RCT of a Learning Collaborative to Implement Health Promotion in Mental Health

项目总结/摘要 患有严重精神疾病的人约占美国人口的6%，是健康差距最大的人之一 在任何群体中，预期寿命最多比一般人口少25年。易患病，肥胖- 久坐不动的生活方式、营养不良和药物治疗导致的相关健康状况是主要原因 差距尽管有各种循证健康促进实践，但我们不知道如何有效地 转变社区精神卫生组织，将健康作为其使命和服务的核心。 尽管学习协作的广泛使用及其在应用集体问题中的潜在好处， 解决问题，纳入消费者的观点，并在实施证据的质量改进方法- 基于实践，很少有（如果有的话）随机试验使用定量方法评估其有效性。 结果。据我们所知，这项拟议的研究是第一个经验性评估的有效性， 一个虚拟的国家学习协作，以实施一种新的循证做法。使用 实施研究框架，我们提出了一个群集随机试验48心理健康提供者 组织评估两种不同的战略在初步实施的有效性， 在精神卫生组织中综合健康促进的SHAPE模型。我们将测试以下研究 假设：教学+学习协作（I+LC）与单独教学（IA）相比， （H1）更大的计划参与（主要服务成果研究假设-通过以下指标衡量 已接受充分暴露于干预措施的入组个体的比例， 在6个月内参加至少50%的健康导师课程）;以及（H2）更大的组织变革 支持健康促进（次级实施成果研究假设-按 一般组织指数适用于In SHAPE）。此外，我们将研究探索性假设， I+LC与IA相比，将与以下方面相关：（E1）更快速的全程序运行;（E2）更大的程序占用， 扩展;（E3）更高的计划保真度;（E4）更高的计划可持续性可能性;以及（E5）更好的 参与者结局（体力活动;营养和体重减轻）。最后，我们将记录增量 与虚拟学习协作相关的时间和成本，以及（E6）探索组织的效果 改变支持健康促进的计划参与，并学习合作坚持 方案参与。这项研究解决了一个主要的差距，在实施研究文献的 学习协作的有效性相比，通常的实施，包括使用虚拟（互动 视频）作为一种实用且可扩展的实施策略。这项研究的结果也可能有助于了解如何 为了克服实施新的循证实践的挑战， 当新的做法需要改变使命、范围和职能时， 实践、提供的服务类型和新的融资。

PROJECT SUMMARY/ABSTRACT People with serious mental illness, about 6% of the US population, have one of the greatest health disparities of any group, with a life expectancy up to 25 years less than the general population. Preventable, obesity- related health conditions due to sedentary lifestyles, poor nutrition, and medications are major causes of this disparity. Despite a variety of evidence-based health promotion practices, we do not know how to effectively transform community mental health organizations to embrace wellness as central to their mission and services. Despite widespread use of Learning Collaboratives and their potential benefits in applying collective problem solving, inclusion of consumer perspective, and quality improvement methods in implementation of evidence- based practices, there have been few (if any) randomized trials evaluating their effectiveness using quantitative outcomes. To our knowledge, the proposed study is among the first to empirically evaluate the effectiveness of a virtual national learning collaborative in implementing a new evidence-based practice. Using an implementation research framework, we propose a cluster-randomized trial of 48 mental health provider organizations to evaluate the effectiveness of two different strategies in the initial implementation of the In SHAPE model of integrated health promotion in mental health organizations. We will test the following study hypotheses: Instruction + Learning Collaborative (I+LC) compared to Instruction Alone (IA) will be associated with: (H1) greater Program Participation (the Primary Service Outcome Study Hypothesis-as measured by the proportion of enrolled individuals who have received an adequate exposure to the intervention defined by attending at least 50% of Health Mentor sessions over 6 months); and (H2) greater Organizational Change supporting health promotion (the Secondary Implementation Outcome Study Hypothesis-as measured by the General Organizational Index adapted for In SHAPE). In addition, we will examine exploratory hypotheses that I+LC vs. IA will be associated with: (E1) more rapid Full Program Operation; (E2) greater Program Uptake and Expansion; (E3) greater Program Fidelity; (E4) greater likelihood of Program Sustainability; and (E5) better Participant Outcomes (physical activity; nutrition and weight loss). Finally, we will document the incremental time and costs associated with the virtual Learning Collaborative, and (E6) explore the effect of Organizational Change supporting health promotion on Program Participation, and of Learning Collaborative Adherence on Program Participation. This study addresses a major gap in the implementation research literature on the effectiveness of Learning Collaboratives compared to usual implementation, including use of virtual (interactive video) as a practical and scalable implementation strategy. Findings from this study may also help inform how to overcome the challenge of implementing a new evidence-based practice demanding organizational transformation among resource-limited providers when the new practice necessitates a shift in mission, scope of practice, type of services delivered, and new financing.