Implementing care for depression and diabetes

实施抑郁症和糖尿病护理

• 批准号: 8302612
• 负责人: HILLARY R BOGNER
• 金额: $ 24万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-05-15 至 2014-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8302612
• 关键词: Academy; Address; Adopted; Adult; American; American College of Physicians; Blood Glucose; Caring; Characteristics; Chronic; Chronic Care; Clinical; Communities; Comorbidity; Development; Diabetes Mellitus; Effectiveness; Environment; Ethnic Origin; Evaluation; Family Physicians; Foundations; Funding; Glycosylated hemoglobin A; Goals; Grant; Health; Home environment; Information Systems; Insurance Carriers; Internist; Intervention; Knowledge; Leadership; Learning; Medical; Mental Depression; Methods; National Institute of Mental Health; Outcome; Patients; Pediatrics; Pennsylvania; Physicians; Primary Health Care; Process; Professional Organizations; Program Evaluation; Provider; Public Health; Qualitative Methods; Questionnaires; Recruitment Activity; Research; Risk; Risk Factors; Rural; Stimulus; Strategic Planning; Support System; Symptoms; Testing; Training; Translational Research; Translations; Wood material; Work; base; blood glucose regulation; chronic care model; comparative efficacy; design; dissemination research; implementation research; improved; innovation; intervention program; meetings; programs; quality assurance; research study; research to practice; response; routine practice; suburb; tool

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. PUBLIC HEALTH RELEVANCE: 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 toolkit to facilitate implementation. We will relat 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). This project can have a significant public health impact because efficacious interventions do not improve patient outcomes without good implementation -- both are needed.

描述（由申请人提供）：R21研究的重新提交将评估不同实践如何实现抑郁症和糖尿病慢性护理模式，最终目标是开发一个工具包以促进实施。我们将把实施的核心组成部分（如实践中开展的培训和指导活动）与患者的结局（即抑郁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？执行进程能否“量身定做”以适应实际情况？本建议在实际实践中的具体目标是：（1）评估和比较混合定量和定性方法的实践中慢性护理模式的实施方法;（2）评估实施核心组件与患者结局之间的关系（抑郁症状改善和血糖控制）;以及（3）开发一个实施工具包，使实施战略能够适合实际情况，加强慢性病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名参与宾夕法尼亚州初级保健联盟的初级保健人员。在这项建议的支持下，我们力求描述与执行和做法变化有关的做法特点，并根据做法特点制定有针对性的执行办法的组成部分。拟议的研究将通过以下方式直接为将研究转化为实践提供信息： 将利益攸关方的知识纳入执行进程。我们的主要患者水平结果是抑郁症状改善（使用患者健康问卷（PHQ- 9）的9项抑郁模块）和血糖控制（使用HbA 1c）。我们的目标是研究实施的核心组成部分（促进行政支持，选择，实习培训，辅导，工作人员评估，计划评估和系统支持）被采用，由谁和开发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，其中包括一个有针对性的执行办法，最终将提交R 01执行赠款。一个有针对性的干预措施比一个强加于其他地方开发的实践工具和方法的干预措施更有可能成为惯例。如果这项提案得到资助，我们就有机会利用初级保健创新的势头，帮助缩小有效性和执行之间的差距。拟议的研究与国家精神卫生研究所的优先事项一致，并与国家精神卫生研究所战略计划的目标4直接相关;即“帮助缩小开发新的、经过研究检验的干预措施与最需要的人广泛使用这些干预措施之间的差距。“这个项目可能会对公共卫生产生重大影响，因为如果没有良好的实施，有效的干预措施就不会改善患者的预后--两者都是需要的。 公共卫生关系：R21研究的重新提交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，最终目标是开发一个工具包，以促进实施。我们将把实施的核心组成部分（如实践中开展的培训和指导活动）与患者的结局（即抑郁症状的改善和血糖控制）联系起来。该项目可能会产生重大的公共卫生影响，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预后-两者都是必要的。