Recovery Bridge: A Peer Facilitated Intervention to help bridge the transition from psychiatric inpatient hospitalization to living in the community

背景：精神科住院出院后的时间是一个高风险时期， 与一系列负面结果有关，包括高再住院率和自杀率(1)。 因为带有桥接成分的过渡性放电干预的证据是混合的，而且仅限于 就同行专家(PS)如何帮助支持此类干预措施而言，还需要进一步的研究。我们的 提案要求开发和初步评估PS支持的技术 基于现有且经常使用的我的恢复计划计划的干预。然而，到目前为止，没有 研究已经检验了使用这一工具来改善出院后的结果。鉴于……的重要性 退伍军人管理局的问题是，退伍军人管理局拥有双方都重视的大型PS基础架构 专业提供者和退伍军人，我们的工作提供了合理的理由和独特的机会来测试 建议对单一的住院和门诊综合服务系统进行干预。 意义：这一项目的意义在于它能够积极解决 研究，即PS干预，侧重于减少重新入院和支持面向康复的 退伍军人的结果。进一步涉及重要的高铁和研发优先事项，该项目旨在推进 在获得护理、心理健康和预防自杀方面的科学知识和临床实践。 创新和影响：拟议研究的一个关键创新是有效地优化现有 针对与退出急性住院设置相关的广泛挑战的资源，以及 有效地将退伍军人连接到优选服务(在这种情况下为对等支持)以防止再次入院， 提高退伍军人精神卫生门诊服务利用率。最后，在与影响、恢复的关系方面 Bridge具有潜在的改善多个临床和功能结果的潜力，这些结果 适用于广泛的退伍军人群体(而不是仅适用于小范围的特定诊断 亚群)。 具体目标1：将我的恢复计划工具与现有的PS工具和战略相结合，以制定 被称为恢复桥的手动干预，由退伍军人PS使用，帮助退伍军人完成过渡 从急性住院精神病住院到社区生活。 具体目标2：完成一项公开的试点试验(n=15)，以检查 恢复桥干预与明确的基准有关，支持继续和扩大 调查。 [具体目标3：作为开放试点试验的一部分：1)探讨干预措施对再住院率的影响 (在30天和90天)，与对照组(n=15)相比，与门诊护理的联系 管理数据，以及；2)探索恢复和生活质量指标随时间的变化 干预参与者]。 方法：将使用建议书中描述的源文档来创建恢复桥 干预措施(如目标1所述)。我们将使用定量、定性和管理服务数据 完成干预措施的公开试验(如目标2和目标3所述)。 下一步：可行性、保真度和可接受性领域的基准；以及探索性 AIM 3中规定的结果将用于指导下一步行动，包括随后进行的更大规模的有效性试验 可能进行混合一期成效/实施试验，为今后传播和实施 在退伍军人事务部进行更广泛的干预。

Background: The time following discharge from psychiatric hospitalization is a high-risk period and has been associated with a range of negative outcomes, including high rates of hospital readmission and suicide (1). Because the evidence for transitional discharge interventions with bridging components is mixed and limited in terms of how Peer Specialists (PS) can help support such interventions, additional research is needed. Our proposal calls for the development and preliminary evaluation of a PS facilitated technology-supported intervention based on the existing and frequently used My Recovery Plan program. However, to date, no studies have examined use of this tool to improve post-hospital discharge outcomes. Given the importance of the problem for the VA, and the fact that the VA has both a large PS infrastructure that is valued by both professional providers and Veterans, our work offers sound justification and the unique opportunity to test the proposed intervention in a single integrated system of inpatient and outpatient services. Significance: The significance of this project lies in its ability to actively address an important gap in the research, namely PS interventions focused on reducing readmission and supporting recovery-oriented outcomes in Veterans. Further relating to important HSR&D priorities the project is designed to advance scientific knowledge and clinical practice in the areas of access to care, mental health, and suicide prevention. Innovation and Impact: A key innovation of the proposed research is the potential to efficiently optimize existing resources to target the widespread challenges associated with transitioning out of acute inpatient settings and effectively connect Veterans to preferred services (in this case peer support) in order to prevent re-admission, and improve utilization of VA outpatient mental health services. Finally, in relationship to impact, Recovery Bridge has potential to result in improvement across multiple clinical and functional outcomes that are applicable to a broad Veteran population (rather than only in small select diagnostically specific subpopulations). Specific Aim 1: Integrate the My Recovery Plan tool and existing PS tools and strategies to develop a manualized intervention called Recovery Bridge for use by VA PS working to help Veterans make the transition from acute inpatient psychiatric hospitalization to community living. Specific Aim 2: Complete an open pilot trial (n=15) to examine the feasibility, fidelity, and acceptability of the Recovery Bridge intervention in relation to well specified benchmarks supporting continued and expanded investigation. [Specific Aim 3: As part of the open pilot trial: 1) explore the impact of the intervention on readmission rates (at 30 and 90 days), and connection to outpatient care compared to a control group (n=15) identified from administrative data, and; 2) explore the change in recovery and Quality of Life measures over time in the intervention participants]. Methodology: Source documents described in the proposal will be used to create the Recovery Bridge intervention (as Specified in Aim 1). Quantitative, qualitative, and administrative services data we will be used to complete an open trial of the intervention (as specified in Aim 2 and Aim 3). Next Steps: Benchmarks across the domains of feasibility, fidelity, and acceptability; as well as exploratory outcomes specified in Aim 3, will be used to inform next steps including a larger effectiveness trial followed by a possible hybrid-I effectiveness/implementation trial to inform future dissemination and implementation of the intervention more broadly across the VA.