Life Goals Collaborative Care to Improve Health Outcomes in Mental Disorders

生活目标 协作护理以改善精神障碍的健康结果

• 批准号: 8597440
• 负责人: AMY M KILBOURNE
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-03-01 至 2015-05-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8597440
• 关键词: Accident and Emergency department; Address; Adherence; Administrator; Antipsychotic Agents; Attention; Behavior; Behavioral; Behavioral Medicine; Bipolar Disorder; Blood Pressure; Cardiovascular Diseases; Caring; Characteristics; Chronic; Chronic Care; Clinic; Communities; Complex; Continuity of Patient Care; Diagnosis; Disease; Economic Burden; Enrollment; General Population; Generations; Goals; Guidelines; Health; Health Promotion; Health behavior; Health behavior change; Healthcare; Healthcare Systems; Hospitalization; Hyperlipidemia; Hypertension; Individual; Inpatients; Intervention; Interview; Lead; Life; Life Style; Longevity; Major Depressive Disorder; Mediating; Medical; Mental Health; Mental Health Services; Mental disorders; Methods; Morbidity - disease rate; Motivation; Outcome; Outpatients; Patient Care; Patient Monitoring; Patients; Persons; Physical activity; Population; Premature Mortality; Primary Health Care; Probability; Provider; Psychiatric Diagnosis; Psychiatric therapeutic procedure; Quality of life; Randomized; Registries; Research; Research Priority; Risk; Risk Factors; Schizophrenia; Self Management; Services; Smoking; Symptoms; System; Time; Veterans; Vulnerable Populations; Weight; base; behavior change; cardiovascular disorder risk; chronic care model; collaborative care; cost; disability; disorder prevention; effectiveness trial; experience; functional disability; health related quality of life; improved; mortality; novel; patient oriented; physical conditioning; programs; psychosocial; severe mental illness; symptom management; treatment adherence; treatment as usual; treatment response; treatment strategy

DESCRIPTION (provided by applicant): Background: VA patients with serious mental illnesses (SMI- e.g., schizophrenia, bipolar disorder) die an average of 13-18 years earlier compared to the general U.S. population, mostly from cardiovascular disease (CVD). Increased risk of CVD and related risk factors in persons with SMI is attributed to patient, provider, and system-level barriers including unhealthy behaviors exacerbated by mental health-related symptoms and barriers to access and continuity of care between physical and mental health services. Objectives: The primary aim of this randomized controlled effectiveness trial (RCT) is to determine whether VA patients with SMI receiving Life Goals Collaborative Care (LGCC), a program that combines customized behavioral change strategies with chronic care management for SMI will experience, within 12 months: a) improved medical outcomes (e.g., reduced CVD risk factors, improved physical health-related quality of life), b) improved mental health outcomes, including reduced psychiatric symptoms or improved mental health-related quality of life or c) improved health behaviors, compared to VA patients with SMI receiving enhanced treatment as usual (i.e., dissemination of health behavior change materials in addition to standard VA medical and psychiatric care). Secondary aims that will inform further implementation of LGCC will be to assess utilization and cost differences of LGCC versus treatment as usual, determine the patient factors associated with LGCC treatment response, and identify the organizational factors associated with LGCC implementation. Methods: LGCC is a groundbreaking psychosocial and behavior change intervention that is based on the Chronic Care Model (CCM) and consists of 1) 10 self-management sessions that cover personal goal-setting and mental health symptom management reinforced through healthy lifestyles; 2) medical care management that includes identification of patient medical risk factors, monitoring of patient symptoms and medical needs via a registry over time; and 3) support for provider guidelines and community linkages. We will enroll 376 individuals diagnosed with SMI and a CVD risk factor who are receiving care within the VA Ann Arbor Healthcare System mental health clinic, and who will be randomized to receive LGCC or enhanced treatment as usual. Key outcomes include changes in CVD risk factors (e.g., blood pressure, BMI), psychiatric symptoms, health-related quality of life, health behaviors (e.g., physical activity), and inpatient and outpatient use assessed at 6 and 12 months. Impact: This study addresses VA HSR&D research priorities related to mental health and care of complex, chronic conditions, and is consistent with the priorities of the VHA's Office of Mental Health Services (Patient Care Services), 10NC, and the National Center for Health Promotion and Disease Prevention. Serious mental illness (SMI) is associated with significant disability, decreased quality of life, and a decreased life span. The VA is undergoing two major quality improvement initiatives: the Patient-Aligned Care Team (PACT), which involves enhanced access and continuity of care based on Chronic Care Model (CCM) principles, and dissemination of behavioral medicine programs. However, to date these programs have not been fully adapted to address gaps in quality or outcomes of care for Veterans with SMI. Findings from this RCT will inform ongoing VA transformational initiatives around systems redesign and behavioral medicine programs for Veterans with SMI and determine whether a customized CCM-behavioral medicine strategy is most effective in improving outcomes for this vulnerable group.

