A Hybrid Effectiveness-Implementation Trial of a Wellness Self-Management Program

描述(由申请人提供)： 背景：患有精神分裂症和其他严重精神疾病(SMI)的退伍军人合并慢性疾病的风险增加，导致残疾风险增加，医疗保健支出增加，生活质量下降和早期死亡。身体健康越来越被认为是退伍军人管理局致力于发展以康复为导向和以退伍军人为中心的心理健康治疗的关键组成部分。人们也越来越认识到促进和改善患者对慢性疾病的自我管理的干预措施的价值。在消费者促进医疗疾病自我管理方案在普通人群中使用的既定疗效的基础上，以及最近在公共卫生部门用于SMI成人的两项改编(包括我们自己对名为 生活良好)，我们建议完成一项生活良好干预的随机对照有效性试验，同时进行一项明确的流程评估，以优化有关重要因素的知识积累，这些重要因素可能会改善退伍军人管理局护理系统中生活良好干预的未来采用、实施和可持续性。目标：主要目标1：完成一项生活质量干预的随机对照有效性试验，对象为250名患有SMI和至少一种慢性疾病的退伍军人，并评估干预对功能和服务相关结果的影响。我们假设，与那些被随机分配到医疗疾病教育和支持组的人相比，那些被随机分配到生活状况良好干预组的患者将显示出包括身体和情感功能在内的一般健康功能的改善，以及医疗急诊室就诊率的降低。我们还将评估干预对更近端的态度和行为结果的影响，并评估这些因素如何调节功能和服务相关结果的改善。主要目的2：在RE-AIM评估框架的基础上完成明确的过程评估，以更好地了解可以改善覆盖范围、有效性、采用、实施和维护的背景因素，这些因素共同决定了生活质量干预对公众健康的潜在影响。方法：将混合使用时间上重叠的定量和定性方法，以最大限度地整合和合成这两个目标上的数据流，以优化知识积累。影响：尽管越来越多的人认识到自我管理战略在改善慢性医疗疾病护理的质量和结果方面具有巨大的前景，而且自我管理作为以精神健康康复为导向的治疗重点日益突出，但目前尚无基于证据的同行促进的医疗疾病自我管理干预措施可供在退伍军人管理局精神健康系统内传播。我们拟议的研究旨在产生证据，支持同行共同促进的干预措施的有效性，并通过收集有关可能改善未来传播和实施工作的因素的重要背景信息，帮助加快对公共卫生影响的吞吐量。

DESCRIPTION (provided by applicant): Background: Veterans with schizophrenia and other serious mental illnesses (SMI) are at elevated risk for co-occurring chronic medical conditions resulting in increased risk of disability high health care spending, reduced quality of life and early mortality. Physical wellness is increasingly recognized as a key component of the VA's commitment to developing recovery-oriented and veteran-centered mental health treatment. There is also growing recognition of the value of interventions that promote and improve patient self-management of chronic medical conditions. Building on the established efficacy of consumer facilitated medical illness self- management programming used in the general population and two recent adaptations for use with SMI adults in the public health sector (including our own evaluation of an intervention called Living Well), we propose to complete a randomized controlled effectiveness trial of our Living Well intervention and simultaneously conduct a well specified process evaluation to optimize knowledge accrual regarding important factors that may improve future adoption, implementation and sustainability of the Living Well intervention in the VA system of care. Aims: Primary AIM 1: Complete a randomized controlled effectiveness trial of our Living Well intervention with 250 veterans with SMI and at least one co-occurring chronic medical condition and evaluate the intervention's effects on functional and service related outcomes. We hypothesize that those randomized to the Living Well intervention will, in comparison to those randomized to a medical illness education and support group, demonstrate improved general health functioning including physical and emotional functioning as well as reduced rates of medical emergency room visits. We will also evaluate intervention effects on more proximal attitudinal and behavioral outcomes and assess how these factors mediate improvement in the functional and services related outcomes. Primary AIM 2: Complete a well specified process evaluation based on the RE-AIM evaluation framework to better understand contextual factors that can improve the Reach, Effectiveness, Adoption, Implementation and Maintenance which together determine the potential public health impact of the Living Well intervention. Methods: A mix of temporally overlapping quantitative and qualitative methods will be used to maximize integration and synthesis of data streams across the two aims to optimize knowledge accrual. Impact: Despite the growing recognition that self-management strategies hold enormous promise for improving quality and outcomes of care for chronic medical illnesses, and the fact that self-management is gaining prominence as a mental health recovery oriented treatment focus, there are currently no evidence-based peer facilitated medical illness self-management interventions available for dissemination within the VA mental health system. Our proposed study is designed to both generate evidence supporting the effectiveness of a peer co-facilitated intervention and to help speed throughput to public health impact by collecting important contextual information about factors that may improve future dissemination and implementation efforts.