Achieving Cardiovascular Health Equity in Community Mental Health: Optimizing Implementation Strategies

患有严重精神疾病（SMI）的人占美国人口的5%， 任何组的CVD相关死亡率差异，其发生率是对照组的2倍，死亡时间提前10-20年， 美国总人口。支持这一巨大差异的是所有CVD风险的患病率显著升高 SMI患者的危险因素控制率较低。针对CVD风险因素的干预措施 需要为经常有与精神症状相关的实质性障碍的重度精神障碍患者量身定制， 认知障碍迫切需要扩大有效的干预措施，以解决 然而，组织和提供者水平障碍阻碍了SMI中多种CVD风险因素的高负担， 实施.改善重度精神障碍患者的护理，克服美国普通医疗系统的碎片化， 专业精神健康系统，行为健康之家，专业精神健康计划， 负责协调初级保健服务的组织激增。虽然他们已经表明， 改善获得初级保健和筛查心血管疾病的危险因素，迄今为止的行为健康之家没有 导致心血管疾病风险因素的改善，可能是因为他们没有实施循证医学， 干预措施。两个有效的干预措施，NHLBI资助的IDEAL和NIMH资助的生活目标干预措施， 已被证明可以降低SMI患者的CVD风险。UG 3/UH 3的首要目标是与 与密歇根州和马里兰州的社区一起为重度精神障碍患者提供服务， 不同的实施策略，以提高对这些减少心血管疾病的循证实践的采用 行为健康之家的SMI风险。复制有效计划（REP）框架组件（例如， 社区工作组、包装、培训、技术支持）将为采用和 此外，还有另外两项实施战略，即辅导和促进， 供应商和组织的障碍，分别。具体目标是：（1）建立一个高度合作的 与密歇根州和马里兰州的24个社区精神卫生项目站点建立了富有成效的伙伴关系， IDEAL/Life Goals循证实践和实施策略，以满足现场需求;（2）确定 加强区域环境方案的两项实施战略-辅导和促进-的有效性， 18个月时的理想/生活目标（主要结局）和B）CVD风险因素的护理质量 和心血管疾病的危险因素，（次要结果）和（3）评估机制（例如， 提供者自我效能），主持人（例如，执行气候）和其他有关措施（例如，忠实度， 为适应性实施干预提供信息，以进一步扩大行为中的IDEAL/生活目标 健康家居环境。这一创新工作将为执行战略的哪一种组合将导致 以最佳方式采取有效干预措施，以减少社区SMI患者的CVD风险 这是减少心血管疾病差异和实现健康公平的关键一步。

People with serious mental illness (SMI) comprise 5% of the US population and experience one of the largest CVD-related mortality disparities of any group with rates 2 times higher, and dying 10-20 years earlier, than the overall US population. Underpinning this wide disparity is marked elevation in prevalence of all CVD risk factors in persons with SMI, with low rates of risk factor control. Interventions addressing CVD risk factors require tailoring for persons with SMI who often have substantial barriers related to psychiatric symptoms and cognitive impairment. There is an urgent need for scale-up of efficacious interventions shown to address the high burden of multiple CVD risk factors in SMI, however, organizational and provider-level barriers impede implementation. To improve care of persons with SMI and overcome fragmentation of the US general medical and specialty mental health systems, behavioral health homes, programs where specialty mental health organizations are responsible for coordinating primary care services, have proliferated. While they have shown improved access to primary care and screening for CVD risk factors, to-date behavioral health homes have not resulted in improvement in CVD risk factors, likely because they are not implementing evidence-based interventions. Two effective interventions, the NHLBI-funded IDEAL and NIMH-funded Life Goals interventions, have been shown to reduce CVD risk in persons with SMI. The overarching goal of this UG3/UH3 is to partner with communities in Michigan and Maryland serving persons with SMI to refine, tailor and test provision of different implementation strategies to improve uptake of these evidenced-based practices for reducing CVD risk in SMI in behavioral health homes. Replicating Effective Programs (REP) Framework components (e.g., community working group, packaging, training, technical support) will lay the groundwork for uptake and sustainment, alongside two additional implementation strategies, Coaching and Facilitation, which address provider and organizational barriers, respectively. The Specific Aims are to (1) Establish a highly collaborative and productive partnership with 24 Michigan and Maryland community mental health program sites to tailor IDEAL/Life Goals evidence-based practices and implementation strategies to fit site needs; (2) Determine effectiveness of two implementation strategy augmentations to REP, Coaching and Facilitation, on a) uptake and delivery of IDEAL/Life Goals at 18-months (primary outcome), and b) quality of care for CVD risk factors and CVD risk factors among persons with SMI, (secondary outcomes) and (3) To assess mechanisms (e.g., provider self-efficacy), moderators (e.g., implementation climate), and other relevant measures (e.g., fidelity, costs) to inform an adaptive implementation intervention to further scale up IDEAL/Life Goals in the behavioral health home setting. This innovative work will inform which combination of implementation strategies will lead to optimal uptake of effective interventions to reduce CVD risk among persons with SMI in community-based settings, a critical step in reducing their CVD disparities and achieving health equity.