Implementing Chronic Care Management for Bipolar Disorder

描述（由申请人提供）：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。这种研究与实践差距的主要原因是缺乏保持治疗保真度的工具和激励措施（例如，培训），同时最大限度地提高跨不同设置的普遍性。这项随机对照试验的目的是确定实施行为健康治疗模式的系统框架是否会改善社区精神卫生实践中的干预保真度和患者结局。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。我们以双相情感障碍护理模式（bipolar disorder care model，简称BPD）作为有效干预的一个例子，将BPD进行包装，然后从三家大型行为健康组织随机抽取60名社区实践者，让他们接受BPD包装沿着接受培训和TA，或者只接受BPD包装。所有的实践将收到一个软件包，其中包括：1）自我管理教育脚本，2）护理管理协议，和3）简化的实践指南。在培训/技术援助部门，各研究中心选定的工作人员将通过一名专家接受技术援助和结构化技术援助方面的标准化培训，该专家将定期与研究中心代表联系，以解决当地实施技术援助的障碍。主要（12个月）结局包括患者对核心要素的忠诚度、临床状态（例如，症状、功能、生活质量）和REP/ESTA成本效益。将有效的治疗模式从研究转化为实践是NIH路线图所阐述的公共卫生优先事项。目前还没有适用于医疗保健环境的实施框架，成功地证明了改善病人的结果。虽然训练和TA旨在最大限度地提高模型保真度，但它们对程序来说可能是昂贵的。然而，培训和技术援助可通过就减少执行障碍进行磋商，提高当地做法的忠实度和接受度。确定培训和TA对改善保真度和患者结局的边际效益对于向医疗保健利益相关者提供REP的商业案例至关重要，最终促进循证治疗模式向社区实践的转化。

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.