至 2028-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10621641
• 关键词: Adoption; Aftercare; Automated Clinical Decision Support; Behavioral; Caring; Certification; Client; Clinic; Clinical; Clinical Decision Support Systems; Collaborations; Communities; Data; Development; Disease; Effectiveness; Electronic Health Record; Elements; Ensure; Ethnic Origin; Evidence based intervention; Feedback; Goals; Health; Hour; Hybrids; Intervention; Intervention Studies; Low income; Measures; Mediating; Mental Depression; Modeling; Neighborhood Health Center; Outcome; Patient-Focused Outcomes; Patients; Phase; Primary Care; Problem Solving; Procedures; Process; Public Health Informatics; Quality of life; Randomized; Reporting; Self Efficacy; Supervision; System; Technology; Testing; Time; Training; Treatment Effectiveness; Work; care delivery; clinical care; depressive symptoms; design; effectiveness evaluation; effectiveness/implementation trial; evidence base; experience; functional improvement; implementation outcomes; implementation strategy; implementation/effectiveness; improved; network informatics; primary care setting; psychosocial; racial diversity; randomized trial; randomized, clinical trials; recruit; response; shared decision making; success; support tools; tool; treatment adherence; treatment as usual; trial comparing; usability; web app

ABSTRACT Evidence-based clinical interventions are often delivered with poor fidelity and abandoned by practitioners soon after training. In response to these findings, we have worked with practitioners and clients to co-design an automated decision support tool supporting Problem Solving Treatment (PST) for depression. PST-Aid is a web- based app that promotes practitioner–client collaboration in the use of PST for goal setting and action planning, which we conceptualize as an educate and reorganize implementation strategy. We propose to further redesign PST Aid by working with stakeholder groups from our partnering OCHIN health informatics network, which includes >300 independent community health centers across 45 states serving >130,000 unique clients monthly. We will conduct a hybrid type III effectiveness-implementation randomized clinical trial comparing standard PST implementation with PST implementation augmented by the PST-Aid implementation strategy. We will test whether: 1) PST Aid results in improved implementation outcomes (initial and sustained fidelity, adoption, reach, and reduced reactive adaptations); 2) changes in usability, engagement, and appropriateness mediate the effect of PST Aid on implementation outcomes; and 3) PST Aid is more effective in reducing client depressive symptoms and improving functioning. We will train 60 practitioners from 20–30 OCHIN clinics in PST, and then randomly assign them training in PST- Aid vs PST as Usual. We will recruit up to 350 clients with elevated depressive symptoms (PHQ-9>10), or an average of 5–6 per each practitioner trained in PST. Client and practitioner-centered decision-support tools embedded in electronic health records such as PST Aid have the potential to enhance appropriateness, engagement, and usability of evidence-based interventions. The ability of such tools to support fidelity to elements of clinical interventions like PST, while at the same time reducing burden, would represent a major step forward for the delivery of care and would have implications for a range of effective but seldom used interventions.

抽象的 基于证据的临床干预措施往往保真度较差，很快就会被从业者放弃 培训后，针对这些发现，我们与从业者和客户共同设计了一个 支持抑郁症问题解决治疗 (PST) 的自动化决策支持工具 PST-Aid 是一个网络工具。 基于应用程序，促进从业者与客户在使用 PST 进行目标设定和行动规划方面的协作， 我们将其概念化为教育和重组实施策略。 我们建议与合作伙伴 OCHIN health 的利益相关者团体合作，进一步重新设计 PST 援助 信息学网络，其中包括遍布 45 个州的超过 300 个独立社区卫生中心，为 我们每月将针对超过 130,000 名唯一客户进行混合 III 型有效性实施随机化。 比较标准 PST 实施与 PST-Aid 增强的 PST 实施的临床试验 我们将测试：1) PST 援助是否能改善实施结果（初始）。 以及持续的保真度、采用率、影响力和减少的反应性适应）；2）可用性、参与度的变化； 适当性调节 PST 援助对实施结果的影响；3) PST 援助更重要； 有效减少服务对象的抑郁症状并改善功能。 我们将在 PST 中培训来自 20-30 个 OCHIN 诊所的 60 名从业者，然后随机分配他们在 PST 中接受培训- 照常援助与 PST 我们将招募最多 350 名抑郁症状加重 (PHQ-9>10) 的客户，或 PST 中每位受过培训的从业者平均 5-6 个。 嵌入电子健康记录中的以客户和从业者为中心的决策支持工具，例如 PST Aid 有潜力提高循证干预措施的适当性、参与度和可用性。 此类工具能够支持对 PST 等临床干预要素的保真度，同时减少 负担，这将是提供护理方面向前迈出的重要一步，并将对一系列问题产生影响 有效但很少使用的干预措施。