Implementation of collaborative care for depression in VA HIV clinics: Translating Initiatives for Depression into Effective Solutions (HITIDES)

在 VA HIV 诊所实施抑郁症协作护理：将抑郁症倡议转化为有效解决方案 (HITIDES)

• 批准号: 9837042
• 负责人: Jacob T Painter
• 金额: --
• 依托单位: CENTRAL ARKANSAS VETERANS HLTHCARE SYS
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-01 至 2027-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/9837042
• 关键词: Address; Address; Adherence; Adherence; Adoption; Adoption; Anti-Retroviral Agents; Anti-Retroviral Agents; Area; Area; Bisexual; Bisexual; Budgets; Caring; Caring; Characteristics; Characteristics; Clinic; Clinic; Clinical; Clinical; Cost Savings; Cost Savings; Coupled; Coupled; Data; Data; Depression screen; Depression screen; Diagnosis; Diagnosis; Economics; Economics; Effectiveness; Effectiveness; Effectiveness of Interventions; Effectiveness of Interventions; Equilibrium; Equilibrium; Evaluation; Evaluation; Feeling suicidal; Feeling suicidal; Future; Future; Gays; Gays; Goals; Goals; HIV; HIV; HIV Seropositivity; HIV Seropositivity; Health Promotion; Health Promotion; Health Services Accessibility; Health Services Accessibility; Healthcare; Healthcare; Healthcare Systems; Healthcare Systems; Hepatitis C; Hepatitis C; Hybrids; Hybrids; Immune system; Immune system; Impairment; Impairment; Improve Access; Improve Access; Intervention; Intervention; Investigator-Initiated Research; Investigator-Initiated Research; Leadership; Leadership; Learning; Learning; Low income; Low income; Mediating; Mediating; Medical; Medical; Mental Depression; Mental Depression; Mental Health; Mental Health; Mental disorders; Mental disorders; Methodology; Methodology; Nature; Nature; Outcome; Outcome; Patient Care; Patient Care; Patient-Focused Outcomes; Patient-Focused Outcomes; Patients; Patients; Persons; Persons; Population; Population; Primary Health Care; Primary Health Care; Provider; Provider; Quality of Care; Quality of Care; Race; Race; Randomized; Randomized; Randomized Controlled Trials; Randomized Controlled Trials; Recommendation; Recommendation; Research; Research; Research Design; Research Design; Resources; Resources; Rest; Rest; Services; Services; Site; Site; Suicide; Suicide; Target Populations; Target Populations; Testing; Testing; Time; Time; Translating; Translating; Update; Update; Veterans; Veterans; Veterans Health Administration; Vulnerable Populations; Vulnerable Populations; Work; Work; arm; arm; base; base; budget impact; care providers; care providers; clinical data warehouse; clinical data warehouse; collaborative care; collaborative care; cost; cost; cost effective; cost effective; depression model; depression model; depressive symptoms; depressive symptoms; design; design; economic evaluation; effectiveness implementation trial; effectiveness outcome; efficacious treatment; ethnic minority population; ethnic minority population; evidence base; evidence base; experience; experience; health administration; health care disparity; health care disparity; health disparity; health disparity; health equity; health equity; high risk; high risk; high standard; high standard; implementation facilitation; implementation intervention; implementation outcomes; implementation strategy; implementation strategy; implementation trial; improved; improved; innovation; innovation; men; men; mortality; mortality; multidisciplinary; multidisciplinary; multimodality; multimodality; novel; novel; patient population; patient population; peer; peer; primary care setting; primary care setting; programs; programs; provider networks; provider networks; racial and ethnic; racial and ethnic; racial minority; racial minority; recruit; recruit; relative cost; relative cost; relative effectiveness; relative effectiveness; sexual minority; sexual minority; standard of care; standard of care; success; success; suicide rate; suicide rate; tool; tool; treatment as usual; treatment as usual; trial design; trial design

