Participatory System Dynamics for Evidence-based Addiction and Mental Healthcare

项目摘要/摘要 我们最重要的长期目标是确定有效的严谨、可扩展的实施创新 用于改善医疗保健系统中循证实践(EBP)的实施。创伤后应激障碍、抑郁症 物质使用障碍非常普遍，使人虚弱，是退伍军人寻求护理的主要原因 在退伍军人健康管理局(VA)。尽管在提高EBP对这些疾病的采用率方面进行了投资 在不同的提供者中，EBPS在收到邮件的时间上有很大的差异，在门诊患者中的覆盖范围有限 人口。如果不改善及时获得高质量服务的机会，患有未得到满足的心理健康和 成瘾需求存在慢性损伤和死亡的风险。EBPS需要协调多个预约 在多学科服务交付团队内以及跨通才和专业计划。重新设计 相互依赖的流程，如日程安排实践、转诊程序、患者流程和人员配备 分配必须是当地量身定做的，需要相当大的利益相关者参与和支持。作为一名运动员晋级 在实地，实施科学必须超越对系统障碍和促进者的描述，以解决这一问题 系统复杂性。参与式系统动力学建模通过对利益相关者进行三角划分来满足这一需求 视角、管理数据和模型模拟，赋予关于 EBP实施在当地环境中有效或无效的机制。我们的短期目标 是评估参与式系统动力学建模是否有助于改善EBP的时机和覆盖范围 由于资源和复杂性(高与低)的差异而选择的VA门诊系统。弗吉尼亚州 专家、当地领导和提供者，以及有精神健康和成瘾患者经验的退伍军人 参与建模过程，以解决多维EBP交付动态。模型测试利益相关者 关于改进战略的假设，并正式规定实施备选方案的系统能力 考虑到本地限制。模型模拟评估新EBP政策或程序的系统影响 在实施之前，与试错法相比，节省了时间和资源。行政性 数据在模型中合成，并使开发特定站点的利益相关者可以执行新的操作 重组计划。有效性测试的目标是：1)增加EBPS在患者群体中的覆盖面，以及 2)与12个月前相比，在12个月的随访期内缩短了从服药到EBP的时间 建模/重新设计。参与式系统动力学建模为实现科学家带来希望 寻求创新方法，围绕更准确地理解EBP交付来吸引利益相关者 改进执行成果的动态和背景。如果被证明是有效的，参与式制度 动力学建模可用于解决以下战略的关键需求：改进EBP实施 卫生服务系统，从而有助于实现国家优先事项，以确保及时、高质量的卫生保健。

PROJECT SUMMARY / ABSTRACT Our overarching, long-range goal is to identify rigorous, scaleable implementation innovations that are effective for improving the implementation of evidence-based practices (EBP) in healthcare systems. PTSD, depression and substance use disorders are highly prevalent and debilitating, and are primary reasons Veterans seek care in the Veterans Health Administration (VA). Despite investment in increasing EBP adoption for these disorders among providers, EBPs have wide variability in time-to-receipt and limited reach among the outpatient population. Without improving timely access to high-quality services, Veterans with unmet mental health and addiction needs are at risk for chronic impairment and death. EBPs require multiple appointments coordinated within multidisciplinary service delivery teams and across generalist and specialty programs. Redesigning interdependent processes, such as scheduling practices, referral procedures, patient flows, and staffing allocations must be locally tailored and require considerable stakeholder buy in and support. To advance as a field, implementation science must move beyond descriptions of system barriers and facilitators to address this system complexity. Participatory system dynamics modeling meets this need by triangulating stakeholder perspectives, administrative data and model simulations, conferring rigor and specificity regarding the mechanisms by which EBP implementation is effective or ineffective in local settings. Our short-term objective is to evaluate whether participatory system dynamics modeling helps to improve EBP timing and reach in two VA outpatient systems that were selected due to differences in resources and complexity (high vs. low). VA experts, local leaders and providers, and Veterans with experience as mental health and addiction patients engage in a modeling process to address multidimensional EBP delivery dynamics. Models test stakeholder hypotheses about improvement strategies and formally specify system capacity for implementation alternatives accounting for local constraints. Model simulations evaluate system impacts of new EBP policies or procedures prior to implementation, saving time and resources as compared to trial-and-error approaches. Administrative data is synthesized in models and made newly actionable to stakeholders who develop site-specific restructuring plans. Effectiveness aims test for: 1) increased reach of EBPs among the patient population, and 2) reduced time from intake to EBP, over a 12-month follow-up period, as compared to twelve months before modeling/redesign. Participatory system dynamics modeling holds promise for implementation scientists seeking innovative methods for engaging stakeholders around more precise understandings of EBP delivery dynamics and context to improve implementation outcomes. If shown to be effective, participatory system dynamics modeling can be used to address the critical need for strategies that improve EBP implementation in health service systems, and thereby, help to meet national priorities to ensure timely, high-quality health care.