Participatory design of mHealth strategies to support collaborative care in perin

标题：支持围产期抑郁症协作护理的移动健康策略的前瞻性设计 伊恩·M班尼特医学博士和哲学博士 项目摘要 迫切需要将围产期抑郁症护理的范围扩大到低收入妇女， 种族/少数民族人口。接受抑郁症治疗的妇女之间的抑郁症护理提供的巨大差异 医疗补助和那些有私人保险的人都有记录。缩小这些差距的战略必须 解决患者方面的经济、社会和文化障碍以及安全网中的资源有限问题 为这些患者服务。尚未应用以患者为中心的结局研究（PCOR）方法 如何缩小这些差距。变革和组织振兴方案中的这一K18职业提升奖提议， 通过辅导方案、正式课程和相关研究项目，培养变革和组织振兴方案方面的技能 针对低收入妇女围产期抑郁症的循证护理方法。在 研究部分将采用参与性设计和快速原型制作方法， 试行移动健康干预措施，以支持持续实施循证协作护理 非专业精神卫生机构中抑郁症服务的方法。该项目将解决所需的工作 准备在开发测试版后进行一项务实的比较有效性试验 mHealth系统的版本。虽然40多项高质量的研究表明，合作护理模式可以改善 抑郁症治疗的质量和结果在一般医疗环境中，这种方法还没有被 广泛实施或持续。协作护理模式的核心是护理经理， 患者依从性、对治疗的反应和副作用，同时向其他患者提供有效的临床反馈。 抑郁症护理团队的成员对病人的状态。护理所需的资源 然而，管理水平很高，特别是在照顾低收入妇女的资源相对不足的地点。 这种高资源成本降低了协作护理的持续实施。移动健康方法， 利用患者广泛使用的移动的电话，有望成为有效的策略， 甚至加强护理经理的工作。这些系统可以潜在地执行 护理管理者的监测、依从性评估/支持和临床反馈功能。提高 建议系统的最终用户可接受性，将以患者参与的方式开发 来自三个不同的产前诊所的护理团队成员，为低收入妇女提供既定的护理 管理者

Title: Participatory design of mHealth strategies to support collaborative care in perinatal depression Ian M. Bennett MD PhD Project Summary There is a pressing need to expand the reach of perinatal depression care to low income women from race/ethnic minority populations. Large disparities in depression care delivery between women receiving Medicaid and those with private insurance are documented. Strategies to reduce these disparities must address economic, social, and cultural barriers on the patient side as well as limited resources in the safety net system serving these patients. Patient Centered Outcomes Research (PCOR) methods have not been applied to the problem of how to reduce these disparities. This K18 career enhancement award in PCOR proposes, through a program of mentoring, formal coursework, and a linked research project, to build skills in PCOR methods targeting the delivery of evidence based care to low income women with perinatal depression. In the research component a participatory design and rapid prototyping approach will be employed to develop and pilot an mHealth intervention to support sustained implementation of the evidence based collaborative care approach to depression services in non specialty mental health settings. This project will address work needed to prepare for a pragmatic comparative effectiveness trial to be carried out after the development of a beta version of the mHealth system. While over 40 high quality studies now show collaborative care models improve the quality of depression treatment and outcomes in general medical settings, this approach has not been widely implemented or sustained. Central to the collaborative care model is a care manager who monitors patient adherence, response to treatments, and side effects, while providing effective clinical feedback to other members of the depression care team regarding the status of the patient. The resources required for care management are high, however, particularly for relatively under-resourced sites caring for low income women~ this high resource cost reduces the sustained implementation of collaborative care. mHealth approaches, which capitalize on the widespread patient use of mobile phones, hold promise as effective strategies to assist and even enhance the work of care managers. These systems can potentially carry out substantial portions of the monitoring, adherence assessment/support, and clinical feedback functions of care managers. To improve the end user acceptability of the proposed system it will be developed in a participatory manner with patients and care team members from three diverse prenatal clinics serving low income women with established care managers.