PracticeGround: Transforming Training and Delivery of Mental Health EBPs

 描述(申请人提供)：精神障碍影响4500万美国人，每年造成1930亿美元的损失和至少3170亿美元的总成本。虽然存在许多心理社会经验支持疗法(EST)，但很少有临床医生受到足够的培训来实施这些疗法。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社会心理测试的交付，以解决心理健康问题。为了确保显著的覆盖范围和对公众健康的影响，练习场将按照商业成功的行业标准进行设计。具体地说，练习场地将被打造为第三方模块，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通过集成以下组件来辅助EST的交付：动态进度监控、临床决策支持、客户结果的丰富可视化显示、EST中的在线培训模块、用于指导实时帮助交付EST的即时培训、教育视频和客户门户。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。之所以特别选择OPT，是因为它的设计和工作流程复杂。我们还将现有的进度监测(PM)培训课程调整为在线培训形式。概念验证分两个阶段确定：(1)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)在整个软件开发过程中的广泛反馈(形成性评估)；(2)最终原型的受试者内先导研究(N=25)(终结性评估)。与最初的假设一致，OPT随着时间的推移显著增加了进度监控，并显著降低了使用障碍。此外，我们自筹资金继续开展OPT第二年(“I-A阶段”)的工作，以完成商业就绪、符合HIPAA标准的产品，将于2014年7月推出。我们达到并超过了最初的目标。在第二阶段，我们打算使用敏捷的开发过程来完成PracticeGround的开发，以确保可用性和优化工作流程。我们将在其中填充针对抑郁症、失眠、躁郁症、创伤后应激障碍和自杀风险干预和管理的EST，使用HL7将PracticeGround松散地集成到PracticeFusion和NetSmart中，并在第三阶段开发将PracticeGround紧密集成到EPIC、PracticeFusion和NetSmart中的系统架构设计。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、跨客户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)和照常护理(n=40)在抑郁症门诊客户中的作用。主要结果包括：抑郁、心理困扰、治疗满意度(客户和临床医生)和治疗退出。二级临床医生的结果包括：在临床医生的工作量中与客户进行全面使用的程度。

 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.