Participatory design of mHealth strategies to support collaborative care in perin

描述（由申请人提供）：迫切需要将围产期抑郁症护理的范围扩大到来自种族/少数民族人口的低收入妇女。记录了接受医疗补助的妇女和那些有私人保险的妇女之间在抑郁症护理方面的巨大差异。减少这些差异的战略必须解决患者方面的经济、社会和文化障碍，以及为这些患者服务的安全网系统资源有限的问题。以患者为中心的结局研究（PCOR）方法尚未应用于如何减少这些差异的问题。变革和组织振兴方案的K18职业提升奖提议，通过一个辅导方案、正式课程和一个相关研究项目，培养变革和组织振兴方案方法的技能，目标是向患有围产期抑郁症的低收入妇女提供循证护理。在研究部分，将采用参与式设计和快速原型方法来开发和试点移动健康干预措施，以支持持续实施基于证据的协作护理方法，在非专业精神卫生环境中提供抑郁症服务。该项目将处理为在移动保健系统测试版开发完成后进行务实的比较有效性试验所需的准备工作。虽然现在有40多项高质量的研究表明，协作护理模式可以提高一般医疗环境中抑郁症治疗的质量和结果，但这种方法尚未得到广泛实施或持续。协作护理模式的核心是护理经理，他监测患者的依从性、对治疗的反应和副作用，同时向抑郁症护理团队的其他成员提供关于患者状态的有效临床反馈。护理管理所需的资源很高;然而，特别是对于资源相对不足的低收入妇女护理点，这种高资源成本降低了协作护理的持续实施。移动健康方法利用了患者广泛使用移动的电话，有望成为协助甚至加强护理管理人员工作的有效战略。这些系统可以潜在地执行护理管理者的监测、依从性评估/支持和临床反馈功能的实质部分。为了提高最终用户对拟议系统的接受程度，将以参与的方式与来自三个不同的产前诊所的患者和护理团队成员一起开发该系统，这些诊所为低收入妇女提供服务，并设有既定的护理管理人员。

DESCRIPTION (provided by applicant): There is a pressing need to expand the reach of perinatal depression care to low income women from race/ethnic minority populations. Large disparities in depression care delivery between women receiving Medicaid and those with private insurance are documented. Strategies to reduce these disparities must address economic, social, and cultural barriers on the patient side as well as limited resources in the safety net system serving these patients. Patient Centered Outcomes Research (PCOR) methods have not been applied to the problem of how to reduce these disparities. This K18 career enhancement award in PCOR proposes, through a program of mentoring, formal coursework, and a linked research project, to build skills in PCOR methods targeting the delivery of evidence based care to low income women with perinatal depression. In the research component a participatory design and rapid prototyping approach will be employed to develop and pilot a mHealth intervention to support sustained implementation of the evidence based collaborative care approach to depression services in non specialty mental health settings. This project will address work needed to prepare for a pragmatic comparative effectiveness trial to be carried out after the development of a beta version of the mHealth system. While over 40 high quality studies now show collaborative care models improve the quality of depression treatment and outcomes in general medical settings, this approach has not been widely implemented or sustained. Central to the collaborative care model is a care manager who monitors patient adherence, response to treatments, and side effects, while providing effective clinical feedback to other members of the depression care team regarding the status of the patient. The resources required for care management are high; however, particularly for relatively under-resourced sites caring for low income women~ this high resource cost reduces the sustained implementation of collaborative care. mHealth approaches, which capitalize on the widespread patient use of mobile phones, hold promise as effective strategies to assist and even enhance the work of care managers. These systems can potentially carry out substantial portions of the monitoring, adherence assessment/support, and clinical feedback functions of care managers. To improve the end user acceptability of the proposed system it will be developed in a participatory manner with patients and care team members from three diverse prenatal clinics serving low income women with established care managers.