A Hybrid Effectiveness-Implementation Trial of a Wellness Self-Management Program

描述（由申请人提供）： 背景资料：患有精神分裂症和其他严重精神疾病（SMI）的退伍军人患有并发慢性疾病的风险较高，导致残疾风险增加，医疗保健支出高，生活质量下降和早期死亡。身体健康越来越多地被认为是VA致力于开发以恢复为导向和以退伍军人为中心的心理健康治疗的关键组成部分。人们也越来越认识到促进和改善慢性病患者自我管理的干预措施的价值。基于在一般人群中使用的消费者促进的医疗疾病自我管理规划的既定功效以及最近在公共卫生部门用于SMI成人的两个调整（包括我们自己对称为 生活好），我们建议完成我们的生活好干预措施的随机对照有效性试验，同时进行一个明确的过程评估，以优化有关重要因素的知识积累，这些因素可能会改善VA护理系统中生活好干预措施的未来采用，实施和可持续性。目的：主要目标1：完成我们的生活良好干预的随机对照有效性试验，其中有250名患有SMI和至少一种并发慢性疾病的退伍军人，并评估干预对功能和服务相关结果的影响。我们假设，与那些随机分配到医疗疾病教育和支持组的人相比，那些随机分配到“生活得好”干预组的人将表现出改善的一般健康功能，包括身体和情感功能，以及降低医疗急诊室就诊率。我们还将评估干预措施对更近端的态度和行为结果的影响，并评估这些因素如何介导功能和服务相关结果的改善。主要目标2：根据RE-AIM评估框架完成明确的流程评估，以更好地了解可以改善覆盖范围、有效性、采用、实施和维护的背景因素，这些因素共同决定了“美好生活”干预措施的潜在公共卫生影响。研究方法：将使用时间上重叠的定量和定性方法，最大限度地整合和综合两个目标的数据流，以优化知识积累。影响力：尽管越来越多的人认识到，自我管理策略持有巨大的承诺，为提高质量和结果的护理慢性医学疾病，自我管理的事实越来越突出的精神健康恢复为导向的治疗重点，目前还没有循证同行促进医疗疾病自我管理干预措施可用于传播内的VA精神卫生系统。我们提出的研究的目的是产生证据支持的有效性的同行共同促进的干预，并帮助加快吞吐量的公共卫生的影响，通过收集重要的上下文信息的因素，可能会改善未来的传播和实施工作。

DESCRIPTION (provided by applicant): Background: Veterans with schizophrenia and other serious mental illnesses (SMI) are at elevated risk for co-occurring chronic medical conditions resulting in increased risk of disability high health care spending, reduced quality of life and early mortality. Physical wellness is increasingly recognized as a key component of the VA's commitment to developing recovery-oriented and veteran-centered mental health treatment. There is also growing recognition of the value of interventions that promote and improve patient self-management of chronic medical conditions. Building on the established efficacy of consumer facilitated medical illness self- management programming used in the general population and two recent adaptations for use with SMI adults in the public health sector (including our own evaluation of an intervention called Living Well), we propose to complete a randomized controlled effectiveness trial of our Living Well intervention and simultaneously conduct a well specified process evaluation to optimize knowledge accrual regarding important factors that may improve future adoption, implementation and sustainability of the Living Well intervention in the VA system of care. Aims: Primary AIM 1: Complete a randomized controlled effectiveness trial of our Living Well intervention with 250 veterans with SMI and at least one co-occurring chronic medical condition and evaluate the intervention's effects on functional and service related outcomes. We hypothesize that those randomized to the Living Well intervention will, in comparison to those randomized to a medical illness education and support group, demonstrate improved general health functioning including physical and emotional functioning as well as reduced rates of medical emergency room visits. We will also evaluate intervention effects on more proximal attitudinal and behavioral outcomes and assess how these factors mediate improvement in the functional and services related outcomes. Primary AIM 2: Complete a well specified process evaluation based on the RE-AIM evaluation framework to better understand contextual factors that can improve the Reach, Effectiveness, Adoption, Implementation and Maintenance which together determine the potential public health impact of the Living Well intervention. Methods: A mix of temporally overlapping quantitative and qualitative methods will be used to maximize integration and synthesis of data streams across the two aims to optimize knowledge accrual. Impact: Despite the growing recognition that self-management strategies hold enormous promise for improving quality and outcomes of care for chronic medical illnesses, and the fact that self-management is gaining prominence as a mental health recovery oriented treatment focus, there are currently no evidence-based peer facilitated medical illness self-management interventions available for dissemination within the VA mental health system. Our proposed study is designed to both generate evidence supporting the effectiveness of a peer co-facilitated intervention and to help speed throughput to public health impact by collecting important contextual information about factors that may improve future dissemination and implementation efforts.