COMMUNITY PARTNERS IN CARE

描述(由申请人提供)：由于抑郁症的高患病率以及穷人获得高质量护理的机会较少，服务不足的有色人种社区面临着过度的抑郁症疾病负担。虽然存在针对抑郁症的循证质量改善计划，但这些计划在服务不足的社区没有得到充分利用，也没有在支持安全网客户的多个机构中使用。这是一项针对社区护理伙伴(CPIC)的修订提案，该研究旨在检查社区参与、网络建设干预相对于低强度传播控制条件在多机构背景下对抑郁症实施循证质量改善干预(PIC/WE护理)的有效性。有效性从a)客户获得护理、健康结果和护理质量；b)实施过程和成本；c)提供者和管理者采用PIC/WE护理方案以及关于抑郁症护理和质量改进工具包的知识和态度方面进行审查。我们建议在洛杉矶南部和好莱坞两个社区进行组级随机对照试验(RCT)。随机化的单位是参与机构的地点或独立团队。机构将包括社会服务、初级保健和精神健康专业组织。这项研究是在客户、临床医生和组织层面上进行的纵向研究。将招募机构和提供者，并将他们的地点随机分配到干预或控制条件下。社区会议引导所有地点进行研究，提供控制条件，并在社区参与模式下启动对试验地点的规划。受试者将从干预和对照地点招募，参加为期一年的结果研究。试验结束后，对照站点接受使用PIC/WE CARE工具包的延迟培训。我们建议在组织有干预措施的情况下，在四年内评估这些计划的实施情况(要么是最初的对照条件；要么是在等待控制的延迟培训名单中)。我们建议使用混合方法来研究在干预和控制条件下，在服务不足的社区实施循证干预的过程。项目调查人员和社区领导人代表了不同的临床和社会科学学科。总体而言，该项目是在社区参与的伙伴方式下进行的。

DESCRIPTION (provided by applicant): Underserved communities of color face an excess burden of illness from depression, due to the high prevalence of depression coupled with lower access to quality care among the poor. While evidence-based quality improvement programs for depression exist, these programs are under-utilized in underserved communities and have not been used across multiple agencies supporting safety-net clients. This is a revised proposal for Community Partners in Care (CPIC), a study designed to examine the effectiveness of a community-engagement, network-building intervention to implement evidence-based quality improvement interventions (PIC/WE Care) for depression within a multi-agency context, relative to a low-intensity dissemination control condition. Effectiveness is examined in terms of a) client access to care, health outcomes and quality of care; b) implementation process and costs; c) provider and administrator adoption of PIC/WE Care protocols and knowledge and attitudes concerning depression care and quality improvement toolkits. We propose a group level randomized control trial (RCT) in two Los Angeles Communities, South Los Angeles and Hollywood. The unit of randomization is the site or independent team of a participating agency. Agencies will include social service, primary care, and mental health specialty organizations. The study is longitudinal at the client, clinician, and organizational levels. Agencies and providers will be recruited and their sites randomized to the intervention or control condition. A community conference orients all sites to the study, provides the control condition and initiates planning under a community engagement model for the experimental sites. Clients will be recruited from intervention and control sites into a one-year outcomes study. Following the trial, the control sites receive delayed training in use of PIC/WE Care toolkits. We propose to evaluate uptake of these programs across four years as organizations have the intervention (either initially versus control condition; or in the wait-list delayed training for controls). We propose to use mixed methods to study the process of implementation of evidence-based interventions in underserved communities, under both the intervention and control conditions. The project investigators and community leaders represent diverse clinical and social science disciplines. The project is conducted, overall, under a community participatory partnered approach.