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

描述(申请人提供)：患有严重精神疾病的人，约占美国人口的6%，是所有群体中健康差距最大的群体之一，预期寿命比一般人少25岁。由于久坐不动的生活方式、营养不良和药物治疗导致的可预防的与肥胖相关的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做法，我们不知道如何有效地转变社区精神卫生组织，使其将健康作为其使命和服务的核心。尽管学习协作的广泛使用及其在实施循证实践中应用集体问题解决、纳入消费者观点和质量改进方法方面的潜在好处，但使用量化结果评估其有效性的随机试验很少(如果有的话)。据我们所知，这项拟议的研究是对虚拟国家合作学习在实施新的循证实践方面的有效性进行实证评估的第一批研究之一。使用实施研究框架，我们提出了一项针对48个精神卫生服务提供者组织的整群随机试验，以评估两种不同策略在精神卫生组织综合健康促进的初步实施中的有效性。我们将测试以下研究假设：与单独教学(IA)相比，教学+学习合作(I+LC)将与：(H1)更多的计划参与(主要服务结果研究假说-通过参加6个月内至少50%的健康导师会议而接受足够干预的登记个人的比例来衡量)；以及(H2)支持健康促进的更大的组织变革(次级实施结果研究假说-根据SHAPE中适应的一般组织指数来衡量)。此外，我们将检验I+LC与IA相关的探索性假设：(E1)更快的全面计划运作；(E2)更大的计划吸收和扩展；(E3)更高的计划保真度；(E4)更大的计划可持续性；以及(E5)更好的参与者结果(体力活动、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，并(E6)探索支持健康促进的组织变革对计划参与的影响，以及学习协作坚持对计划参与的影响。这项研究解决了实施研究文献中关于学习协作的有效性与通常实施相比的一个主要差距，包括使用虚拟(互动视频)作为一种实用和可扩展的实施战略。这项研究的结果还可能有助于说明，当新的做法需要改变任务、实践范围、提供的服务类型和新的融资时，如何克服实施新的循证做法的挑战，这要求在资源有限的提供者中进行组织变革。

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.