Improving and Sustaining Delivery of CPT for PTSD in Mental Health Systems

改善和维持心理健康系统中针对 PTSD 的 CPT 实施

• 批准号: 9210120
• 负责人: CANDICE M. MONSON
• 金额: $ 64.97万
• 依托单位: PALO ALTO VETERANS INSTIT FOR RESEARCH
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-01-26 至 2020-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9210120
• 关键词: Address; Adherence; Budgets; Canada; Clinic; Clinical; Cluster randomized trial; Cognitive; Collaborations; Competence; Consultations; Data; Doctor of Philosophy; Effectiveness; Elements; Eligibility Determination; Enrollment; Ensure; Evidence based treatment; Goals; Health system; Healthcare; Healthcare Systems; Hybrids; Injury; Intervention; Interview; Investments; Learning; Literature; Mental Health; Methodology; Methods; Minority; Modification; Monitor; Online Systems; Organizational Change; Outcome; Patient-Focused Outcomes; Patients; Penetration; Perception; Phase; Policies; Post-Traumatic Stress Disorders; Process; Provider; Psyche structure; Psychotherapy; Public Health; Public Sector; Qualitative Research; Quality of life; Randomized; Reporting; Research; Research Infrastructure; Research Methodology; Research Personnel; Services; Stress; Surveys; Symptoms; System; Testing; Texas; Training; Training Programs; Treatment Effectiveness; Treatment Protocols; United States; United States Department of Veterans Affairs; Use Effectiveness; cohort; effective therapy; evidence base; experience; experimental study; health care economics; health care service utilization; implementation science; improved; innovation; learning community; physical conditioning; programs; public health relevance; routine care; satisfaction; skills; success; theories

 DESCRIPTION (provided by applicant): Large-scale implementation of evidence-based psychotherapies (EBPs) such as Cognitive Processing Therapy (CPT) for Post-traumatic Stress Disorder can have a tremendous impact on mental and physical health, healthcare utilization, and quality of life. While many mental health systems have invested heavily in programs to implement EBPs, recent research has revealed a number of challenges to long-term sustainability and high- quality provision of these treatments. Few eligible patients receive EBPs in routine care settings, and clinicians do not appear to deliver the full treatment protocol to many of their patients. Emerging evidence suggest that when CPT and other EBPs are delivered at low levels of fidelity, clinical outcomes are negatively impacted. Clinicians have identified a number of reasons that they do not deliver EBPs that are related to the fit between the EBP and their patients or the clinical setting. To date, there is a dearth of guidance on how best to support and sustain high-quality EBP delivery. While some systems have policies and programs in place to support EBP implementation at the organization level, little is known about how to address remaining barriers that have been identified by clinicians. Identifying strategies to improve and sustain the delivery of CPT and other EBPs is therefore critical. Two competing strategies have been suggested in the existing literature. One emphasizes fidelity to the treatment protocol through ongoing consultation and fidelity monitoring. The other focuses on improving the fit and effectiveness of these treatments by making appropriate adaptations to the treatment or the clinical setting through a process of data-driven, continuous quality improvement. Neither has been evaluated in terms of impact on sustained implementation. To compare these approaches on key sustainability outcomes and provide some of the first guidance on strategies to promote sustainment, we propose a cluster randomized trial with mental health clinics (n=32) in three diverse mental health systems that have implemented CPT. Cohorts of clinicians and clinical managers will participate in one year of a fidelity oriented consultation or one year of a continuous quality improvement-oriented learning collaborative. Patient-level PTSD symptom change, fidelity and adaptation of CPT, penetration, and clinics' capacity to deliver EBP will be examined. Survey and interview data will also be collected to investigate multilevel influences on the success of the two implementation strategies. This research will be conducted by a team of investigators with expertise in CPT implementation, mixed-methods research strategies, quality improvement, and implementation science, with input from stakeholders in each participating mental health system. It will have broad implications for supporting ongoing delivery of EBPs in mental health and healthcare systems and settings. The resulting products have the potential to significantly improve efforts to ensure ongoing high quality implementation and consumer access to EBPs.

 描述（由申请人提供）：大规模实施循证心理疗法（EBP），如认知加工疗法（CPT）治疗创伤后应激障碍，可以对身心健康，医疗保健利用和生活质量产生巨大影响。虽然许多精神卫生系统已经在实施EBP的计划中投入了大量资金，但最近的研究揭示了这些治疗的长期可持续性和高质量提供的一些挑战。很少有符合条件的患者在常规护理环境中接受EBP，临床医生似乎没有向许多患者提供完整的治疗方案。新出现的证据表明，当CPT和其他EBP以低水平的保真度提供时，临床结果会受到负面影响。临床医生已经确定了一些原因，他们不提供EBP与EBP和他们的患者或临床环境之间的配合有关。到目前为止，缺乏关于如何最好地支持和维持高质量EBP交付的指导。虽然一些系统已经制定了政策和计划来支持组织层面的EBP实施，但对于如何解决临床医生发现的剩余障碍知之甚少。因此，确定战略以改进和维持儿童继续接受预防性培训和其他基本基本商业做法的提供至关重要。在现有文献中提出了两种竞争策略。一种是通过持续的咨询和保真度监测来强调对治疗方案的保真度。另一个重点是通过数据驱动的持续质量改进过程，对治疗或临床环境进行适当调整，以提高这些治疗的适应性和有效性。这两项措施都没有在对持续执行的影响方面得到评价。为了比较这些方法的关键可持续发展成果，并提供一些第一指导的战略，以促进可持续发展，我们提出了一个集群随机试验与心理健康诊所（n=32）在三个不同的心理健康系统，已实施CPT。临床医生和临床管理人员将参加为期一年的忠诚导向咨询或为期一年的持续质量改进导向学习协作。将检查患者水平的PTSD症状变化、CPT的保真度和适应性、渗透率和诊所提供EBP的能力。调查和访谈数据也将收集调查的成功的两个实施战略的多层次的影响。这项研究将由一组具有CPT实施，混合方法研究策略，质量改进和实施科学方面专业知识的调查人员进行，并由每个参与精神卫生系统的利益相关者提供投入。它将对支持在精神卫生和医疗保健系统和环境中持续提供EBP产生广泛的影响。由此产生的产品有可能大大改善努力，以确保持续的高质量实施和消费者获得EBP。