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

项目总结/摘要 家庭作业，即治疗期间学到的技能的课间练习，是迄今为止最重要的练习之一 高质量的、基于证据的心理健康治疗（EBT）的未充分利用的组成部分，如认知 行为疗法（CBT）。许多提供者都在努力始终如一地开发、分配和评估作业 练习，许多患者很难记住以正确的方式练习技能， 及时的方式，促进充分的学习。需要创新的医疗IT解决方案来克服这些问题 实施高质量EBT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，南卡罗来纳州医科大学， 和Doxy.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 改善提供者的实施和患者在EBT期间的家庭作业参与。Adhere.ly包括 参与治疗练习，供提供者介绍，实践，并作为家庭作业分配给患者， 收到短信/电子邮件提醒与链接练习这些练习在一周内。Adhere.ly最初是 为治疗PTSD儿童的提供者及其照顾者开发。扩展Adhere.ly的功能， 演习将增加其临床实用性和能力，以支持NIMH的优先事项和PA-18-579特定领域， 研究兴趣为“改善EBT传播和实施的工具和平台”。的 本STTR第一阶段提案的目标是在加速创建到维持模型的指导下， 修订的实施研究综合框架有三个方面。首先，我们将努力 通过开展以下活动，了解关键利益相关方的目标、挑战、可提供性和制约因素，并对其进行优先排序： 对成年精神健康患者、提供者和 管理员（每个n≤20）和100个供应商的定量调查。我们将采取混合方法 分析，为Adhere.ly新功能和练习的设计以及实施/维持（I/S）提供信息 蓝图（目标1）。其次，我们将使用参与式设计方法（例如，共同设计研讨会）， 成人精神健康患者和提供者反复设计，完善和开发新的Adhere.ly功能， 支持一系列成人EBT的治疗练习，以及I/S蓝图（目标2）。第三，我们会进行 可行性优化，有效性和实施（OEI）混合试验，20个社区精神卫生 提供者随机分为CBT+Adhere.ly组（n=10）和CBT单独组（n=10），40名寻求治疗的患者， 提供者推荐的临床焦虑和/或抑郁升高的成年患者（结局），我们将 在基线和基线后3个月进行评估。我们将评估供应商的家庭作业使用情况和遵守 患者（目标）每周通过会话录音和患者报告。我们将优化新功能， 在试验期间，我们会评估测试和测试的结果，以及我们的I/S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).