RCT of a Learning Collaborative to Implement Health Promotion in Mental Health

描述（由申请人提供）：患有严重精神疾病的人，约占美国人口的6%，是任何群体中健康差距最大的群体之一，预期寿命比一般人群短25年。由于久坐不动的生活方式、营养不良和药物治疗而导致的易患肥胖相关健康状况是造成这种差异的主要原因。尽管有各种基于证据的健康促进实践，我们不知道如何有效地转变社区精神卫生组织，以接受健康作为其使命和服务的核心。尽管广泛使用的学习协作和他们的潜在好处，在应用集体解决问题，纳入消费者的观点，并在实施基于证据的做法质量改进方法，有很少（如果有的话）的随机试验评估其有效性使用定量结果。据我们所知，拟议的研究是第一个经验性地评估虚拟国家学习合作在实施新的循证实践中的有效性。使用一个实施研究框架，我们提出了一个集群随机试验的48个心理健康提供者组织，以评估两种不同的策略的有效性，在初始实施的形状模型的综合健康促进在心理健康组织。我们将测试以下研究假设：与单独教学（IA）相比，教学+学习协作（I+LC）将与以下因素相关：（H1）更高的计划参与度（主要服务结果研究假设-通过在6个月内参加至少50%的健康导师课程来衡量接受充分干预的登记个人的比例）;和（H2）更大的组织变革支持健康促进（次要实施结果研究假设-通过适用于In SHAPE的一般组织指数测量）。此外，我们还将研究探索性假设，即I+LC与IA相比，将与以下因素相关：（E1）更快的全面计划运行;（E2）更大的计划吸收和扩展;（E3）更大的计划忠诚度;（E4）更大的计划可持续性可能性;以及（E5）更好的参与者结果（体育活动;营养和减肥）。最后，我们将记录与虚拟学习协作相关的增量时间和成本，以及（E6）探索组织变革支持健康促进对计划参与的影响，以及学习协作坚持对计划参与的影响。这项研究解决了一个主要的差距，在实施研究文献的有效性学习协作相比，通常的实施，包括使用虚拟（互动视频）作为一个实用的和可扩展的实施策略。这项研究的结果也可能有助于了解如何克服挑战，实施一个新的循证实践，要求资源有限的供应商之间的组织转型时，新的做法需要改变使命，实践范围，提供的服务类型，和新的融资。

DESCRIPTION (provided by applicant): People with serious mental illness, about 6% of the US population, have one of the greatest health disparities of any group, with a life expectancy up to 25 years less than the general population. Preventable, obesity- related health conditions due to sedentary lifestyles, poor nutrition, and medications are major causes of this disparity. Despite a variety of evidence-based health promotion practices, we do not know how to effectively transform community mental health organizations to embrace wellness as central to their mission and services. Despite widespread use of Learning Collaboratives and their potential benefits in applying collective problem solving, inclusion of consumer perspective, and quality improvement methods in implementation of evidence- based practices, there have been few (if any) randomized trials evaluating their effectiveness using quantitative outcomes. To our knowledge, the proposed study is among the first to empirically evaluate the effectiveness of a virtual national learning collaborative in implementing a new evidence-based practice. Using an implementation research framework, we propose a cluster-randomized trial of 48 mental health provider organizations to evaluate the effectiveness of two different strategies in the initial implementation of the In SHAPE model of integrated health promotion in mental health organizations. We will test the following study hypotheses: Instruction + Learning Collaborative (I+LC) compared to Instruction Alone (IA) will be associated with: (H1) greater Program Participation (the Primary Service Outcome Study Hypothesis-as measured by the proportion of enrolled individuals who have received an adequate exposure to the intervention defined by attending at least 50% of Health Mentor sessions over 6 months); and (H2) greater Organizational Change supporting health promotion (the Secondary Implementation Outcome Study Hypothesis-as measured by the General Organizational Index adapted for In SHAPE). In addition, we will examine exploratory hypotheses that I+LC vs. IA will be associated with: (E1) more rapid Full Program Operation; (E2) greater Program Uptake and Expansion; (E3) greater Program Fidelity; (E4) greater likelihood of Program Sustainability; and (E5) better Participant Outcomes (physical activity; nutrition and weight loss). Finally, we will document the incremental time and costs associated with the virtual Learning Collaborative, and (E6) explore the effect of Organizational Change supporting health promotion on Program Participation, and of Learning Collaborative Adherence on Program Participation. This study addresses a major gap in the implementation research literature on the effectiveness of Learning Collaboratives compared to usual implementation, including use of virtual (interactive video) as a practical and scalable implementation strategy. Findings from this study may also help inform how to overcome the challenge of implementing a new evidence-based practice demanding organizational transformation among resource-limited providers when the new practice necessitates a shift in mission, scope of practice, type of services delivered, and new financing.