Remote Supervision for Implementing Collaborative Care for Perinatal Depression

 描述(申请人提供)：抑郁症是孕妇中的一种常见和严重的疾病，但很少有低收入群体得到有效的治疗。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。在尝试大规模、务实地实施这一创新的情况下，各个卫生中心的成功情况差异很大。在实施这种护理创新的大规模努力中取得与更多受控有效性试验相同的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。尽管通过内容专家对正在实施的医疗创新进行纵向咨询，发现了培训、技术援助、质量改进和工具等形式的持续支持，以改善实施情况和患者结果，但大多数实施工作主要依靠对工作人员进行简短的强化培训。这些内容专家是互补的，但不同于处理适用于实施任何创新的一般流程的一般实践促进者。为了实现CC的潜在公共健康利益，可能需要一种有效和可扩展的纵向协商模式，以促进其有效实施。我们提出了一种实用的整群随机纵向远程会诊(LRC)试验，利用视频会议来有效地将提供者与提供及时反馈和培训的顾问联系起来。我们计划使用混合型III实施设计，重点放在实施结果上，同时也关注临床结果。这项拟议的研究将涉及20个联邦合格的保健中心(FQHC)，它们提供产前护理，是拥有共享电子健康记录的国家OCHIN网络的一部分。所有地点都将得到目前许多广泛执行工作中使用的标准的多方面执行办法。在实施前培训后，将随机选择其中10个地点接受LRC。在12个月的实施期和13-21个月的持续期后，将比较研究条件下的实施和临床结果以及成本。拟议研究的结果将提供有关持续咨询对实施复杂干预措施(如协作护理)的好处的关键概括知识。

 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.