Center to Accelerate Translation of Interventions to Decrease Premature Mortality in SMI

严重精神疾病(SMI)患者是美国最易受伤害的群体之一， 死亡早10到20年，死亡率比总人口高两到三倍。 这种过早死亡很大程度上可归因于心血管疾病(CVD)，并且可能是可以预防的；所有 心血管疾病危险行为(不健康饮食、缺乏体育锻炼、吸烟)和危险因素(肥胖、 高血压、糖尿病和血脂异常)在SMI患者中显著升高。随之而来的是，人们 患有SMI的患者通常接受的护理质量较差。虽然这些健康和死亡率差距是 被广泛认为是一种公共卫生危机，个人、提供者、组织和政策层面的障碍 进步。虽然许多患有SMI的人从公共精神卫生部门得到了大部分护理， 降低心血管风险的干预措施在临床试验中显示对患有SMI的人有效(例如，对于体重减轻， 戒烟)在社区心理健康环境中尚未被广泛采用。有意义地 促进自闭症患者的健康和减少死亡率差距需要迫切的发展和 测试扩大实际、有效干预措施的执行战略。 为了应对失去多年的生命这一非同寻常的负担，我们的目标是创建中心，以加速 翻译干预措施以降低SMI中的过早死亡率，这将使用尖端跨学科 为减少这一高度脆弱人群的心血管疾病风险而取得的短期和长期进展的方法。这个 中心独一无二的合格团队将进行3项R34研究，以开发和试点创新实施 社区精神卫生中重度精神障碍患者心脑血管疾病危险行为及危险因素应对策略 设置。R34将专注于以证据为基础的方法：1)通过节食和 体力活动；2)戒烟治疗；3)糖尿病、高血压和 血脂异常。核心方法将使用结合临床和行为学的跨学科方法 干预研究、实施科学、人因工程、系统科学和健康 从服务研究到支持中心研究。方法核心还将在1)中推进研究方法 人因工程，以支持执行；2)虚拟化身辅助培训和评估 激励性访谈；3)支持干预扩大的量化方法；4)系统科学。 行政核心将使利益攸关方参与进来，建立在马里兰州和 在全国范围内，并将中心的所有活动结合起来。预期寿命和心血管疾病之间的巨大差异 SMI患者的风险因素负担要求采取集中的、跨学科的方法来解决。这 中心将围绕T2翻译创造创新和动力的纽带，以降低 SMI。我们的愿景是健康公平--患有SMI的人，与没有SMI的人一样，健康长寿。

Persons with serious mental illness (SMI) comprise one of the most highly vulnerable groups in the US, dying 10 to 20 years earlier and with mortality rates two to over three times higher than the overall population. Much of this premature death is attributable to cardiovascular disease (CVD) and is potentially preventable; all CVD risk behaviors (unhealthy diet, physical inactivity, tobacco smoking) and risk factors (obesity, hypertension, diabetes and dyslipidemia) are markedly elevated in persons with SMI. Concomitantly, persons with SMI often receive poor quality of care for these conditions. While these health and mortality gaps are widely recognized as a public health crisis, individual, provider, organizational, and policy level barriers impede progress. While many persons with SMI receive most of their care from the public mental health sector, tailored interventions to decrease CVD risk shown effective in clinical trials for those with SMI (e.g., for weight loss, smoking cessation) have not been widely adopted in community mental health settings. Meaningfully advancing health and decreasing mortality disparities for persons with SMI requires urgent development and testing of implementation strategies for scale-up of practical, effective interventions. In response to this extraordinary burden of years of life lost, our goal is to create the Center to Accelerate Translation of Interventions to Decrease Premature Mortality in SMI that will use cutting-edge transdisciplinary methods towards short and long-term progress to reduce CVD risk in this highly vulnerable population. The Center’s uniquely qualified team will conduct 3 R34 studies to develop and pilot test innovative implementation strategies to address all CVD risk behaviors and risk factors in persons with SMI in community mental health settings. The R34s will focus on evidence-based approaches for: 1) behavioral weight loss with diet and physical activity; 2) tobacco smoking cessation treatment; 3) care delivery for diabetes, hypertension and dyslipidemia. The Methods Core will use a transdisciplinary approach incorporating clinical and behavioral intervention research, implementation science, human factors engineering, systems science, and health services research to support Center research. The Methods Core will also advance research methods in 1) human factors engineering to support implementation; 2) avatar-assisted training and assessment in motivational interviewing; 3) quantitative methods to support intervention scale-up; 4) and systems science. The Administrative Core will engage stakeholders, building on well-established partnerships in Maryland and nationally, and bring together all of the Center’s activities. The gaping differential in life expectancy and CVD risk factor burden in persons with SMI calls for concentrated, transdisciplinary approaches to solutions. This Center will create a nexus of innovation and momentum around T2 translation to reduce premature mortality in SMI. Our vision is health equity – that persons with SMI, similar to persons without SMI, live long healthy lives.