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.

项目概要/摘要 背景：艾滋病毒将抑郁症转化为有效解决方案 (HITIDES) 是一项合作项目 将抑郁症治疗的初级保健协作护理模式应用于艾滋病毒诊所的护理干预。 在一项随机对照试验中，HITIDES 显着改善了退伍军人的抑郁症状 HIV (VLWH) 并节省了成本。然而，还没有 VHA HIV 诊所实施 HITIDES。目标 本研究的目的是通过测试两种适当的方法来支持 HITIDES 干预措施的广泛实施 实施策略：来自每个站点的临床冠军，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，在他们的现场实施 HITIDES 干预措施， 无需实施专家的外部协助。 意义/影响：初步工作已经完成，以确定可接受的实施策略 VLWH 和艾滋病毒护理提供者；然而，这些实施策略的相对有效性和成本 未知。虽然 HITIDES 抑郁症护理团队 (DCT) 位于异地并可以提供服务 DCT 能够始终保持高质量和保真度，与 HIV 护理提供者进行互动和接触 地点未知。此外，站点级实施结果（例如覆盖范围和影响力）的中介效应 干预措施的有效性是否被采纳尚不清楚。因为DCT可以为多个 艾滋病毒诊所，在考虑在全国范围内推广之前，需要先小规模地推广干预措施。 创新：本研究采用创新的混合研究设计，同时检查实施情况和 有效性结果。使用实施成功作为干预的中介因素 效果也新颖。实施活动影响弱势群体护理的相对能力 人口是一个鲜为人知的研究领域。 VHA HIV 诊所是检查的理想测试案例 这些问题是因为 VLWH 是一个由少数族裔、低收入、性少数退伍军人组成的群体 所占比例不成比例。 具体目标： 1) 通过 VHA HIV 诊所的整群随机对照试验，确定以下药物的效果： 为实施策略添加外部促进，其中包括现场级临床冠军和 学习协作。 2) 确定 HITIDES 对抑郁症和自杀意念变化的影响 接受干预的艾滋病毒阳性退伍军人。 3) 估计 HITIDES 的预算影响 通过计算每个策略的成本来实施策略。 方法：使用混合 3 型有效性实施试验来检查以下各项之间的相互作用： 实施和干预有效性是一种创新方法，非常适合缺乏实施和干预效果的情况 强有力的有效性证据与节省成本的干预措施相结合。此混合试验将使用集群 8 个 VHA HIV 诊所的随机分组。这些诊所的选择将考虑诊所的平衡性和多样性 特征并随机分配给两个实施部门之一。每个目标的评估将使用 主要（例如 QUERI 开发的时间跟踪工具）和次要（例如临床数据仓库）的混合 数据。我们期望临床冠军、学习协作和外部促进部门能够联合起来 具有更大的影响力和采用率；然而，临床冠军和学习协作单独手臂是 预计成本会更低。 后续步骤：对 8 个 VHA HIV 诊所实施 HITIDES 干预措施的结果将用于 为未来广泛推广的实施策略的选择提供信息。调查结果将在 与我们的运营合作伙伴 VA HIV、丙型肝炎和 VACO 相关疾病计划合作， 威信领导力。