PracticeGround: Transforming Training and Delivery of Mental Health EBPs

 精神障碍影响着4500万美国人，每年造成1930亿美元的损失，总成本至少为3170亿美元。虽然存在许多心理社会经验支持疗法（EST），但很少有临床医生接受过充分的培训来提供这些疗法。该项目的总体目标是开发一个全面的软件解决方案，有效和高效地促进心理健康问题的心理社会无害环境技术的交付。为了确保显著的覆盖面和公共卫生影响，实践场将使用商业成功的行业标准进行设计。具体而言，Practice Ground将作为第三方模块构建，无缝集成到电子健康记录（EHR）中，并优化用户的工作流程。Practice Ground通过整合以下组件来帮助提供EST：动态进度监控，临床决策支持，客户结果的丰富视觉显示，EST的在线培训模块，在提供EST时提供指导性实时帮助的即时培训，教育视频和客户门户网站。 在第一阶段，我们开发并测试了在线进度跟踪器（OPT）原型的可用性、可接受性和可行性。OPT之所以被特别选中，是因为其设计和工作流程的复杂性。我们还将现有的进度监测培训课程改编为在线培训形式。概念验证分两个阶段确定：（1）在整个软件开发过程中，目标最终用户（临床医生、客户）和其他利益相关者（诊所主任、项目经理）的广泛反馈（形成性评价）;（2）最终原型的受试者内试点研究（N=25）（总结性评价）。与最初的假设一致，OPT随着时间的推移显着增加了进度监测，并显着减少了使用障碍。此外，我们自筹资金继续进行第二年的OPT工作（“阶段I-A”），以完成商业就绪，符合HIPAA的产品，并于2014年7月推出。我们达到并超过了最初的目标。 在第二阶段，我们打算使用敏捷开发流程完成PracticeGround的开发，以确保可用性并优化工作流程。我们将用抑郁症、失眠症、双相情感障碍、创伤后应激障碍和自杀风险干预和管理的EST填充它，使用HL 7将PracticeGround松散地集成到PracticeFusion和NetSmart中，并在第三阶段开发一个系统架构设计，将PracticeGround紧密集成到EPIC、PracticeFusion和NetSmart中。我们将在三个地点进行可行性现场测试，重点是：可用性和满意度，客户在其案例中的使用频率，以及使用障碍。然后，我们将进行一项为期18周的随机对照试验（N=80），比较PracticeGround（n=40）和抑郁症门诊患者的常规护理（n=40）。主要结果包括：抑郁，心理困扰，治疗满意度（客户和临床医生）和治疗脱落。次要临床医生结局包括：临床医生病例量中客户使用PracticeGround的程度。

 DESCRIPTION (provided by applicant): Mental disorders affect 45 million Americans and result in an annual loss of $193 billion and total costs of at least $317 billion. While numerous psychosocial empirically supported therapies (ESTs) exist, few clinicians are adequately trained to deliver them. The overarching goal of this project is to develop a comprehensive software solution that effectively and efficiently facilitates the delivery of psychosocial ESTs for mental health problems. To ensure significant reach and public health impact, Practice Ground will be designed using industry standards for commercial success. Specifically, Practice Ground will be built as a third-party module that seamlessly integrates into electronic health records (EHRs) and optimizes users' workflow. Practice Ground aids delivery of ESTs by integrating the following components: dynamic progress monitoring, clinical decision support, rich visual displays of client outcomes, online training modules in ESTs, just-in-time training for guided real-time assistance in delivering ESTs, educational videos, and a client portal. In Phase I, we developed and tested the usability, acceptability, and feasibility of an online progress tracker (OPT) prototype. OPT was specifically selected because of its design and workflow complexities. We also adapted an existing training course on progress monitoring (PM) to an online training format. Proof of concept was determined in two phases: (1) extensive feedback from target end-users (clinicians, clients) and other stakeholders (clinic directors, program managers) throughout software development (formative evaluation); and (2) a within-subjects pilot study (N=25) of the final prototype (summative evaluation). Consistent with initial hypotheses, OPT significantly increased progress monitoring over time and significantly reduced barriers to use. In addition, we self-funded continued work on OPT for a second year ("Phase I-A") in order to complete a commercial-ready, HIPAA-compliant product for launch in July, 2014. We met and exceeded original aims. In Phase II, we intend to complete the development of PracticeGround using an agile development process to ensure usability and optimize workflow. We will populate it with ESTs for depression, insomnia, bipolar disorder, PTSD, and suicide risk intervention and management, loosely integrate PracticeGround into PracticeFusion and NetSmart using HL7, and develop a systems architecture design for tight integration of PracticeGround into EPIC, PracticeFusion, and NetSmart in Phase III. We will conduct feasibility field tests at three sites that focus on: usability and satisfaction, frequencyof use across clients in their caseload, and barriers to use. We will then conduct an 18-week randomized controlled trial (N=80) comparing PracticeGround (n=40) to care-as-usual (n=40) in depressed outpatient clients. Primary outcomes include: depression, psychological distress, treatment satisfaction (clients and clinicians), and treatment drop out. Secondary clinician outcomes include: extent of PracticeGround use with clients across clinicians' caseload.