Adapting and Implementing a Chronic Disease Self-Management Program for Primary Care Patients with Opioid Use Disorder and Serious Mental Illness

这个K 01奖申请是为博士伊丽莎白Siantz，博士培训的社会工作者，其总体 职业目标是成为一名独立的临床研究者，使用实施科学来促进 采用和整合基于证据的慢性病自我管理计划， 慢性疾病，主要是阿片类药物使用障碍（OUD）和严重精神疾病（SMI）。此K 01将支持 职业发展的四个关键领域：1）与心理健康和初级保健有关的干预适应 OUD患者的护理需求; 2）在现实环境中进行临床试验设计和管理方面的培训; 3） 提高对干预措施实施情况进行定性评估的技能; 4）加强研究 领导力，重点是科学领域的性别平等和多样性。Siantz博士组织了一个跨学科的 指导团队由Adam Gordon医学博士（初级导师）组成，他是一位专家传播和 实施（D&I）研究人员专注于提高对弱势患者群体护理质量， OUD;和Leopoldo Cabassa，博士，MSW（共同导师），一位专家混合方法D&I研究员，专注于 促进重度精神障碍患者的身体健康。其他顾问包括：Gerald Cochran，博士，MSW，a 具有OUD专业知识的临床试验专家; Lawrence Palinkas博士，D&I混合方法设计专家 研究;安吉拉·普雷森博士，临床试验统计分析专家;安吉拉·法格林博士， 专家在病人的决策支持干预和性别平等和多样性的研究领导。 OUD患者同时患有严重精神疾病（SMI）和其他慢性疾病。 疾病，并且经常受到临床症状和社会脆弱性的挑战。虽然初级保健 由于医疗机构经常治疗OUD和SMI患者，初级保健提供者几乎没有支持这一点的工具 在自我管理这些复杂的健康状况的人口。慢性病自我管理计划 CDSMPs可以改善疾病管理技能和行为，但尚未适用于初级保健 OUD和SMI患者。未经改编的版本可能与这一人群和环境缺乏相关性。博士 Siantz将解决这一实施差距。这项研究将支持未来的混合有效性研究， 测试适用于OUD和SMI初级保健患者的CDSMP。本研究的具体目的包括：1） 调整适用于OUD和SMI成人的CDSMP，以便在初级保健环境中使用 合作干预计划框架; 2）测试的可行性，可接受性，和初步的影响， 在初级保健环境中为SMI和OUD患者调整CDSMP;以及3）评估实施情况 采用快速评估方法知情的临床民族志的适应CDSMP的过程和背景。 这项拟议中的研究意义重大，因为它将为人口开发健康教育资源， 早期死亡风险高。拟议的研究是创新的，因为它将现有的CDSMP扩展到 新患者人群（OUD和SMI患者）和新环境（初级保健）。

This K01 award application is for Dr. Elizabeth Siantz, a PhD-trained social worker whose overarching career goal is to become an independent clinical investigator who uses implementation science to promote the adoption and integration of evidence-based Chronic Disease Self-Management programs for persons with chronic disease, primarily opioid use disorder (OUD) and serious mental illness (SMI). This K01 will support four key areas of career development: 1) intervention adaptation as it relates to the mental health and primary care needs of persons with OUD; 2) training in clinical trial design and management in real-world settings; 3) advanced skills for qualitatively evaluating intervention implementation; and 4) strengthening research leadership with a focus on gender equity and diversity in science. Dr. Siantz has assembled an interdisciplinary mentoring team comprised of Adam Gordon, MD (Primary Mentor), who is an expert dissemination and implementation (D&I) researcher focused on improving quality of care to vulnerable patient populations with OUD; and Leopoldo Cabassa, PhD, MSW (co-mentor), an expert mixed-methods D&I researcher focused on promoting the physical health of persons with SMI. Additional advisors include: Gerald Cochran, PhD, MSW, a clinical trialist with OUD expertise; Lawrence Palinkas, PhD, an expert in mixed-method designs for D&I research; Angela Presson, PhD, an expert in clinical trials statistical analyses; and Angela Fagerlin, PhD, an expert in patient decision support interventions and in gender equity and diversity in research leadership. People with OUD have a high co-occurrence of serious mental illness (SMI) and other chronic diseases, and are often challenged by their clinical symptoms and social vulnerabilities. While primary care settings frequently treat patients with OUD and SMI, primary care providers have few tools to support this population in self-managing these complex health conditions. Chronic Disease Self-Management programs (CDSMPs) can improve disease management skills and behaviors, but have not been adapted for primary care patients with OUD and SMI. Un-adapted versions might lack relevance to this population and setting. Dr. Siantz will address this implementation gap. This research will support a future hybrid-effectiveness study to test the adapted CDSMP for primary care patients with OUD and SMI. This study’s Specific Aims include: 1) Adapt the CDSMP for adults with OUD and SMI for implementation in a primary care setting using the Collaborative Intervention Planning Framework; 2) Test the feasibility, acceptability, and initial impact of the adapted CDSMP for persons with SMI and OUD in a primary care setting; and 3) Evaluate implementation process and context of the adapted CDSMP using Rapid Assessment Method Informed Clinical Ethnography. This proposed research is significant because it will develop a health education resource for a population at high risk for early mortality. The proposed research is innovative because it will extend an existing CDSMP to a new patient population (persons with OUD and SMI) and novel setting (primary care).