Life Goals Collaborative Care to Improve Health Outcomes in Mental Disorders

生活目标 协作护理以改善精神障碍的健康结果

• 批准号: 8276290
• 负责人: AMY M KILBOURNE
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-03-01 至 2015-05-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8276290
• 关键词: Accident and Emergency department; Address; Adherence; Administrator; Antipsychotic Agents; Attention; Behavior; Behavioral; Behavioral Medicine; Bipolar Disorder; Blood Pressure; Cardiovascular Diseases; Caring; Characteristics; Chronic; Chronic Care; Clinic; Communities; Complex; Continuity of Patient Care; Diagnosis; Disease; Economic Burden; Enrollment; General Population; Generations; Goals; Guidelines; Health; Health Promotion; Health behavior; Health behavior change; Healthcare; Healthcare Systems; Hospitalization; Hyperlipidemia; Hypertension; Individual; Inpatients; Intervention; Interview; Lead; Life; Life Style; Longevity; Major Depressive Disorder; Mediating; Medical; Mental Health; Mental Health Services; Mental disorders; Methods; Morbidity - disease rate; Motivation; Outcome; Outpatients; Patient Care; Patient Monitoring; Patients; Persons; Physical activity; Population; Premature Mortality; Primary Health Care; Probability; Provider; Psychiatric Diagnosis; Psychiatric therapeutic procedure; Quality of life; Randomized; Registries; Research; Research Priority; Risk; Risk Factors; Schizophrenia; Self Management; Services; Smoking; Symptoms; System; Time; Veterans; Vulnerable Populations; Weight; base; behavior change; cardiovascular disorder risk; chronic care model; collaborative care; cost; disability; disorder prevention; effectiveness trial; experience; functional disability; health related quality of life; improved; mortality; novel; patient oriented; physical conditioning; programs; psychosocial; severe mental illness; symptom management; treatment adherence; treatment as usual; treatment response; treatment strategy

DESCRIPTION (provided by applicant): Background: VA patients with serious mental illnesses (SMI- e.g., schizophrenia, bipolar disorder) die an average of 13-18 years earlier compared to the general U.S. population, mostly from cardiovascular disease (CVD). Increased risk of CVD and related risk factors in persons with SMI is attributed to patient, provider, and system-level barriers including unhealthy behaviors exacerbated by mental health-related symptoms and barriers to access and continuity of care between physical and mental health services. Objectives: The primary aim of this randomized controlled effectiveness trial (RCT) is to determine whether VA patients with SMI receiving Life Goals Collaborative Care (LGCC), a program that combines customized behavioral change strategies with chronic care management for SMI will experience, within 12 months: a) improved medical outcomes (e.g., reduced CVD risk factors, improved physical health-related quality of life), b) improved mental health outcomes, including reduced psychiatric symptoms or improved mental health-related quality of life or c) improved health behaviors, compared to VA patients with SMI receiving enhanced treatment as usual (i.e., dissemination of health behavior change materials in addition to standard VA medical and psychiatric care). Secondary aims that will inform further implementation of LGCC will be to assess utilization and cost differences of LGCC versus treatment as usual, determine the patient factors associated with LGCC treatment response, and identify the organizational factors associated with LGCC implementation. Methods: LGCC is a groundbreaking psychosocial and behavior change intervention that is based on the Chronic Care Model (CCM) and consists of 1) 10 self-management sessions that cover personal goal-setting and mental health symptom management reinforced through healthy lifestyles; 2) medical care management that includes identification of patient medical risk factors, monitoring of patient symptoms and medical needs via a registry over time; and 3) support for provider guidelines and community linkages. We will enroll 376 individuals diagnosed with SMI and a CVD risk factor who are receiving care within the VA Ann Arbor Healthcare System mental health clinic, and who will be randomized to receive LGCC or enhanced treatment as usual. Key outcomes include changes in CVD risk factors (e.g., blood pressure, BMI), psychiatric symptoms, health-related quality of life, health behaviors (e.g., physical activity), and inpatient and outpatient use assessed at 6 and 12 months. Impact: This study addresses VA HSR&D research priorities related to mental health and care of complex, chronic conditions, and is consistent with the priorities of the VHA's Office of Mental Health Services (Patient Care Services), 10NC, and the National Center for Health Promotion and Disease Prevention. Serious mental illness (SMI) is associated with significant disability, decreased quality of life, and a decreased life span. The VA is undergoing two major quality improvement initiatives: the Patient-Aligned Care Team (PACT), which involves enhanced access and continuity of care based on Chronic Care Model (CCM) principles, and dissemination of behavioral medicine programs. However, to date these programs have not been fully adapted to address gaps in quality or outcomes of care for Veterans with SMI. Findings from this RCT will inform ongoing VA transformational initiatives around systems redesign and behavioral medicine programs for Veterans with SMI and determine whether a customized CCM-behavioral medicine strategy is most effective in improving outcomes for this vulnerable group.