描述（由申请人提供）： 背景：患有严重精神疾病（SMI，例如精神分裂症、双相情感障碍）的 VA 患者比美国普通人群平均早 13-18 年死亡，大部分死于心血管疾病 (CVD)。 SMI 患者罹患 CVD 和相关危险因素的风险增加归因于患者、提供者和系统层面的障碍，包括因心理健康相关症状而加剧的不健康行为，以及身心健康服务之间获得和连续性护理的障碍。目的：这项随机对照有效性试验 (RCT) 的主要目的是确定患有 SMI 的 VA 患者在接受生活目标协作护理 (LGCC)（一项将定制行为改变策略与 SMI 长期护理管理相结合的计划）后，是否会在 12 个月内体验到：a) 改善的医疗结果（例如，减少 CVD 危险因素，改善身体健康相关的生活质量），b) 改善心理健康结果，包括减少 精神症状或心理健康相关生活质量的改善，或 c) 与照常接受强化治疗的 VA 患有 SMI 的患者相比，健康行为得到改善（即，除了标准 VA 医疗和精神护理之外，还传播健康行为改变材料）。为进一步实施 LGCC 提供信息的次要目标是评估 LGCC 与常规治疗的利用率和成本差异，确定与 LGCC 治疗反应相关的患者因素，并确定与 LGCC 实施相关的组织因素。方法：LGCC 是一项突破性的社会心理和行为改变干预措施，基于慢性护理模式 (CCM)，包括 1) 10 次自我管理课程，涵盖通过健康生活方式强化的个人目标设定和心理健康症状管理； 2) 医疗护理管理，包括识别患者医疗风险因素、通过登记监控患者症状和医疗需求； 3) 支持提供者指南和社区联系。我们将招募 376 名被诊断患有 SMI 和 CVD 危险因素的个人，他们正在 VA Ann Arbor 医疗保健系统心理健康诊所接受护理，并将像往常一样随机接受 LGCC 或强化治疗。主要结果包括 CVD 危险因素（例如血压、BMI）、精神症状、健康相关生活质量、健康行为（例如体力活动）以及 6 个月和 12 个月时评估的住院和门诊使用情况的变化。影响：本研究涉及 VA HSR&D 与心理健康和复杂慢性疾病护理相关的研究重点，并且与 VHA 心理健康服务办公室（患者护理服务）、10NC 和国家健康促进和疾病预防中心的重点一致。严重精神疾病 (SMI) 与严重残疾、生活质量下降和寿命缩短有关。 VA 正在实施两项主要的质量改进举措：患者协调护理团队 (PACT)，其中涉及根据慢性护理模式 (CCM) 原则增强护理的可及性和连续性，以及传播行为医学计划。然而，迄今为止，这些计划尚未完全适应解决 SMI 退伍军人护理质量或结果方面的差距。这项随机对照试验的结果将为退伍军人管理局正在进行的围绕系统重新设计和针对患有 SMI 的退伍军人的行为医学计划的转型举措提供信息，并确定定制的 CCM 行为医学策略是否最有效地改善这一弱势群体的结果。

项目成果

GPSAdb: a comprehensive web resource for interactive exploration of genetic perturbation RNA-seq datasets.

• DOI: 10.1093/nar/gkac1066
• 发表时间: 2023-01-06
• 期刊: NUCLEIC ACIDS RESEARCH
• 影响因子: 14.9
• 作者: Guo, Shipeng;Xu, Zhougeng;Dong, Xiangjun;Hu, Dongjie;Jiang, Yanshuang;Wang, Qunxian;Zhang, Jie;Zhou, Qian;Liu, Shengchun;Song, Weihong
• 通讯作者: Song, Weihong