Implementing care for depression and diabetes

描述(由申请人提供)：这项重新提交的R21研究研究将评估不同的做法如何实现抑郁症和糖尿病的慢性护理模式的实施，最终目标是开发一个工具包来促进实施。我们将把实施的核心部分(如实践所进行的培训和指导活动)与患者的结果(即抑郁症症状的改善和血糖控制)联系起来。我们寻求解决的问题包括：如何改进执行进程？实施过程是否可以根据实际情况“量身定做”？这项建议将在现实世界的实践中实施，其具体目标是：(1)结合定量和定性方法，评估和比较慢性护理模式在不同实践中的实施方法；(2)评估实施核心组成部分与患者结果(抑郁症症状的改善和血糖控制)之间的关系；以及(3)开发实施工具包，以便能够根据实际情况量身定制实施战略，加强慢性护理模式的可持续性。我们将在宾夕法尼亚州东南部招募30家参与宾夕法尼亚州初级保健联盟的初级保健诊所。在这项提议的支持下，我们试图描述与实施和做法变化相关的做法特点，并根据做法特点制定量身定做的实施办法的组成部分。拟议的研究将通过以下方式直接将研究转化为实践 将利益攸关方知识纳入实施过程。我们的主要患者层面的结果是抑郁症状的改善(使用患者健康问卷(PHQ-9)的九项抑郁模块)和血糖控制(使用HbA1c)。我们的目标是研究实施的核心组成部分(促进行政支持、选拔、职前培训、指导、工作人员评估、计划评估和系统支持)以及由谁采用，并制定适应实践环境和可持续的干预措施。一个主要目标将是开发一个执行工具包，其中包括一种量身定制的执行方法，最终将提交R01执行赠款。量身定做的干预措施更有可能成为惯例的制度化，而不是强加于其他地方制定的做法工具和方法的干预措施。如果这项提议得到资助，我们就有机会利用初级保健领域的创新势头，帮助缩小有效性和执行力之间的差距。建议的研究符合NIMH的优先事项，并与NIMH战略计划的目标4直接相关，即“帮助缩小新的、经过研究检验的干预措施的开发与最有需要的人广泛使用之间的差距。”该项目可能对公共卫生产生重大影响，因为如果没有良好的实施，有效的干预措施不会改善患者的结果--两者都是必需的。

DESCRIPTION (provided by applicant): This resubmission of a R21 research study will assess how different practices approach implementation of the chronic care model for depression and diabetes with the ultimate goal of developing a tool kit to facilitate implementation. We will relate implementation core components (such as training and coaching activities undertaken by the practices) to patient outcomes (namely, depression improvement in symptoms and blood glucose control). Questions we seek to address include: How can implementation processes are improved? Can implementation processes be "tailored" to practice? The specific aims of this proposal to be carried out in real-world practices are: (1) to assess and compare implementation approaches of the chronic care model across practices mixing both quantitative and qualitative methods; (2) to evaluate the relationship between implementation core components and patient outcomes (depression improvement in symptoms and blood glucose control); and, (3) to develop an implementation tool kit so that implementation strategies can be tailored to the practices, enhancing sustainability of the chronic care model. We will recruit 30 primary care practices in southeastern Pennsylvania involved in the Pennsylvania Primary Care Coalition. With support of this proposal, we seek to describe the practice characteristics associated with implementation and practice change and to develop the components of a tailored approach to implementation based on practice characteristics. The proposed study will directly inform the translation of research to practice by building stakeholder knowledge into the implementation process. Our main patient-level outcomes are depression improvement in symptoms (using the nine-item depression module of the Patient Health Questionnaire (PHQ- 9)) and blood glucose control (using HbA1c). Our goal is to study what implementation core components (facilitative administrative support, selection, preservice training, coaching, staff evaluation, program evaluation, and system support) are adopted and by whom and to develop interventions that are adapted to the practice environment and sustainable. A major goal will be to develop an implementation tool kit consisting of a tailored approach to implementation that will culminate in the submission of an R01 implementation grant. A tailored intervention is more likely to become institutionalized into the routine of the practice than an intervention that imposes upon the practice tools and approaches that were developed elsewhere. If this proposal is funded, we have an opportunity to capitalize on the momentum for innovation in primary care to help close the gap between effectiveness and implementation. The research proposed is consistent with NIMH priorities and directly relevant to objective 4 in the NIMH Strategic Plan; namely, "to help close the gap between the development of new, research-tested interventions and their widespread use by those most in need." This project can have a significant public health impact because efficacious interventions do not improve patient outcomes without good implementation -- both are needed.