描述(由申请人提供)： 背景：与美国普通人群相比，患有严重精神疾病(如精神分裂症、双相情感障碍)的退伍军人平均早死13-18年，主要死于心血管疾病(CVD)。SMI患者心血管疾病风险和相关风险因素的增加归因于患者、提供者和系统层面的障碍，包括因精神健康相关症状而加剧的不健康行为，以及身体和精神健康服务之间获得和持续护理的障碍。目的：这项随机对照有效性试验(RCT)的主要目的是确定接受生活目标协作护理(LGCC)的患有SMI的VA患者在12个月内是否会经历：a)改善的医疗结果(例如，减少CVD风险因素，提高与身体健康相关的生活质量)，b)改善心理健康结果，包括减少精神症状或改善与精神健康相关的生活质量，或者c)改善健康行为，相比于通常接受强化治疗的SMI患者(即，除了标准的退伍军人医疗和精神护理外，还传播健康行为改变材料)。为进一步实施LGCC提供信息的次要目标将是评估LGCC与常规治疗的利用率和成本差异，确定与LGCC治疗反应相关的患者因素，并确定与LGCC实施相关的组织因素。方法：LGCC是一种突破性的心理社会和行为改变干预措施，以慢性护理模式(CCM)为基础，包括1)10次自我管理会议，涵盖通过健康生活方式加强的个人目标设定和精神健康症状管理；2)医疗管理，包括识别患者的医疗风险因素，通过登记监测患者的症状和医疗需求；以及3)支持提供者指南和社区联系。我们将招募376名被诊断为患有SMI和心血管疾病风险因素的患者，他们将在VA Ann Arbor Healthcare System心理健康诊所接受治疗，并将被随机安排接受LGCC或强化治疗。主要结果包括心血管疾病危险因素(如血压、体重指数)、精神症状、与健康相关的生活质量、健康行为(如体力活动)以及在6个月和12个月时评估的住院和门诊使用情况的变化。影响：这项研究阐述了退伍军人管理局HSR&D与精神健康和复杂、慢性病护理相关的研究重点，并与VHA精神健康服务办公室(患者护理服务)、10NC和国家健康促进和疾病预防中心的优先事项一致。严重精神疾病(SMI)与严重残疾、生活质量下降和寿命缩短有关。退伍军人管理局正在进行两项主要的质量改进计划：以患者为中心的护理团队(PACT)，其中包括基于慢性护理模式(CCM)原则增强护理的可及性和连续性，以及传播行为医学计划。然而，到目前为止，这些方案还没有完全适应于解决患有SMI的退伍军人在护理质量或结果方面的差距。这项随机对照试验的结果将为退伍军人管理局正在进行的围绕系统重新设计和针对患有SMI的退伍军人的行为医学计划的转型举措提供信息，并确定定制的CCM-行为医学战略是否在改善这一弱势群体的结局方面最有效。