An Intervention Mapping Process to Increase Evidence-Based Psychotherapy Within a Complex Healthcare System
An Intervention Mapping Process to Increase Evidence-Based Psychotherapy Within a Complex Healthcare System
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DOI：
10.1037/amp0000631
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发表时间：
2020-11-01
影响因子：
16.4
通讯作者：
Stirman, Shannon Wiltsey
中科院分区：
文献类型：
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作者：
Crowe, Chris;Collie, Claire;Stirman, Shannon Wiltsey
根据创伤后应激障碍特别委员会(PTSD)、美国退伍军人事务部、退伍军人健康管理局(VHA)的建议，退伍军人健康管理局(VHA)成立了一个工作组，以确定通过临床医生培训举措改善VHA实施的循证心理疗法(EBPS)的覆盖面和忠诚度的战略。该工作组由VHA内各种角色的利益相关者组成，使用了干预映射过程，这是一种基于理论、证据和利益相关者输入来设计变革战略的实用方法。高层建议围绕实施最新的VHA/国防部(VA/DoD)治疗指南。除了推荐的一线和建议的二线治疗外，这些指南还包括基于测量的护理和围绕EBPS及其替代方案的共享决策，以确保护理是以目标为导向和以患者为中心的。为了支持扩大覆盖范围和忠诚度，工作组提出了四项广泛的建议：(A)加强领导力支持；(B)按照临床实践指南的建议，调整影响EBP覆盖范围的政策、计划和流程，包括在EBP培训的同时提供实施支持；(C)使用临床数据为多个层面的决策提供信息，并在结果低于预期或期望时提供忠诚度支持；以及(D)提高退伍军人和利益相关者教育，提高对指南建议和EBPS可用性的认识。这些建议附有一套更详细的建议执行步骤。这篇文章描述了干预映射过程和工作组最终建议的摘要。公共意义声明本研究表明，干预映射过程是一种基于理论、证据和广泛的利益相关者投入来设计变化战略的有用方法。这里提出的流程和建议为在大型医疗保健系统中提高获得高质量的循证心理治疗提供了指导。
In response to recommendations from the Special Committee on posttraumatic stress disorder (PTSD), the United States Department of Veterans Affairs, Veterans Health Administration (VHA) chartered a workgroup to identify strategies for improving the reach and fidelity of evidence-based psychotherapies (EBPs) implemented by VHA through clinician training initiatives. The workgroup, which comprised stakeholders in a variety of roles within the VHA, used an Intervention Mapping process, a practical approach to designing change strategies based on theory, evidence, and stakeholder input. High-level recommendations centered around implementation of recent VHA/Department of Defense (VA/DoD) treatment guidelines. In addition to recommended first-line and suggested second-line treatments, the guidelines include measurement-based care and shared decision making around EBPs and their alternatives to ensure that care is goal-oriented and patient-centered. To support increased reach and fidelity, the workgroup made four broad recommendations: (a) enhancing leadership support; (b) alignment of policies, programs, and processes that influence reach of EBPs as recommended in clinical practice guidelines, including implementation support to accompany EBP trainings; (c) use of clinical data to inform decision making at multiple levels, and to provide fidelity support when outcomes are lower than expected or desired; and (d) increasing veteran and stakeholder education and awareness of guideline recommendations and availability of EBPs. These recommendations accompanied a more detailed set of recommended steps for implementation. This article describes the Intervention Mapping process and a summary of resulting workgroup recommendations.Public Significance StatementThis study suggests an Intervention Mapping process is a useful approach for designing change strategies based on theory, evidence, and broad stakeholder input. The process and recommendations presented here provide guidance for enhancing access to high quality, evidence-based psychotherapy in a large healthcare system.