Recovery-oriented structures, practices and outcomes in CMHCs: A National Study

描述（由申请人提供）：尽管最近取得了进展，但治疗不依从性仍然是严重精神疾病（SMI）患者康复的主要障碍，导致毁灭性的个人和社会成本。研究表明，将以人为本的医学和协作式护理计划纳入临床实践可能会提高参与和坚持治疗的比率。这些原则被认为是新兴的以康复为导向的护理模式的基石，在这种模式中，治疗的目标不仅仅是减轻症状和管理，而是包括在社区中有意义的生活，无论疾病如何。随着行为健康组织开始响应地方和联邦的要求，采用以康复为导向的护理框架，关于最可能被消费者获取、遵守并与更积极的结果相关联的具体以康复为导向的做法（rop）的指导性数据缺乏，以及可能促进或阻碍将此类做法纳入日常护理的背景因素。拟议的项目是与代表全国社区精神卫生中心（CMHCs）的全国社区行为保健委员会和全国州精神卫生机构的研究/评估机构NASMPD国家研究所（NRI）合作进行的，这将是对与机构传播rop相关的组织和个人因素的第一次全国代表性研究。具体目标是：1)描述cmhc采用rop的程度，并了解与机构采用这些做法相关的系统、组织和提供者因素；2)识别组织的结构、功能和背景特征，这些特征与增强的消费者结果和对护理的参与/坚持有关；3)识别与坚持和参与护理和积极的消费者结果相关的特定rop，以及可能影响rop与结果之间关系的大小或路径的特定组织和提供者特征；4)运用定性研究方法，深入了解组织采用康复导向的护理服务框架的机制。这些目标将通过三个阶段的研究来实现：1)在360个CMHCs的随机样本中，对与rop采用程度相关的组织社会技术因素进行全国性调查；2)检查机构实施rop与现有大型国家数据集中捕获的患者水平结果之间的关系；3)通过集体案例研究分析，深入探讨机构采用ROPs的促进因素和障碍。通过对代理机构rop扩散相关的基础设施、工具、支持和结果的更深入了解，本研究将有助于填补现有的知识空白，并提供可操作的建议，以指导组织努力提高对重度精神障碍患者的护理质量和有效性。

DESCRIPTION (provided by applicant): Despite recent advances, treatment non-adherence continues to be a major barrier to recovery for persons with severe mental illnesses (SMI), resulting in devastating personal and societal costs. Research suggests that incorporating elements of person-centered medicine and collaborative care planning into clinical practice may enhance rates of engagement in and adherence to treatment. Such principles are considered to be the cornerstones of the emerging paradigm of recovery-oriented care, in which the goals of treatment reach beyond symptom reduction and management to include a meaningful life in the community, irrespective of illness. As behavioral health organizations begin to respond to local and federal mandates to adopt a recovery-oriented framework of care, there is a paucity of guiding data on the specific recovery-oriented practices (ROPs) that are most likely to be accessed by, adhered to, and associated with more positive outcomes for consumers, and the contextual factors that may facilitate or impede the uptake of such practices into routine care. The proposed project, conducted in partnership with the National Council for Community Behavioral Healthcare, the umbrella organization representing community mental health centers (CMHCs) nationally, and the NASMPD National Research Institute (NRI), the research/evaluation agency for State Mental Health Agencies across the country, will be the first nationally representative study of the organizational and individual factors associated with agency diffusion of ROPs. The specific aims are: 1) To describe the extent to which ROPs are being adopted by CMHCs and to understand the system, organizational, and provider factors associated with agency uptake of these practices; 2) To identify structural, functional, and contextual characteristics of an organization that are associated with enhanced consumer outcomes and engagement in/adherence to care; 3) To identify specific ROPs that are associated with adherence to and involvement in care and positive consumer outcomes, and specific organizational and provider characteristics that may impact the magnitude or path of the relationship between ROPs and outcomes; and 4) To gain an in-depth understanding, using qualitative research methods, of the mechanisms by which an organization adopts a recovery-oriented framework for care delivery. These aims will be achieved through three phases of research: 1) a national survey of the organizational socio-technical factors associated with degree of adoption of ROPs in a random sample of 360 CMHCs; 2) an examination of the relationship between agency implementation of ROPs and patient-level outcomes as captured in large, existing national datasets; and 3) an in-depth exploration of the facilitators and barries associated with agency uptake of ROPs via collective case study analysis. Through a greater understanding of the infrastructure, tools, supports, and outcomes associated with agency diffusion of ROPs, this research will help to fill the existing gaps in knowledge and provide actionable recommendations to guide organizations as they strive to improve the quality and effectiveness of care for persons with SMI.