Implementing Technology-Assisted Drug Treatment and relapse prevention in FQHCs

描述（由申请人提供）：本提案由威斯康星州大学、达特茅斯学院、Forward Health Group、Arapahoe SUD治疗、Access、Salud和Partnership社区卫生中心以及国家理事会合作完成 社区行为健康和领导的多个PI大卫H.古斯塔夫森博士和丽莎马施博士。要求初级保健提供者将药物使用障碍治疗和艾滋病毒护理纳入其实践。这意味着在已经不堪重负的系统中增加新的复杂案件。我们建议测试一项战略，以实现一个无线智能手机为基础的交付系统，由经过验证的治疗和恢复计算机程序，将增加SUD服务和艾滋病毒护理，但减轻负担。两 信息和通信系统已证明有能力提高SUD治疗和艾滋病毒护理（TES）以及持续护理（ACHESS）的有效性。虽然它们的潜力很大，但成功不仅取决于技术，还取决于创造一个友好的环境和有效的实施和维持过程。我们建议克服关键障碍，将药物滥用治疗和艾滋病毒护理纳入初级保健，通过使用三种经过验证的策略（通过质量改进）的混合，实施一个无缝结合的循证计算机辅助系统，称为Seva（梵语中的无私关怀）。Seva包括：TES成瘾治疗，ACHESS复发预防，视频咨询以及注册人口管理器。Seva将HIV风险行为、状态和服务集成到患者界面和提供者注册组件中。Seva的每一个组成部分都被证明是有效的，但每一个 具有其自己的界面并且独立地操作，使得难以容易地利用它们的协同潜力。我们假设，我们的实施战略将创造一个友好的环境，并通过消除障碍和建立促进者来提高实施的成功率和可持续性，从而使Seva蓬勃发展。我们将使用定量和定性的方法来确定我们在多大程度上执行 SEVA将改善：覆盖范围、有效性、采用、实施和维护。我们将在3个国家和地区实施Seva。将使用一个社区卫生中心（麦迪逊的ACCESS社区卫生中心）来测试和完善实施策略，并调整SEVA以满足社区卫生中心的需求，并确保易用性。另外两名CIMHC将在阶梯楔形（多基线）设计中每隔6个月接受SEVA。将为每个社区卫生服务中心指派一名教练（这在质量改进中很常见），以帮助实施、运作和维持SEVA。我们将在三年的时间内衡量对国家住房和城乡建设部的影响。

DESCRIPTION (provided by applicant): This proposal is a collaboration of the University of Wisconsin, Dartmouth College, Forward Health Group, Arapahoe SUD treatment, Access, Salud and Partnership community health centers, and The National Council for Community Behavioral Health and led by multiple PIs David H. Gustafson PhD and Lisa Marsch PhD. Primary care providers are being asked to integrate substance use disorder (SUD) treatment and HIV care into their practices. That means adding a new, complex caseload to an already overburdened system. We propose to test a strategy to implement a wireless smart phone based delivery system, composed of proven treatment and recovery computer programs that will add SUD services and HIV care but relieve the burden. Two information and communication systems have demonstrated ability to improve the effectiveness of SUD treatment and HIV care (TES) and continuing care (ACHESS). While their potential is great, success relies not only on technology, but on a creating a welcoming environment and effective processes to implement and sustain. We propose to overcome key barriers to integrating substance abuse treatment and HIV care into primary care by using a blending of three proven strategies (informed by quality improvement) to implement a seamless combination of evidence-based computer assisted system called Seva (the Sanskrit word for selfless caring). Seva includes: TES addiction treatment, ACHESS relapse prevention, video counseling as well as registry PopulationManager. Seva integrates HIV risk behaviors, status, and services into both the patient interface and provider registry components. Each component of Seva has proven to be effective, but each has its own interface and operates independently making it difficult to easily take advantage of their synergistic potential. We hypothesize that our implementation strategy will create welcoming environment, and enhance implementation success and sustainability by removing barriers and building on facilitators, thus allowing Seva to flourish. We will use quantitative and qualitative methods to determine how much our implementation of SEVA will improve: Reach, Effectiveness, Adoption, Implementation and Maintenance. We will implement Seva in 3 FQHCs. One FQHC (ACCESS community health center in Madison) will be used to test and refine the implementation strategy and adapt SEVA to meet FQHC needs and ensure ease of use. Two other FQHCs will receive SEVA at six-month intervals in a stepped wedge (multiple baseline) design. A coach will be assigned to each FQHC (as is common in quality improvement) to help implement, operate and sustain SEVA. We will measure impact on the FQHC over a three year period.