A Hybrid Effectiveness-Implementation Trial of a Wellness Self-Management Program

健康自我管理计划的混合有效性实施试验

• 批准号: 8695118
• 负责人: RICHARD Warren GOLDBERG
• 金额: --
• 依托单位: BALTIMORE VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-04-01 至 2017-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8695118
• 关键词: Accident and Emergency department; Address; Adoption; Adult; Attention; Attitude; Behavior; Behavioral; Caring; Categories; Chronic; Chronic Care; Chronic Disease; Complement; Cost Analysis; Data; Disease; Education; Effectiveness; Effectiveness of Interventions; Emotional; Evaluation; Feedback; Future; General Population; Health; Health Status; Health system; Healthcare; Hybrids; Intervention; Knowledge; Life; Maintenance; Mediating; Medical; Mental Health; Methods; Modeling; Outcome; Patients; Personal Satisfaction; Physical Function; Population Study; Problem Solving; Process; Public Health; Qualitative Methods; Quality of life; Randomized; Recovery; Risk; Schizophrenia; Self Efficacy; Self Management; Services; Specialist; Specific qualifier value; Speed; Stream; Support Groups; System; Training; Veterans; Visit; base; care systems; contextual factors; cost; design; disability; effectiveness trial; evidence base; functional outcomes; group intervention; health related quality of life; implementation trial; improved; innovation; intervention effect; mental health center; mortality; peer; post intervention; programs; service utilization; severe mental illness; trial comparing; uptake

DESCRIPTION (provided by applicant): Background: Veterans with schizophrenia and other serious mental illnesses (SMI) are at elevated risk for co-occurring chronic medical conditions resulting in increased risk of disability high health care spending, reduced quality of life and early mortality. Physical wellness is increasingly recognized as a key component of the VA's commitment to developing recovery-oriented and veteran-centered mental health treatment. There is also growing recognition of the value of interventions that promote and improve patient self-management of chronic medical conditions. Building on the established efficacy of consumer facilitated medical illness self- management programming used in the general population and two recent adaptations for use with SMI adults in the public health sector (including our own evaluation of an intervention called Living Well), we propose to complete a randomized controlled effectiveness trial of our Living Well intervention and simultaneously conduct a well specified process evaluation to optimize knowledge accrual regarding important factors that may improve future adoption, implementation and sustainability of the Living Well intervention in the VA system of care. Aims: Primary AIM 1: Complete a randomized controlled effectiveness trial of our Living Well intervention with 250 veterans with SMI and at least one co-occurring chronic medical condition and evaluate the intervention's effects on functional and service related outcomes. We hypothesize that those randomized to the Living Well intervention will, in comparison to those randomized to a medical illness education and support group, demonstrate improved general health functioning including physical and emotional functioning as well as reduced rates of medical emergency room visits. We will also evaluate intervention effects on more proximal attitudinal and behavioral outcomes and assess how these factors mediate improvement in the functional and services related outcomes. Primary AIM 2: Complete a well specified process evaluation based on the RE-AIM evaluation framework to better understand contextual factors that can improve the Reach, Effectiveness, Adoption, Implementation and Maintenance which together determine the potential public health impact of the Living Well intervention. Methods: A mix of temporally overlapping quantitative and qualitative methods will be used to maximize integration and synthesis of data streams across the two aims to optimize knowledge accrual. Impact: Despite the growing recognition that self-management strategies hold enormous promise for improving quality and outcomes of care for chronic medical illnesses, and the fact that self-management is gaining prominence as a mental health recovery oriented treatment focus, there are currently no evidence-based peer facilitated medical illness self-management interventions available for dissemination within the VA mental health system. Our proposed study is designed to both generate evidence supporting the effectiveness of a peer co-facilitated intervention and to help speed throughput to public health impact by collecting important contextual information about factors that may improve future dissemination and implementation efforts.

描述（由申请人提供）： 背景：具有精神分裂症和其他严重精神疾病（SMI）的退伍军人（SMI）的同时发生慢性医疗状况的风险较高，从而增加了残疾人的高度医疗保健支出，降低生活质量和早期死亡率的风险。身体健康越来越被认为是VA致力于发展面向恢复和以资深心理健康治疗的承诺的关键组成部分。人们对促进和改善患者自我管理的慢性医疗状况的干预措施的价值也越来越多。以消费者促进医学疾病的自我管理计划的确定疗效为基础 我们建议，我们提议完成对我们生活井干预的随机控制有效性试验，并同时进行特定的过程评估，以优化有关重要因素的知识，这些因素可能会改善未来的采用，实施和可持续性在VA护理体系中的生活井干预。目的：主要目的1：完成我们的生活井干预的随机控制有效性试验，其中250名具有SMI的退伍军人和至少一个共同发生的慢性病状况，并评估干预措施对功能和服务相关结果的影响。我们假设，与随机分配给医学疾病教育和支持小组的人相比，那些随机进行生活井干预的人将表明一般健康功能改善，包括身体和情感功能以及降低医疗急诊室就诊率。我们还将评估干预对更近端和行为结果的影响，并评估这些因素如何介导与功能和服务相关的结果的改善。主要目的2：基于Re-AIM评估框架完成了良好的过程评估，以更好地理解可以改善覆盖范围，有效性，采用，实施和维护的上下文因素，从而共同决定了生活井干预的潜在公共健康影响。方法：将使用时间重叠的定量和定性方法的混合物来最大化两个目的的数据流的集成和合成，以优化知识应计。影响：尽管人们越来越认识到自我管理策略具有改善慢性医学疾病质量和护理结果的巨大希望，并且随着心理健康恢复为导向的治疗的重点，自我管理正在变得越来越突出，但目前尚无基于证据的同伴促进的医疗疾病自我管理干预措施可在VA心理健康系统内提供传播。我们提出的研究旨在既既是为支持同伴共同采用干预措施的有效性的证据，又通过收集有关可能改善未来传播和实施工作的因素的重要上下文信息来帮助对公共卫生的影响加快影响的证据。