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.

项目摘要/摘要