Investigating the Payer Role in the Implementation of EBP in the Public Sector

描述(由申请者提供)：Ruth L.Kirschstein国家研究服务奖的目标是支持申请者发展独立研究计划所需的关键技能，通过付款人政策和资金促进循证实践(EBPS)在社区精神健康中的实施。这项F32申请建议进行研究，以解决NIMH战略计划的目标4：加强NIMH支持的研究对公共健康的影响，特别是改善各种利益相关者对有效的基于研究的干预措施的理解和实施，以及改善获得有效的精神健康干预措施的机会。在执行科学专家David S.Mandell的指导下要实现的具体培训目标是：1)在社区心理健康和更广泛的领域发展执行科学和支付者激励方面的专业知识，2)在建议的项目和未来的执行科学和社区心理健康研究中获得适当的设计、方法和分析方面的相关经验，以及3)建立协作和跨学科关系网络，以协助当前和未来的研究工作。本F32的研究部分将调查支付者在EBP实施中的角色这一重要问题。尽管支付者可以通过各种策略在激励使用EBP方面发挥关键作用，但研究公共精神卫生系统使用哪些激励措施的研究非常少。这项拟议研究的目标是检查公共资助的社区精神卫生保健的支付者在多大程度上使用不同的激励措施，他们如何实施这些激励措施，以及使用这些激励措施的促进者和障碍。具体地说，申请人建议在初步成果的基础上，制定和部署一项县和州一级支付者全国调查，以：1)系统地确定、记录和描述公共精神卫生系统支付者为在社区精神卫生提供者中更多地使用循证做法而采用的激励措施；以及2)审查文献中提出的激励措施实施的潜在障碍和促进者。申请者还将使用定性方法，并对付款人进行半结构化访谈，根据他们实施不同激励措施以增加EBP使用的程度进行分层，以确定使用不同战略的障碍和促进者。在这个项目的过程中，申请者将在政府实体和支付者在实施和维持EBP中的作用方面发展专门知识，并将在执行科学、支付者和激励性融资以及调查设计和开发方面获得关键知识和技能，并由经验丰富和成熟的导师团队提供专业知识。

DESCRIPTION (provided by applicant): The goal of this Ruth L. Kirschstein National Research Service Award is to support the applicant in developing the critical skills necessary for an independent research program in promoting the implementation of evidence- based practices (EBPs) in community mental health through payer policy and financing. This F32 application proposes research to address Objective 4 of the NIMH Strategic Plan: Strengthen the Public Health Impact of NIMH-Supported Research, specifically improving the uptake and implementation of effective research-based interventions by various stakeholders and improving access to effective mental health interventions. Specific training goals to be achieved under the mentorship of David S. Mandell, ScD, an expert in implementation science are to: 1) develop expertise in implementation science and payer incentives in community mental health and broader fields, 2) gain relevant experience in the design, methods, and analyses appropriate for the proposed project and future research in implementation science and community mental health, and 3) establish a network of collaborative and cross-disciplinary relationships to assist in current and future research endeavors. The research component of this F32 will investigate the important question of the payer's role in the implementation of EBP. Despite the critical role payers can play in incentivizing the use of EBP through various strategies, there is remarkably little research examining which incentives are used in public mental health systems. The goal of the proposed study is to examine the extent to which payers for publicly-funded community mental health care use different incentives, how they implement them, and the facilitators and barriers to their use. Specifically, the applicant proposes to build on preliminary results by developing and fielding a national survey of county and state-level payers to: 1) systematically identify, document, and describe incentives employed by payers in the public mental health system to increase the use of evidence- based practices among community mental health providers and 2) examine potential barriers and facilitators to the implementation of incentives proposed in the literature. The applicant will also use qualitative methods and conduct semi-structured interviews with payers, stratified by the extent to which they implement different incentives to increase use of EBP, to determine barriers and facilitators to the use of different strategies. Over the course of this project the applicant will develop expertise in the role of governmental entities and payers in the implementation and sustainment of EBP, and will gain critical knowledge and skills in implementation science, payer and incentive financing, and survey design and development with the expertise of an experienced and established team of mentors.