Remote Supervision for Implementing Collaborative Care for Perinatal Depression

远程监督对围产期抑郁症实施协作护理

• 批准号: 9256545
• 负责人: IAN Moore BENNETT
• 金额: $ 86.73万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-04-08 至 2021-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9256545
• 关键词: Address; Affect; Birth; Caring; Clinical; Cluster randomized trial; Complex; Consultations; Cost Analysis; Disease; Electronic Health Record; Elements; Evaluation; Evidence based practice; Family; Federally Qualified Health Center; Feedback; General Practices; Health; Health Benefit; Healthcare; Hybrids; Individual; Infant; Intervention; Knowledge; Link; Low income; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Modeling; Outcome; Patient-Focused Outcomes; Patients; Penetration; Perinatal Disorder; Population; Pregnancy; Pregnant Women; Prenatal care; Primary Health Care; Process; Provider; Public Health; Randomized; Remote Consultation; Research Support; Resources; Services; Site; Supervision; Technology; Testing; Time; Training; Variant; Vulnerable Populations; Woman; Work; base; clinical practice; collaborative care; cost; cost effectiveness; depression model; design; disability; disparity reduction; effective therapy; effectiveness trial; efficacy trial; evidence base; experience; health care disparity; improved; innovation; member; peripartum depression; pragmatic trial; prospective; public health relevance; racial minority; research to practice; safety net; scale up; skills; success; symposium; theories; tool

 DESCRIPTION (provided by applicant): Depression is a common and serious disorder among pregnant women but few from low income groups receive effective treatment. The highly evidence based collaborative care (CC) model for depression has been shown to work for women in pregnancy but has not been widely implemented. In cases where large scale pragmatic implementation of this innovation has been attempted there has been great variation in the success at individual health centers. A major obstacle to achieving the same success in large scale efforts to implement this care innovation as is seen in more controlled effectiveness trials is the limit of resources available to support the staff members carrying out this care. Although ongoing support in the form of training, technical assistance, quality improvement, and tools has been found to improve implementation and patient outcomes through longitudinal consultation by content experts in the health innovation being implemented most implementation efforts rely primarily on brief intensive training for staff. These content experts are complementary but distinct from general practice facilitators that address general processes that are applicable to implementation of any innovation. In order to achieve the potential public health benefits of CC an efficient and scalable model of longitudinal consultation may be needed to facilitate its effective implementation. We propose a pragmatic cluster randomized trial of longitudinal remote consultation (LRC) utilizing video conferencing to efficiently link providers to consultants who provide timely feedback and training. We plan to use a Hybrid Type III implementation design with a focus on implementation outcomes but also clinical outcomes. The proposed study will involve twenty federally qualified health centers (FQHCs) providing prenatal care and which are part of the national OCHIN Network with a shared electronic health record. All sites will receive a standard multifaceted approach to implementation used in many current broad implementation efforts. After pre-implementation training ten of the sites will be randomly selected to receive the LRC. Implementation and clinical outcomes as well as costs will be compared between the study conditions after a 12 month implementation period and a 13-21 month sustainment period. The results of the proposed study will provide critical generalizable knowledge regarding the benefits of ongoing consultation for implementation of complex interventions like collaborative care.

 描述（申请人提供）：抑郁症是孕妇中常见和严重的疾病，但低收入群体很少得到有效的治疗。高度循证的抑郁症协作护理（CC）模式已被证明对怀孕妇女有效，但尚未广泛实施。在已经尝试大规模实用地实施这种创新的情况下，在各个健康中心的成功方面存在很大差异。在实施这种护理创新的大规模努力中取得同样成功的一个主要障碍是，可用于支持开展这种护理的工作人员的资源有限。虽然培训、技术援助、质量改进和工具等形式的持续支持已被发现通过内容专家在正在实施的卫生创新中进行的纵向咨询改善了实施和患者结果，但大多数实施工作主要依赖于对工作人员的简短强化培训。这些内容专家是互补的，但不同于一般做法的促进者，解决适用于任何创新的实施一般过程。为了实现CC的潜在公共卫生效益，可能需要一个有效和可扩展的纵向咨询模式，以促进其有效实施。我们提出了一个务实的集群随机试验的纵向远程咨询（LRC），利用视频会议，有效地链接供应商的顾问谁提供及时的反馈和培训。我们计划使用混合III型实施设计，重点关注实施结果和临床结果。这项拟议的研究将涉及20个提供产前护理的联邦合格卫生中心（UDHCs），这些中心是国家OCHIN网络的一部分，拥有共享的电子健康记录。所有地点都将接受目前许多广泛执行工作中采用的标准多层面执行办法。在实施前培训后，将随机选择10个研究中心接受LRC。在12个月实施期和13-21个月维持期后，将比较研究条件下的实施和临床结局以及成本。拟议的研究结果将提供关键的概括性知识的好处，正在进行的协商，实施复杂的干预措施，如合作护理。