Improving adherence to evidence-based practice using an innovative and easy-to-use health IT solution

项目摘要/摘要 家庭作业，或在治疗期间学到的技能的间歇练习，是迄今为止最重要的组成部分之一 未得到充分利用的高质量循证心理健康治疗(EBT)的组成部分，如认知 行为疗法(CBT)。许多供应商努力一致地开发、分配和评估家庭作业 与患者一起练习，许多患者在记忆中难以正确和正确地练习技能 这是促进充分学习的及时方式。需要创新的医疗IT解决方案来克服这些问题 实施高质量电子技术的这一关键组成部分的障碍。为了满足这一需求，我们经验丰富的团队 在Adhere.ly，LLC，与南佛罗里达大学、南卡罗来纳医科大学合作， 和Dox.me，LLC开发了Adhere.ly，这是一个创新的、最先进的、用户友好的基于Web的解决方案 在EBTS期间改善提供者的实施和患者在作业中的参与度。Adhere.ly包括 让提供者进行治疗练习，介绍、练习并将其作为家庭作业分配给患者，世卫组织 接收带有链接的短信/电子邮件提醒，以便在一周内练习这些练习。Adhere.ly最初是 为治疗创伤后应激障碍儿童及其照顾者的提供者开发。拓宽Adhere.ly的功能和 演习将增加其临床实用性和支持NIMH优先事项和PA-18-579特定领域的能力 对“改进EBTS传播和实施的工具和平台”的研究兴趣。这个 此第一阶段STTR提案的目标--以加速创建到可持续发展模式和 经修订的实施研究综合框架--有三个方面。首先，我们将寻求 通过开展以下工作，了解关键利益相关者的目标、挑战、负担和约束并确定其优先顺序 对成人精神健康患者、提供者和 管理员(n≤每人20人)和对100个提供商的定量调查。我们将采取一种混合的方法 为Adhere.ly新功能和演习以及实施/维持的设计提供信息的分析(我/S) 蓝图(目标1)。第二，我们将使用参与式设计方法(例如，联合设计研讨会) 成人精神健康患者和提供者反复设计、改进和开发新的Adhere.ly功能和 支持一系列成人EBTS的治疗练习和I/S蓝图(目标2)。第三，我们将开展 可行性优化、有效性和实施(OEI)与20个社区心理健康的混合试验 提供者被随机分为CBT+Adhere.ly(n=10)和单独CBT(n=10)，40人寻求治疗， 提供者转介患有临床焦虑和/或抑郁(结果)的成年患者，我们将 在基线和基线后3个月进行评估。我们将评估供应商使用家庭作业的情况以及遵守 患者(目标)每周通过会议录音和患者报告。我们将优化新功能， 我/S在试验期间的计划，并在实施后评估实施结果(目标3)。

PROJECT SUMMARY/ABSTRACT Homework, or between-session practice of skills learned during therapy, is one of the most integral, yet underutilized components of high-quality, evidence-based mental health treatments (EBTs) such as Cognitive Behavioral Therapy (CBT). Many providers struggle to consistently develop, assign, and assess homework exercises with their patients, and many patients have difficulty remembering to practice skills in a correct and timely way that fosters adequate learning. Innovative health IT solutions are needed to overcome these barriers to implementing this crucial component of high quality EBTs. To meet this need, our experienced team at Adhere.ly, LLC, in partnership with the University of South Florida, the Medical University of South Carolina, and Doxy.me, LLC developed Adhere.ly, an innovative, state-of-the art, and user-friendly web-based solution to improve provider implementation and patient engagement in homework during EBTs. Adhere.ly includes engaging therapeutic exercises for providers to introduce, practice, and assign as homework to patients, who receive SMS/email reminders with links to practice those exercises during the week. Adhere.ly was initially developed for providers treating children with PTSD and their caregivers. Broadening Adhere.ly’s features and exercises will increase its clinical utility and ability to support NIMH priorities and PA-18-579 Specific Areas of Research Interest in “Tools and Platforms to Improve the Dissemination and Implementation of EBTs.” The objectives of this Phase I STTR proposal–guided by the Accelerated Creation to Sustainment model and Modified Consolidated Framework for Implementation Research–are threefold. First, we will seek to understand and prioritize key stakeholder goals, challenges, affordances, and constraints by conducting individual, semi-structured qualitative interviews with adult mental health patients, providers, and administrators (n≤20 each) and a quantitative survey of 100 providers. We will conduct a mixed methods analysis to inform the design of new Adhere.ly features and exercises and an implementation/sustainment (I/S) blueprint (Aim 1). Second, we will use participatory design methodologies (e.g., co-design workshops) with adult mental health patients and providers to iteratively design, refine, and develop new Adhere.ly features and therapeutic exercises that support a range of adult EBTs, and an I/S blueprint (Aim 2). Third, we will conduct a feasibility Optimization, Effectiveness, and Implementation (OEI) Hybrid trial with 20 community mental health providers randomized to CBT+Adhere.ly (n=10) vs. CBT alone (n=10), and 40 treatment seeking, provider-referred adult patients with clinically elevated anxiety and/or depression (outcomes), which we will assess at baseline and 3-months post-baseline. We will assess homework use by providers and adherence of patients (targets) weekly via session audio recordings and patient-report. We will optimize new features, exercises, and our I/S plan during the trial and assess implementation outcomes post-implementation (Aim 3).