Project Summary / Abstract Background: HIV Translating Initiatives for Depression into Effective Solutions (HITIDES) is a collaborative care intervention that adapts the primary care collaborative care model for depression treatment to HIV clinics. In a randomized controlled trial, HITIDES significantly improved depression symptoms for Veterans Living with HIV (VLWH) and delivered cost savings. However, no VHA HIV clinics have implemented HITIDES. The goal of this study is to support broad implementation of the HITIDES intervention by testing two appropriate implementation strategies: a clinical champion from each site who, with the help of a learning collaborative of peers, will work with local clinicians and leadership to implement the HITIDES intervention at their site with and without the assistance of external facilitation from an implementation expert. Significance/Impact: Preliminary work has been completed to identify implementation strategies acceptable to VLWH and HIV care providers; however, the relative effectiveness and cost of these implementation strategies is unknown. While the HITIDES depression care team (DCT) is housed off-site and can deliver services consistently with high quality and fidelity, the ability of the DCT to interface and engage with HIV care providers at sites is unknown. Additionally, the mediating effect of site-level implementation outcomes such as reach and adoption on effectiveness of the intervention is unknown. Because the DCT can provide services to multiple HIV clinics, a small-scale rollout of the intervention is needed before considering a national roll out. Innovation: This study employs an innovative hybrid study design to concurrently examine implementation and effectiveness outcomes. The use of implementation success as a mediating factor for intervention effectiveness is also novel. The relative ability of implementation activities to impact care for vulnerable populations is an area of research where little is known. VHA HIV clinics are an ideal test case for examining these questions because VLWH are a group where racial minority, low income, sexual minority Veterans are disproportionately represented. Specific Aims: 1) Determine, through a cluster-randomized controlled trial among VHA HIV clinics, the effect of adding external facilitation to an implementation strategy consisting of a site-level clinical champion and learning collaborative. 2) Determine the impact of HITIDES on changes in depression and suicidal ideation among HIV-positive Veterans receiving the intervention. 3) Estimate the budget impact of HITIDES implementation strategies by calculating the costs of each strategy. Methodology: The use of a hybrid type-3 effectiveness-implementation trial to examine the interaction of implementation and intervention effectiveness is an innovative methodology ideal for situations where the lack of robust evidence of effectiveness is coupled with a cost-saving intervention. This hybrid trial will use a cluster randomization of 8 VHA HIV clinics. These clinics will be chosen for balance and diversity of clinic characteristics and randomly assigned to one of the two implementation arms. Evaluation of each aim will use a mix of primary (e.g., QUERI-developed time-tracking tool) and secondary (e.g., clinical data warehouse) data. We expect the clinical champion, learning collaborative, and external facilitation arm to be associated with greater reach and adoption; however, the clinical champion and learning collaborative alone arm is expected to be less costly. Next steps: The findings from implementation of the HITIDES intervention to 8 VHA HIV clinics will be used to inform selection of implementation strategies for a broad roll out in the future. Findings will be presented in cooperation with our operational partner, VA HIV, Hepatitis C, and Related Condition Program to VACO and VISN leadership.

项目总结/摘要 背景：艾滋病毒将抑郁症转化为有效解决方案（HITIDES）是一个合作项目， 护理干预，适应初级保健合作护理模式，抑郁症治疗艾滋病毒诊所。 在一项随机对照试验中，HITIDES显着改善了患有抑郁症的退伍军人的抑郁症状。 艾滋病毒（VLWH），并实现了成本节约。然而，没有任何VHA艾滋病毒诊所实施了HITIDES。目标 这项研究的目的是通过测试两个适当的方法来支持广泛实施HITIDES干预措施。 实施策略：来自每个研究中心的临床冠军，在学习协作的帮助下， 同行，将与当地临床医生和领导层合作，在他们的研究中心实施HITIDES干预措施， 没有执行专家的外部协助。 意义/影响：已完成初步工作，以确定可接受的实施策略 极低妇女健康和艾滋病毒护理提供者;然而，这些实施战略的相对有效性和成本 不明虽然HITIDES抑郁症护理团队（DCT）设在场外，可以提供服务， 与高质量和保真度一致，DCT与艾滋病毒护理提供者接口和参与的能力 地点不详。此外，站点级实施结果（如覆盖范围和 干预措施的有效性尚不清楚。因为DCT可以为多个 艾滋病毒诊所，在考虑全国推广之前，需要小规模推广干预措施。 创新：本研究采用创新的混合研究设计，同时检查实施情况， 成效成果。使用执行成功作为干预的中介因素 有效性也是新颖的。执行活动对照顾弱势群体产生影响的相对能力 人口是一个鲜为人知的研究领域。VHA艾滋病诊所是一个理想的测试案例， 这些问题，因为VLWH是一个群体，种族少数，低收入，性少数退伍军人是 不成比例的代表。 具体目的：1）通过在VHA HIV诊所中进行的随机分组对照试验，确定 在实施策略中增加外部促进，包括研究中心级临床负责人， 学习协作。2)确定HITIDES对抑郁和自杀意念变化的影响 在接受干预的艾滋病毒阳性退伍军人中。3)估计HITIDES的预算影响 通过计算每个策略的成本来确定执行策略。 方法：使用混合型3型有效性-实施试验来检查以下因素的相互作用： 实施和干预的有效性是一种创新的方法，适用于缺乏 有效性的有力证据与节省成本的干预措施相结合。这项混合试验将使用一个群集 随机分配8个VHA HIV诊所。选择这些诊所是为了诊所的平衡和多样性 根据这两个机构的特点，随机分配给两个执行机构之一。每个目标的评价将使用 初级（例如，QUERI开发的时间跟踪工具）和次要（例如，临床数据仓库） 数据我们希望临床冠军，学习合作，和外部促进手臂相关联 更大的覆盖范围和采用;然而，临床冠军和学习协作单独手臂是 预计成本会更低。 今后的步骤：将利用在8个VHA艾滋病毒诊所实施HITIDES干预措施的结果， 为今后的广泛推广选择执行战略提供信息。调查结果将在 与我们的业务合作伙伴，VA艾滋病毒，丙型肝炎和相关疾病计划VACO合作， 领导力。