Technology Enabled Services for Coordinated Care of Depression in Healthcare Settings

摘要 技术支持服务（TES），为患者使用基于Web的和移动的应用程序， 护理协调员的支持，一直通过随机对照试验显示， 有效治疗抑郁症然而，在医疗机构中实施TES的尝试失败了， 主要是因为现实世界的患者和提供者都没有使用我们在研究中开发和评估的工具。 该中心通过多层次战略解决了这一研究到实践的问题。在研究 建议（RP）水平，我们将在三个独特的医疗环境中设计和评估抑郁症的TES， 一般都能控制抑郁症每个RP将包括一个独特的设计创新。RP1将设计和评估 工商业污水附加费，以支持初级保健协作护理计划。RP1的设计创新将集中在 集成移动的电话传感技术，以创建更简单、更吸引患者的工具。RP2设计 并评估产后抑郁症的专业产科护理设置的TES。设计创新 将专注于面向护理经理的工具和流程，这些工具和流程可以简化、组织和自动化工作流程。 RP 3设置在老年服务中，将重点关注居家老年人，他们几乎没有治疗选择。 设计创新将是利用语音控制的智能个人助理来支持居家 老年人，为家庭照顾者提供支持。在研究层面，我们将利用这三个RP来完善 我们的“加速从研究到维持”（Accelerated Problems to Sustainment，简称ESTs）研究框架，旨在克服“从研究到维持”的问题， 实践差距在几个方面。嵌入式系统集成了人机交互（HCI）方法， 语音终端用户的设计和评估的技术，服务协议，和实施 为RP制定计划，从而确保最终产品是可用的，有用的，并且可以实现。核心 研究设计元素和测量在RP中是一致的，这将使我们能够评估 在所有RP中使用可持续发展框架，以验证可持续发展框架的核心研究原则。与 在我们的外部科学顾问委员会的帮助下，将利用这一经验制定研究指南， 数字化心理健康研究，并将有关TES和组织特征的知识汇总到 代表研究人员和开发人员基本信息的分类法。我们会做到的 通过一个高度跨学科的团队工作，由两名PI领导，他们是数字心理领域的领先专家 健康和HCI（莫尔和雷迪），在医学，实施科学，心理学， 研究方法和统计数据。每个RP都由诊所或服务负责人和一名研究人员共同领导， 从而确保临床服务需求与研究之间的深度合作。因此，该中心通过使用 一个多层次的方法，侧重于个人的研究项目和方法，将产生第一个 TES设计用于在真实的世界医疗保健环境中实施，并将提供实质性和持久的 对提高科学质量的研究方法的贡献。

Abstract Technology-enabled services (TESs), which use web-based and mobile applications for patients coupled with support from a care coordinator, have consistently been shown through randomized controlled trials to be effective at treating depression. However, attempts to implement TESs in healthcare settings have failed, primarily because neither real-world patients nor providers use the tools we develop and evaluate in research. This center addresses this research-to-practice problem through a multi-level strategy. At the research proposal (RP) level, we will design and evaluate TESs for depression in three unique medical settings that commonly manage depression. Each RP will include a unique design innovation. RP1 will design and evaluate a TES to support a primary care collaborative care program. The design innovation of RP1 will focus on integrating mobile phone sensing technologies to create simpler, more engaging patient tools. RP2 will design and evaluate a TES for a specialty obstetrics care setting for postpartum depression. The design innovation will focus on care manager-facing tools and processes that can simplify, organize, and automate workflows. RP3, set in a geriatric service, will focus on homebound older adults, for whom there are few treatment options. The design innovation will be to harness a voice-controlled intelligent personal assistant to support homebound older adults, with supports for family caregivers. At the research level, we will harness the three RPs to refine our Accelerated Create-to-Sustainment (ACTS) research framework, which aims to overcome the research-to- practice gap in several ways. ACTS integrates human computer interaction (HCI) methods to incorporate the voice of end users into the design and evaluation of the technologies, service protocol, and implementation plan for the RPs, thereby ensuring that the end product is usable, useful, and can be implemented. Core research design elements and measurements are consistent across the RPs, which will allow us to evaluate the ACTS framework across all RPs to validate the core research principles of the ACTS framework. With the help of our External Scientific Advisory Board, will use this experience to produce research guidelines for digital mental health research, and aggregate the knowledge gained about TES and organization features into a taxonomy that represents essential information for researchers and developers. We will achieve this this work through a highly interdisciplinary team, led by two PIs who are leading experts in experts in digital mental health and HCI (Mohr and Reddy), with additional expertise in medicine, implementation science, psychology, research methods, and statistics. Each of the RPs is co-led by the clinic or service chief and a researcher, thereby ensuring a deep collaboration between clinical service needs and research. Thus, this Center, by using a multilevel approach focusing on both the individual research projects and methodology, will produce the first TESs designed for implementation in real world healthcare settings, and will provide substantial and enduring contributions to research methodology that will improve the quality of science.