Effectiveness of Technology Assisted Diffusion For Evidence Based Treatment

描述(由申请人提供)：自医学研究所发布里程碑式的报告(国际移民组织，1998年)以来，已经有十多年的时间了，该报告描述了研究和实践之间“弥合差距”的必要性。自那时以来，已开始努力将循证治疗(EBT)传播到通常的护理提供环境，但人们对这些努力的长期有效性知之甚少。例如，自2006年以来，物质滥用治疗中心(CSAT)资助了全国81个药物使用治疗点，以提供EBT作为其治疗制度的一部分。一旦这一倡议结束，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EBT实施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环境中维持EBT的情况。我们提出了以下目标：1)通过以下方式纵向描述获得CSAT资助以实施A-CRA的项目的EBT实施水平：a.确定EBT的持续方面、EBT实施中的创新、候选促进者和实施障碍；b.描述81个项目随着时间的推移实施质量的轨迹。我们假设，在政府资助结束后，将会发生重大变化。具体地说，我们假设项目将随着时间的推移证明维持能力的下降，并且项目之间的变化将随着时间的推移而有所不同；以及2)对预测EBT维持程度的因素进行经验评估。我们假设，在控制了一些特定于计划的因素(例如，规模)后，EBT持续的程度将与环境因素(即服务的报销)和组织因素(即，在资助阶段结束时是否有训练有素的监督员和临床医生)相关。提出的研究具有非常重要的意义。更好地了解影响EBT提供可持续性的因素可能会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.