Implementing Technology-Assisted Drug Treatment and relapse prevention in FQHCs

描述(申请人提供)：本提案由威斯康星大学、达特茅斯学院、Forward Health Group、Arapahoe Sud Treatment、Access、Salud and Partnership社区卫生中心和国家委员会合作完成 社区行为健康，由多位PI领导，David H.Gustafson博士和Lisa Marsch博士。初级保健提供者被要求将物质使用障碍(SUD)治疗和艾滋病毒护理纳入他们的实践。这意味着在已经不堪重负的系统中增加一个新的、复杂的案件数量。我们建议测试一项实施基于无线智能手机的交付系统的战略，该系统由经过验证的治疗和康复计算机程序组成，这些程序将增加SUD服务和艾滋病毒护理，但减轻负担。二 信息和通信系统已证明有能力提高对艾滋病的治疗和艾滋病毒护理(TES)和持续护理(ACHESS)的有效性。虽然它们的潜力很大，但成功不仅取决于技术，还取决于创造一个友好的环境以及有效的实施和维持进程。我们建议克服将药物滥用治疗和艾滋病毒护理整合到初级保健中的关键障碍，方法是混合使用三种经过验证的战略(通过质量改进)，以实施基于证据的计算机辅助系统的无缝组合，称为Seva(梵语中无私关怀的意思)。Seva包括：TES成瘾治疗、ACHESS复发预防、视频咨询以及注册人口管理器。Seva将艾滋病毒风险行为、状态和服务集成到患者界面和提供者注册组件中。Seva的每一个组成部分都被证明是有效的，但每个 拥有自己的接口并独立运行，这使得很难轻松地利用它们的协同潜力。我们假设，我们的执行战略将创造有利的环境，并通过消除障碍和建立促进者来加强执行的成功和可持续性，从而使塞瓦得以蓬勃发展。我们将使用定量和定性的方法来确定我们实施了多少 Seva将改进：覆盖范围、有效性、采用、实施和维护。我们将在3个FQHC中实施Seva。将使用一个FQHC(麦迪逊接入社区卫生中心)来测试和改进实施战略，并调整Seva以满足FQHC的需求并确保易用性。另外两个FQHC将采用阶梯式楔形(多基线)设计，每隔六个月接受Seva治疗。将为每个FQHC指派一名教练(这在质量改进中很常见)，以帮助实施、操作和支持Seva。我们将在三年内衡量对FQHC的影响。

DESCRIPTION (provided by applicant): This proposal is a collaboration of the University of Wisconsin, Dartmouth College, Forward Health Group, Arapahoe SUD treatment, Access, Salud and Partnership community health centers, and The National Council for Community Behavioral Health and led by multiple PIs David H. Gustafson PhD and Lisa Marsch PhD. Primary care providers are being asked to integrate substance use disorder (SUD) treatment and HIV care into their practices. That means adding a new, complex caseload to an already overburdened system. We propose to test a strategy to implement a wireless smart phone based delivery system, composed of proven treatment and recovery computer programs that will add SUD services and HIV care but relieve the burden. Two information and communication systems have demonstrated ability to improve the effectiveness of SUD treatment and HIV care (TES) and continuing care (ACHESS). While their potential is great, success relies not only on technology, but on a creating a welcoming environment and effective processes to implement and sustain. We propose to overcome key barriers to integrating substance abuse treatment and HIV care into primary care by using a blending of three proven strategies (informed by quality improvement) to implement a seamless combination of evidence-based computer assisted system called Seva (the Sanskrit word for selfless caring). Seva includes: TES addiction treatment, ACHESS relapse prevention, video counseling as well as registry PopulationManager. Seva integrates HIV risk behaviors, status, and services into both the patient interface and provider registry components. Each component of Seva has proven to be effective, but each has its own interface and operates independently making it difficult to easily take advantage of their synergistic potential. We hypothesize that our implementation strategy will create welcoming environment, and enhance implementation success and sustainability by removing barriers and building on facilitators, thus allowing Seva to flourish. We will use quantitative and qualitative methods to determine how much our implementation of SEVA will improve: Reach, Effectiveness, Adoption, Implementation and Maintenance. We will implement Seva in 3 FQHCs. One FQHC (ACCESS community health center in Madison) will be used to test and refine the implementation strategy and adapt SEVA to meet FQHC needs and ensure ease of use. Two other FQHCs will receive SEVA at six-month intervals in a stepped wedge (multiple baseline) design. A coach will be assigned to each FQHC (as is common in quality improvement) to help implement, operate and sustain SEVA. We will measure impact on the FQHC over a three year period.