Implementing care for depression and diabetes

描述（由申请人提供）：本次重新提交的R21研究将评估不同的实践如何实现抑郁症和糖尿病的慢性护理模式，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组成部分（如实践开展的培训和指导活动）与患者结果（即抑郁症症状改善和血糖控制）联系起来。我们寻求解决的问题包括：如何改进实施过程？实施过程可以“量身定制”以适应实践吗？在现实世界的实践中，本建议的具体目的是：(1)评估和比较混合定量和定性方法的慢性护理模式的实施方法；(2)评估实施核心成分与患者结局（抑郁症状改善和血糖控制）的关系；(3)开发实施工具包，使实施策略能够根据实际情况量身定制，提高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。在此建议的支持下，我们试图描述与实施和实践变更相关的实践特征，并根据实践特征开发定制的实施方法的组成部分。所提出的研究将直接为翻译研究提供实践依据

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.