Development of an MI Implementation Intervention in Adolescent HIV Care Settings

在青少年艾滋病毒护理环境中制定 MI 实施干预措施

• 批准号: 8990069
• 负责人: Karen MacDonell
• 金额: $ 27.83万
• 依托单位: WAYNE STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-08-20 至 2018-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8990069
• 关键词: AIDS/HIV problem; Address; Adherence; Administrator; Adolescent; Adolescent Medicine Trials Network; Adoption; Behavior; Behavior Therapy; Caring; Clinic; Clinical; Clinical Services; Code; Collaborations; Communication; Data; Development; Diagnostic; Discipline; Effectiveness; Elements; Empathy; Ensure; Evaluation; Evidence based intervention; Evidence based practice; Goals; Guidelines; HIV; HIV risk; Health; Healthcare; Hybrids; Individual; Intervention; Intervention Studies; Intervention Trial; Interview; Link; Malignant Neoplasms; Measurement; Measures; Medical; Methods; Modeling; NIH Office of AIDS Research; Outcome; Outcome Measure; Patient-Centered Care; Patients; Phase; Phase III Clinical Trials; Population; Preparation; Procedures; Process; Protocols documentation; Provider; Research; Research Activity; Risk Behaviors; Risk Reduction; Site; Slice; Strategic Planning; Testing; Time; Training; Treatment Protocols; United States National Institutes of Health; Youth; behavior change; clinical care; clinical practice; communication behavior; design; evidence base; implementation science; implementation trial; improved; innovation; member; motivational enhancement therapy; multi-component intervention; multi-site trial; multidisciplinary; patient population; primary outcome; programs; public health relevance; quality assurance; therapy development; uptake

 DESCRIPTION (provided by applicant): The goal of this implementation science R34 is to develop an implementation intervention to increase evidence-based patient-provider communication strategies using a Motivational Interviewing (MI) framework, and pilot all evaluation procedures included measurement and the development of a statistical analysis plan. MI is an evidence-based intervention for improving patient-provider relationships and promoting behavior change, and is one of the only interventions to produce change across multiple behaviors in youth with HIV. MI is already embedded in the clinical guidelines for HIV care and HIV risk reduction. However, the inconsistent implementation of clinical guidelines is a constant concern. Fidelity of implementation refers to the degree to which staff members actually implement programs as intended by the developer, or how faithful they are to specification of the evidence-based practice. Several studies suggest that delivering MI with high fidelity can be difficult for many practitioners, but practitioners benefit from carefully designed, multicomponent interventions to help them understand and use evidence-based practices. These implementation interventions consist of a strategy or set of strategies to increase implementation of evidence-based practice. Thus, the primary goal of this proposal is to develop and pilot test a multi-level implementation intervention to increase MI fidelity and improve patient-provider communication in adolescent HIV care settings within the Adolescent Trials Network for HIV/AIDS (ATN). Leading the way in implementation science in health care is the VA's Quality Enhancement Research Initiative (QUERI), created to link research activities to clinical services in "real time" to promote the rapid uptake of best clinical practices and improvement in patient outcomes. Utilizing the QUERI model of implementation intervention development, this proposal will prepare for a full-scale implementation intervention trial with the following aims: 1) To develop a method of measuring MI fidelity to ensure methodological rigor, acceptability and feasibility of administration, and clinical usefulness (Phase 1). We will compare ratings of 200 recordings of full patient-provider interactions with ratings of thin slices (recordng 1 minute every 5 minutes); 2) To conduct evidence-based tailoring of MI training for adolescent HIV care settings (Phase 2a). We will code and utilize sequential analysis of the 200 recordings to identify those specific provider communication behaviors that predict subsequent youth motivational statements; 3) To collaboratively develop the implementation intervention with clinic teams from at least 10 different adolescent HIV clinics (Phase 2b). We will conduct a formative evaluation to provide local diagnostic data regarding barriers and facilitators to adoption and create development panels - local development teams made up of clinicians and administrators from the site, and study staff to address barriers and facilitators from formative evaluation and draft locally-customized clinical care and multi-level implementation strategies with initial sustainability plans; 4) To pilot test the implementation intervention and process/outcome evaluation protocols at two sites (Phase 3) to prepare for a full-scale implementation trial.

 描述（由申请人提供）：本实施科学R34的目标是开发实施干预措施，以使用动机性访谈（MI）框架增加基于证据的患者-提供者沟通策略，并试行所有评估程序，包括测量和统计分析计划的制定。MI是一种以证据为基础的干预措施，用于改善患者与提供者的关系并促进行为改变，并且是唯一能够改变艾滋病毒感染者多种行为的干预措施之一。MI已被纳入艾滋病毒护理和降低艾滋病毒风险的临床指南。然而，临床指南的执行不一致是一个持续的问题。实施的忠诚度是指工作人员实际上按照开发人员的意图实施项目的程度，或者他们对基于证据的实践规范的忠诚程度。几项研究表明，对许多从业者来说，高保真地提供MI可能是困难的，但从业者受益于精心设计的多组分 干预措施，以帮助他们了解和使用循证实践。这些实施干预措施包括一项或一套战略，以加强循证实践的实施。因此，本提案的主要目标是制定和试点测试多层次的实施干预措施，以提高MI的保真度，并改善青少年艾滋病毒护理环境中的青少年艾滋病毒/艾滋病试验网络（ATN）的患者-提供者的沟通。在医疗保健中实施科学的领先者是VA的质量增强研究计划（QUERI），该计划旨在将研究活动与“真实的时间”的临床服务联系起来，以促进最佳临床实践的快速吸收和患者结局的改善。利用QUERI实施干预发展模式，该提案将为全面实施干预试验做准备， 以下目标：1）开发一种测量MI保真度的方法，以确保方法学的严谨性、给药的可接受性和可行性以及临床有用性（第1阶段）。我们将比较 对200份完整的患者-提供者互动记录进行评级，并对薄片进行评级（每5分钟记录1分钟）; 2）为青少年艾滋病毒护理环境进行基于证据的MI培训定制（阶段2a）。我们将编码和利用200个记录的顺序分析，以确定那些特定的提供者沟通行为，预测随后的青年动机陈述; 3）与来自至少10个不同的青少年艾滋病诊所的诊所团队合作开发实施干预（第2b阶段）。我们将进行形成性评估，以提供关于采用障碍和促进因素的本地诊断数据，并创建开发小组-由研究中心的临床医生和管理人员以及研究人员组成的本地开发团队，以解决形成性评估的障碍和促进因素，并起草本地定制的临床护理和多层次实施策略，以及初始可持续性计划;（4）在两个地点试行执行干预和过程/结果评价议定书（第三阶段），为全面执行试验做准备。