Indianapolis Interventions and Practice Research Infrastructure Program

描述（由申请人提供）：在过去的几年中，多项研究报告了综合护理管理模式改善初级保健机构对老年精神疾病患者的护理的有希望的结果。然而，国家心理健康咨询委员会的老龄化研究工作组（2006年）报告说，“在了解影响其采用的因素之前，对老年精神疾病的综合病例管理不太可能实施....需要通过传播和实施研究来解决这些问题和许多其他问题，通过建立一个关于如何传播和转化精神卫生保健信息和新做法以供特定环境下的卫生保健服务使用的知识库，弥合临床研究和日常实践之间的差距。”NIMH过去30年的研究已经确定，初级保健是大多数精神疾病患者接受护理的场所。在这个修订后的申请中，我们建议通过建立一个初级保健中老年人抑郁症和认知障碍研究的IP-RISP，来建立我们在精神病学、初级保健和老年病学交叉领域的研究经验。印第安纳波利斯IP-RISP将通过我们的研究团队与城市社区医疗保健系统合作，为弱势老年人提供服务，包括高比例的非洲裔美国人，从而推进实施科学。此外，在初级保健范围内建立精神卫生服务研究实验室，使人们有机会研究合并症（例如心血管疾病）如何影响护理过程和结果。我们的合作伙伴关系旨在确定将知识转化为常规临床实践的障碍和促进因素。根据与社区伙伴的需求评估，我们正在提议两个试点项目：(a)创建和评估综合电子病历，以支持患有抑郁症或认知障碍的老年人的临床护理和研究；(b)对患有抑郁症、认知障碍或两者兼而有之的老年人实施协同护理模式，并整合心血管疾病的护理。

DESCRIPTION (provided by applicant): Over the past few years, multiple studies have reported promising results from integrated care management models to improve the care of older adults with mental illness in primary care settings. The National Advisory Mental Health Council's Workgroup on Aging Research (2006) reported, however, that "integrated case management for mental illness in old age is unlikely to be implemented until the factors that affect its adoption are understood.... Dissemination and implementation research to address these issues and many others is needed to bridge the gap between clinical research and everyday practice by building a knowledge base about how mental health care information and new practices are transmitted and translated for health care service use in specific settings." NIMH research over the past 30 years has identified primary care as the site of care where most patients with mental illness receive care. In this revised application, we propose to build on our research experience at the intersection of psychiatry, primary care, and geriatrics by establishing an IP-RISP for the study of depression and cognitive impairment among older adults in primary care. The Indianapolis IP-RISP will advance implementation science by partnering our research team with an urban community-based health care system serving vulnerable older adults, including a high proportion of African Americans. In addition, building a laboratory for mental health services research within primary care allows opportunities to study how comorbid medical conditions (e.g. cardiovascular disease) affect the process and outcomes of care. Our partnership is designed to identify barriers and facilitators to translating knowledge into routine clinical practice. Based on an needs assessment with our community partner, we are proposing two pilot projects: (a) create and evaluate an integrated electronic medical record to support clinical care and research for older adults with depression or cognitive impairment; and (b) implement a collaborative care model for older adults with depression, cognitive impairment, or both and also integrate the care of cardiovascular disease.