Recovery Bridge: A Peer Facilitated Intervention to help bridge the transition from psychiatric inpatient hospitalization to living in the community

康复桥梁：同伴协助干预，帮助弥合从精神病住院到社区生活的过渡

• 批准号: 10637987
• 负责人: RICHARD Warren GOLDBERG
• 金额: --
• 依托单位: BALTIMORE VA MEDICAL CENTER
• 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 2025-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10637987
• 关键词: Acute; Address; Advocacy; Ambulatory Care; Anxiety; Area; Benchmarking; Caring; Clinical; Clinical Trials; Communities; Compensation; Control Groups; Crisis Intervention; Data; Development; Dissemination and Implementation; Effectiveness; Elements; Emotional; Evaluation; Future; Health; Health Services Accessibility; Homelessness; Hospitalization; Hospitals; Hybrids; Individual; Infrastructure; Inpatients; Internet; Intervention; Intervention Trial; Investigation; Knowledge; Manuals; Measures; Mental Depression; Mental Health; Mental Health Services; Methodology; Methods; Outcome; Outpatients; Patients; Play; Positioning Attribute; Provider; Psychiatric Hospitals; Quality of life; Recovery; Recovery Support; Research; Resources; Role; Scientific Advances and Accomplishments; Services; Source; Specialist; Specific qualifier value; Structure; Subcategory; Substance abuse problem; Suicide; Suicide prevention; Systems Integration; Technology; Testing; Time; Veterans; Vocational rehabilitation; Work; acceptability and feasibility; clinical practice; community living; design; effectiveness evaluation; effectiveness trial; effectiveness/implementation trial; empowerment; experience; functional outcomes; high risk; hospital readmission; implementation intervention; improved; innovation; inpatient service; intervention participants; military veteran; outpatient programs; peer; peer support; pilot trial; prevent; programs; psychoeducation; psychoeducational; readmission rates; severe mental illness; social; sound; tool

Background: The time following discharge from psychiatric hospitalization is a high-risk period and has been associated with a range of negative outcomes, including high rates of hospital readmission and suicide (1). Because the evidence for transitional discharge interventions with bridging components is mixed and limited in terms of how Peer Specialists (PS) can help support such interventions, additional research is needed. Our proposal calls for the development and preliminary evaluation of a PS facilitated technology-supported intervention based on the existing and frequently used My Recovery Plan program. However, to date, no studies have examined use of this tool to improve post-hospital discharge outcomes. Given the importance of the problem for the VA, and the fact that the VA has both a large PS infrastructure that is valued by both professional providers and Veterans, our work offers sound justification and the unique opportunity to test the proposed intervention in a single integrated system of inpatient and outpatient services. Significance: The significance of this project lies in its ability to actively address an important gap in the research, namely PS interventions focused on reducing readmission and supporting recovery-oriented outcomes in Veterans. Further relating to important HSR&D priorities the project is designed to advance scientific knowledge and clinical practice in the areas of access to care, mental health, and suicide prevention. Innovation and Impact: A key innovation of the proposed research is the potential to efficiently optimize existing resources to target the widespread challenges associated with transitioning out of acute inpatient settings and effectively connect Veterans to preferred services (in this case peer support) in order to prevent re-admission, and improve utilization of VA outpatient mental health services. Finally, in relationship to impact, Recovery Bridge has potential to result in improvement across multiple clinical and functional outcomes that are applicable to a broad Veteran population (rather than only in small select diagnostically specific subpopulations). Specific Aim 1: Integrate the My Recovery Plan tool and existing PS tools and strategies to develop a manualized intervention called Recovery Bridge for use by VA PS working to help Veterans make the transition from acute inpatient psychiatric hospitalization to community living. Specific Aim 2: Complete an open pilot trial (n=15) to examine the feasibility, fidelity, and acceptability of the Recovery Bridge intervention in relation to well specified benchmarks supporting continued and expanded investigation. [Specific Aim 3: As part of the open pilot trial: 1) explore the impact of the intervention on readmission rates (at 30 and 90 days), and connection to outpatient care compared to a control group (n=15) identified from administrative data, and; 2) explore the change in recovery and Quality of Life measures over time in the intervention participants]. Methodology: Source documents described in the proposal will be used to create the Recovery Bridge intervention (as Specified in Aim 1). Quantitative, qualitative, and administrative services data we will be used to complete an open trial of the intervention (as specified in Aim 2 and Aim 3). Next Steps: Benchmarks across the domains of feasibility, fidelity, and acceptability; as well as exploratory outcomes specified in Aim 3, will be used to inform next steps including a larger effectiveness trial followed by a possible hybrid-I effectiveness/implementation trial to inform future dissemination and implementation of the intervention more broadly across the VA.

背景：从精神科住院出院后的时间是高风险时期，已经是 与一系列负面结果相关，包括高医院再入院和自杀率（1）。 因为与桥接组件的过渡分院干预措施的证据混合在一起，有限 同伴专家（PS）如何帮助支持此类干预措施的条款，需要其他研究。我们的 提案要求对PS促进技术支持的开发和初步评估 基于现有的并经常使用我的恢复计划计划的干预措施。但是，迄今为止，没有 研究检查了该工具改善院后出院结果的使用。考虑到重要性 VA的问题，以及VA具有大型PS基础设施的事实，这两者都重视 专业提供者和退伍军人，我们的工作提供了合理的理由和独特的机会来测试 提出了对住院和门诊服务的单个集成系统的干预。 意义：该项目的重要性在于它有能力积极解决重要差距 研究，即PS干预措施，重点是减少再入院和支持以恢复为导向 退伍军人的成果。与重要的HSR＆D优先事项有关的进一步有关该项目旨在提高 在获得护理，心理健康和预防自杀领域的科学知识和临床实践。 创新和影响：拟议研究的关键创新是有效地优化现有的潜力 针对与急性住院设置过渡相关的广泛挑战的资源 有效地将退伍军人连接到首选服务（在本例中为同伴支持），以防止重新加入， 并改善VA门诊精神卫生服务的利用。最后，与影响关系，恢复 桥有可能导致多个临床和功能结果之间的改善 适用于广泛的退伍军人人口（而不是仅适用于小型诊断特定于诊断 亚群）。 特定目的1：整合我的恢复计划工具以及现有的PS工具和策略以开发一个 手动干预措施称为恢复桥，用于VA PS使用以帮助退伍军人进行过渡 从急性住院精神病医院到社区生活。 特定目标2：完成开放试验试验（n = 15），以检查可行性，忠诚度和可接受性 恢复桥梁干预涉及支持良好的基准支持的基准持续和扩展 调查。 [特定目标3：作为开放试点试验的一部分：1）探索干预对再入院率的影响 （在30和90天），与对照组（n = 15）相比，与门诊护理的联系 管理数据，并且； 2）探索随着时间的流逝的恢复和生活质量措施的变化 干预参与者]。 方法：提案中描述的源文档将用于创建恢复桥 干预（如AIM 1所示）。定量，定性和行政服务数据我们将被使用 要完成干预措施的公开试验（如AIM 2和AIM 3所示）。 下一步：可行性，保真度和可接受性的整个领域的基准测试；以及探索性 AIM 3中指定的结果将用于告知下一步，包括更大的有效性试验，然后 一项可能的混合I效力/实施试验，以告知未来的传播和实施 干预更广泛地遍及整个VA。