Testing implementation facilitation for uptake of an evidence-based psychosocial intervention in VA homeless programs: A hybrid type III trial.
Testing implementation facilitation for uptake of an evidence-based psychosocial intervention in VA homeless programs: A hybrid type III trial.
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DOI：
10.1371/journal.pone.0265396
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发表时间：
2022
期刊：
影响因子：
3.7
通讯作者：
Gabrielian S
中科院分区：
文献类型：
--
作者：
Smelson DA;Yakovchenko V;Byrne T;McCullough MB;Smith JL;Bruzios KE;Gabrielian S
医疗保健系统在实施循证实践方面面临困难，特别是多成分干预措施。在为无家可归的退伍军人等弱势群体提供服务的环境中，由于人口的敏锐性、多种服务需求和组织障碍，还存在其他挑战。执行便利化是一项支持采用循证做法的战略。本研究的目的是同时检查IF对通过系统集成，外展和网络保持独立性和清醒-退伍军人版的吸收（MISSION-Vet）是一项针对无家可归的退伍军人的循证多成分治疗参与干预，这些退伍军人同时患有精神健康和药物滥用，和临床结果之间的退伍军人接受MISSION-Vet。这种多站点混合III修改阶梯-楔形试验涉及两个退伍军人事务医疗中心的七个项目，比较了实施作为指导（IU;培训和教育材料）和IF（IU +内部和外部促进）。共进行了110次平均27分钟的促进活动，其中85%是虚拟的。工作人员（病例管理员和同行专家; n = 108）接受了MISSION-Vet培训，并完成了组织准备情况评估（n = 77）。虽然这两个网站都报告说愿意创新，并希望改善成果，实施气候显着不同。在IU之后，两个研究中心都没有工作人员进行MISSION-Vet。在IF之后，研究中心之间的MISSION-Vet实施情况存在显著差异（53% vs. 14%，p = 0.002）。在93名接受任何MISSION-Vet服务的退伍军人中，他们平均接受了六次会议。MISSION-Vet会话的数量与通过参加的门诊访问数量测量的门诊治疗参与度之间存在显著的正相关。虽然工作人员对改善患者结局感兴趣，但MISSION-Vet未与IU一起实施。IF支持MISSION-Vet的采用和提高门诊服务利用率，但MISSION-Vet仍然难以实施，特别是在更大的医疗保健系统中。未来的研究可能会调整实施战略，以组织的准备。ClinicalTrials.gov，NCT02942979。
Healthcare systems face difficulty implementing evidence-based practices, particularly multicomponent interventions. Additional challenges occur in settings serving vulnerable populations such as homeless Veterans, given the population’s acuity, multiple service needs, and organizational barriers. Implementation Facilitation (IF) is a strategy to support the uptake of evidence-based practices. This study’s aim was to simultaneously examine IF on the uptake of Maintaining Independence and Sobriety Through Systems Integration, Outreach and Networking-Veterans Edition (MISSION-Vet), an evidence-based multicomponent treatment engagement intervention for homeless Veterans with co-occurring mental health and substance abuse, and clinical outcomes among Veterans receiving MISSION-Vet. This multi-site hybrid III modified stepped-wedge trial involved seven programs at two Veterans Affairs Medical Centers comparing Implementation as Usual (IU; training and educational materials) to IF (IU + internal and external facilitation). A total of 110 facilitation events averaging 27 minutes were conducted, of which 85% were virtual. Staff (case managers and peer specialists; n = 108) were trained in MISSION-Vet and completed organizational readiness assessments (n = 77). Although both sites reported being willing to innovate and a desire to improve outcomes, implementation climate significantly differed. Following IU, no staff at either site conducted MISSION-Vet. Following IF, there was a significant MISSION-Vet implementation difference between sites (53% vs. 14%, p = .002). Among the 93 Veterans that received any MISSION-Vet services, they received an average of six sessions. Significant positive associations were found between number of MISSION-Vet sessions and outpatient treatment engagement measured by the number of outpatient visits attended. While staff were interested in improving patient outcomes, MISSION-Vet was not implemented with IU. IF supported MISSION-Vet uptake and increased outpatient service utilization, but MISSION-Vet still proved difficult to implement particularly in the larger healthcare system. Future studies might tailor implementation strategies to organizational readiness. ClinicalTrials.gov, NCT02942979.
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DOI：
10.1136/bmj.h1258
发表时间：
2015-03-19
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Moore GF;Audrey S;Barker M;Bond L;Bonell C;Hardeman W;Moore L;O'Cathain A;Tinati T;Wight D;Baird J
通讯作者：
Baird J
影响因子：
7.2
作者：
Kauth, Michael R.;Sullivan, Greer;Teasdale, Thomas A.
通讯作者：
Teasdale, Thomas A.
影响因子：
5.7
作者：
Goetz, Matthew Bidwell;Tuyen Hoang;Asch, Steven M.
通讯作者：
Asch, Steven M.
影响因子：
7.2
作者：
Fritz, Johanna;Wallin, Lars;Sandborgh, Maria
通讯作者：
Sandborgh, Maria
影响因子：
3.8
作者：
Brunette, Mary F.;Asher, Dianne;McHugo, Gregory J.
通讯作者：
McHugo, Gregory J.