Implementing Chronic Care Management for Bipolar Disorder

描述(申请人提供)：很少有基于证据的精神障碍治疗模式被转化为基于社区的实践。造成这一研究与实践差距的一个主要原因是缺乏工具和激励措施来维持治疗的保真度(例如，培训)，同时最大限度地提高在不同环境中的推广能力。这项随机对照试验的目标是确定实施行为健康治疗模式的系统框架是否能够在社区心理健康实践中提高干预保真度和患者结果。我们将测试复制有效计划(REP)实施框架的组成部分，其中包括：1)将有效的治疗模式转化为文化上合适的非技术组成部分(“包装”)，2)对提供者进行实施一揽子计划的正式培训，以及3)通过技术援助(TA)支持一揽子计划的转让。使用双相情感障碍护理模式(BCM)作为有效干预的例子，我们将打包BCM，然后随机选择来自三个大型行为健康组织的60个基于社区的实践，以获得BCM套餐以及培训和TA，或者仅接受BCM套餐。所有实践都将收到BCM包，其中包括：1)自我管理教育脚本，2)护理管理规程，3)简化实践指南。在培训/技术援助部门，现场选定的工作人员将通过一名专家接受业务流程管理和结构化技术援助的标准化培训，该专家将定期联系现场代表，以解决当地实施业务流程管理的障碍。主要(12个月)结果包括患者水平对BCM核心要素的忠诚度、临床状态(例如，症状、功能、生活质量)和REP/BCM成本效益。将有效的治疗模式从研究转化为实践是美国国立卫生研究院路线图阐明的公共卫生优先事项。目前还没有应用于卫生保健环境的实施框架成功地证明改善了患者的结果。虽然培训和助教旨在最大限度地提高模型保真度，但它们对项目来说可能是昂贵的。然而，培训和技术援助可以通过就减少执行障碍进行协商来提高忠诚度，并接受当地做法。确定培训和技术援助在提高保真度和患者结果方面的边际效益，对于向医疗保健利益相关者提供代表的业务案例至关重要，最终有助于将循证治疗模式转化为基于社区的实践。

DESCRIPTION (provided by applicant): Few evidence-based treatment models for mental disorders have been translated into community-based practices. A primary reason for this research-to-practice gap is the lack of tools and incentives to maintain treatment fidelity (e.g., training) while maximizing generalizability across different settings. The goal of this randomized controlled trial is to determine whether a systematic framework for implementing behavioral health treatment models leads to improved intervention fidelity and patient outcomes in community-based mental health practices. We will test components of the Replicating Effective Programs (REP) implementation framework, which includes: 1) translation of effective treatment models into culturally appropriate, non- technical components ("packaging"), 2) formal training of providers in implementing the package, and 3) supporting the transfer of the package through technical assistance (TA). Using the bipolar disorder care model (BCM) as an example of an effective intervention, we will package the BCM, and then randomize 60 community-based practices from three large behavioral health organizations to receive the BCM package along with training and TA, or the BCM package only. All practices will receive the BCM package, which includes: 1) self-management education scripts, 2) care management protocols, and 3) simplified practice guidelines. In the training/TA arm, selected staff at sites will receive standardized training in the BCM and structured TA via a specialist who will contact site representatives on a regular basis to problem-solve local barriers to BCM implementation. Primary (12-month) outcomes include patient-level fidelity to BCM core elements, clinical status (e.g., symptoms, functioning, quality of life), and REP/BCM cost-effectiveness. Translating effective treatment models from research to practice is a public health priority articulated by the NIH Roadmap. There have been no implementation frameworks applied to health care settings that have successfully demonstrated improved patient outcomes. While training and TA are designed to maximize model fidelity, they can be costly for programs. Yet training and TA may enhance fidelity and buy-in from local practices through consultations on reducing implementation barriers. Determining the marginal benefit of training and TA on improved fidelity and patient outcomes is crucial for making the business case for REP to health care stakeholders, ultimately facilitating translation of evidence-based treatment models to community- based practices.