Effectiveness of Technology Assisted Diffusion For Evidence Based Treatment

描述（由申请人提供）：自医学研究所发布具有里程碑意义的报告（IOM, 1998）以来，已经有十多年了，该报告描述了在研究与实践之间“弥合差距”的必要性。从那时起，开展了将循证治疗（ebt）推广到常规医疗服务环境的工作，但对这些工作的长期有效性知之甚少。例如，自2006年以来，药物滥用治疗中心（CSAT）资助了全国81个药物使用治疗站点，将EBT作为其治疗方案的一部分。一旦这一举措结束，EBT的交付在很大程度上取决于当地站点的支持。如果不注意确保可持续性，这些支持实施EBT的努力可能无法充分发挥其潜力。目前的建议是审查在这些情况下维持EBT。我们提出以下目标：1)通过以下方式，纵向表征接受CSAT资助实施A- CRA的项目的EBT实施水平：A .确定EBT持续的方面，EBT实施的创新，以及实施的候选促进因素和障碍；b.描述81个项目在一段时间内的实施质量轨迹。我们假设在政府资助结束后会发生实质性的变化。具体来说，我们假设随着时间的推移，项目的可持续性会下降，并且随着时间的推移，项目之间的变化会有所不同；2)实证评价影响企业经营活动持续程度的因素。我们假设，在控制了一些特定项目（例如规模）的因素后，EBT的持续程度将与环境因素（例如，服务报销）和组织因素（例如，在资助阶段结束时训练有素的主管和临床医生的存在）有关。这项建议的研究是非常重要的。更好地了解影响EBT提供可持续性的因素可能导致更有效的传播战略，并最终提高社区成瘾治疗环境中提供的护理质量。

DESCRIPTION (provided by applicant): It has been more than a decade since the release of the Institute of Medicine's landmark report (IOM, 1998) that described the need to "bridge the gap" between research and practice. Since then, efforts to disseminate evidence-based treatments (EBTs) to usual care delivery settings have been launched, however little is known about the long-term effectiveness of these efforts. For example, since 2006, the Center for Substance Abuse Treatment (CSAT) funded 81 substance use treatment sites across the country to deliver an EBT as part of their treatment regime. Once this initiative ends, the deliver of the EBT is largely left up to the local sites to support. Without attention to ensuring sustainability, these efforts to support EBT implementation may not meet their full potential. The current proposal is to examine the sustainment of an EBT in these settings. We propose the following aims: 1) Characterize levels of EBT implementation longitudinally for programs that received CSAT funding to implement A- CRA by: a. Identifying aspects of the EBT that are sustained, innovations in EBT implementation, and candidate facilitators and barriers to implementation; b. Characterizing the trajectory of implementation quality among the 81 programs over time. We hypothesize that substantial changes will occur after government funding ends. Specifically, we hypothesize that programs will demonstrate decreases in sustainment over time and that there will be differences among programs in change over time; and 2) empirically evaluate factors that predict the degree of EBT sustainment. We hypothesize that the extent to which the EBT is sustained will be associated with environmental (i.e., reimbursement for services) and organizational factors (i.e., presence of trained supervisors and clinicians at the end of the funding phase) after controlling for a number of program-specific (e.g., size) factors. The proposed research is highly significant. Gaining a better understanding of the factors that influence the sustainability of EBT delivery may lead to more effective dissemination strategies and ultimately improve the quality of care being delivered in community based addiction treatment settings.