Evaluation of implementation facilitation integrated into a national mentoring programme to improve access to evidence-based psychotherapy for post-traumatic stress disorder within the veterans health administration: a quality improvement report.
Evaluation of implementation facilitation integrated into a national mentoring programme to improve access to evidence-based psychotherapy for post-traumatic stress disorder within the veterans health administration: a quality improvement report.
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对实施促进的评估融合到国家指导计划中，以改善退伍军人卫生管理局中创伤后应激障碍的循证心理治疗的获取：质量改进报告。
DOI：
10.1136/bmjoq-2023-002449
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发表时间：
2024-01-12
期刊：
影响因子：
1.4
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中科院分区：
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尽管美国退伍军人健康管理局为创伤后应激障碍（PTSD）患者提供了专门的精神保健资源，但基于证据的PTSD心理疗法（EBP）尚未得到充分利用，这一点从EBP对患者的覆盖范围很低就可以证明。一项研究-操作合作评估了地区PTSD导师作为国家指导计划的一部分提供的实施促进是否与低强度的质量改善干预措施相比改善了EBP的效果。我们采用非等效对照组设计，包括所有基线EBP较低的PTSD诊所（n=51）。根据区域PTSD导师的自我选择，将诊所分为四种质量改善条件之一：促进（n=6）、学习协作（n=15）、在有促进目标诊所的地区照例指导（n=15）和其他地区照例指导（n=15）。主要结局是PTSD患者在干预前基线和干预后维持期的EBP达到。我们使用两个时间段之间的优势比（ROR）来评估与其他条件相比，促进的有效性，调整患者水平和临床水平的混杂因素。在干预前基线期和干预后维持期，26 126名PTSD退伍军人在51个低距离PTSD诊所之一接受心理治疗。患者接受EBP治疗的几率随着时间的推移而增加。与三种比较条件相比，接受EBP治疗的患者从基线到维持的调整后ror是接受促进治疗的患者的1.35-1.69倍（比较条件与促进治疗的调整后ror范围为0.59 （95% CI 0.47至0.75）至0.74 (95% CI 0.58至0.94)）。促进实施可纳入改善创伤后应激障碍专科护理质量的国家方案，在低强度方法不够有效时可能特别有用。
Despite the resources dedicated to specialised mental healthcare for patients with post-traumatic stress disorder (PTSD) within the US Veterans Health Administration, evidence-based psychotherapies (EBPs) for PTSD have been underutilised, as evidenced by low EBP reach to patients. A research-operation collaboration evaluated whether implementation facilitation delivered by regional PTSD mentors as part of a national mentoring programme improved EBP reach compared with less-intensive quality improvement interventions. We used a non-equivalent comparison-group design that included all PTSD clinics with low EBP reach at baseline (n=51). Clinics were grouped into one of four quality improvement conditions according to self-selection by regional PTSD mentors: facilitation (n=6), learning collaborative (n=15), mentoring as usual in the regions that had facilitation-target clinics (n=15) and mentoring as usual in other regions (n=15). The primary outcome was EBP reach among therapy patients with PTSD at preintervention baseline and postintervention sustainment periods. We used the ratio of odds ratios (ROR) between the two time periods to evaluate the effectiveness of facilitation compared with the other conditions, adjusting for patient-level and clinic-level confounders. 26 126 veterans with PTSD received psychotherapy in one of 51 low-reach PTSD clinics during preintervention baseline and postintervention sustainment periods. The odds of a patient receiving an EBP increased over time across conditions. The adjusted ORs of a patient receiving an EBP from baseline to sustainment were 1.35–1.69 times larger in clinics that received facilitation compared with the three comparison conditions (adjusted RORs of comparison condition versus facilitation ranged from 0.59 (95% CI 0.47 to 0.75) to 0.74 (95% CI 0.58 to 0.94)). Implementation facilitation can be integrated into a national programme for quality improvement for PTSD specialty care and may be particularly useful when less-intensive approaches are not sufficiently effective.