Strengthening Research on Complex Health Interventions: State-of-the-Art Conference

项目摘要/摘要 复杂的卫生干预措施，包括临床、保健服务提供和公共卫生干预措施 随着解决多个干预目标的多个自适应组件在 美国的医疗体系。CHI代表着解决复杂健康问题的有希望的解决方案，需要 同时协调努力，针对患者、临床医生、卫生系统、社区、 和/或区域、州和国家各级。CHIS给研究和开发带来了独特的挑战和障碍 然而，评估：流行的与健康相关的研究方法被优化为简单、固定、 以高度标准化提供的同类干预措施(例如，药物干预措施) 和保真度，但缺乏处理复杂、多组件、异质和适应性强的能力 干预措施。此外，简单干预研究的主要目标--e平均效果大小 对“干预有效吗？”等问题的估计和回答。或者“干预是否优于 干预B？“--对CHI没有用处，对于CHI，普遍的答案是”视情况而定“。决断 制定者需要指导以支持CHI的多个决策，包括：(A)选择匹配的干预措施 根据其环境的特点，(B)适应当地情况，(C)管理当地情况 通过改善干预-背景一致性来提高干预有效性。 能够指导所需的复杂、多项决策和管理行动的研究方法 因为CHI与那些为估计平均干预效果大小而优化的CHI非常不同。池鱼 需要独特的研究设计、干预交付和适应活动、数据收集和分析 方法等研究特点。本申请书中提出的专家会议将召集关键政策， 实践和研究领导(1)审查研究评估的目标和预期结果 可用于这类研究的方法、标准和指南；(2)评估中国的现行研究做法 以及现行做法与推荐做法之间的关系；(3)确定障碍和促进者 改进研究实践，以及(4)为政策、实践和 研究利益相关者活动，以加强对信息和通信技术的研究。拟议的会议将包括 会前准备，为期三天的有组织的会议，包括小组会议和密集的小组会议 工作会议和会后工作，以落实各项建议并促进其 实施。该倡议将促进提高对复杂结构的研究的质量和价值 加强这项研究贡献的干预措施：(A)改进证据、洞察力和 了解CHIS的操作和效果，并(B)改善临床医生和医疗保健 领导者正确选择、实施和管理CHIS的成功。

PROJECT SUMMARY/ABSTRACT Complex health interventions (CHIs), including clinical, health service delivery and public health interventions with multiple adaptable components addressing multiple intervention targets are increasingly prevalent within the U.S. health system. CHIs represent promising solutions to complex health problems requiring simultaneous, coordinated efforts targeting root causes at the patient, clinician, health system, community, and/or regional, state and national levels. CHIs pose unique challenges and barriers to research and evaluation, however: prevailing health-related research approaches are optimized for simple, fixed, homogeneous interventions (e.g., pharmaceutical interventions) delivered with high levels of standardization and fidelity, but are poorly equipped to handle complex, multiple-component, heterogeneous and adaptable interventions. Furthermore, the primary goals of research on simple interventions – e average effect size estimates and answers to questions such as “is intervention A effective?” or “is intervention A superior to intervention B?” – are not useful for CHIs, for which the prevailing answer is generally “it depends.” Decision makers require guidance to support multiple decisions for CHIs, including (a) selecting interventions matched to features of their settings, (b) adapting CHIs to meet local circumstances, and (c) managing local conditions to enhance intervention effectiveness through improved intervention-context concordance. Research approaches capable of guiding the complex, multiple decisions and management actions required for CHIs are very different from those optimized to produce estimates of average intervention effect sizes. CHIs require distinctive study designs, intervention delivery and adaptation activities, data collection and analysis methods, and other study features. The expert meeting proposed in this application will convene key policy, practice and research leaders to (1) review the goals and desired outcomes of research evaluating CHIs and available methods standards and guidance for such studies, (2) assess prevailing research practices for CHIs and the relationship between prevailing vs. recommended practices, (3) identify barriers and facilitators to improved research practices, and (4) produce guidance and a set of recommendations for policy, practice and research stakeholder activities that will strengthen research on CHIs. The proposed conference will include pre-meeting preparation, a structured three-day meeting containing panel sessions and intensive small-group working sessions, and post-meeting work to operationalize the recommendations and facilitate their implementation. The initiative will facilitate improvement in the quality and value of research on complex interventions to enhance the contributions of this research to (a) improved evidence, insights and understanding of the operation and effects of CHIs and to (b) improvements in clinicians' and healthcare leaders' success in appropriately selecting, implementing and managing CHIs.