Implementing Chronic Care Management for Bipolar Disorder

描述（由申请人提供）：很少有基于证据的精神障碍治疗模式被转化为社区实践。造成这种从研究到实践差距的主要原因是缺乏工具和激励措施来维持治疗的保真度（例如，培训），同时最大限度地提高不同情况下的普遍性。本随机对照试验的目的是确定实施行为健康治疗模式的系统框架是否能改善社区心理健康实践中的干预保真度和患者结果。我们将测试复制有效方案（REP）实施框架的组成部分，其中包括：1)将有效的治疗模式转化为文化上合适的非技术组件（“包装”），2)对提供者进行实施一揽子计划的正式培训，以及3)通过技术援助（TA）支持一揽子计划的转移。以双相情感障碍护理模式（BCM）作为有效干预的一个例子，我们将对BCM进行打包，然后从三个大型行为健康组织中随机抽取60个基于社区的实践，让他们接受BCM包以及培训和TA，或者只接受BCM包。所有的实践都将收到BCM包，其中包括：1)自我管理教育脚本，2)护理管理协议，和3)简化的实践指南。在培训/技术支持方面，各地点选定的工作人员将通过一名专家接受有关BCM和结构化技术支持的标准化培训，该专家将定期与现场代表联系，以解决当地实施BCM的障碍。主要（12个月）结局包括患者对BCM核心要素的忠实度、临床状态（如症状、功能、生活质量）和REP/BCM的成本效益。将有效的治疗模式从研究转化为实践是NIH路线图所阐述的公共卫生优先事项。目前还没有应用于卫生保健环境的实施框架成功地证明改善了患者的治疗效果。虽然训练和TA是为了最大化模型保真度而设计的，但它们对程序来说可能是昂贵的。然而，培训和助教可以通过就减少实施障碍进行磋商，提高当地实践的忠诚度和参与度。确定培训和辅助医疗在提高保真度和患者预后方面的边际效益，对于向医疗保健利益相关者提出REP的商业案例至关重要，最终有助于将循证治疗模式转化为基于社区的实践。

DESCRIPTION (provided by applicant): Few evidence-based treatment models for mental disorders have been translated into community-based practices. A primary reason for this research-to-practice gap is the lack of tools and incentives to maintain treatment fidelity (e.g., training) while maximizing generalizability across different settings. The goal of this randomized controlled trial is to determine whether a systematic framework for implementing behavioral health treatment models leads to improved intervention fidelity and patient outcomes in community-based mental health practices. We will test components of the Replicating Effective Programs (REP) implementation framework, which includes: 1) translation of effective treatment models into culturally appropriate, non- technical components ("packaging"), 2) formal training of providers in implementing the package, and 3) supporting the transfer of the package through technical assistance (TA). Using the bipolar disorder care model (BCM) as an example of an effective intervention, we will package the BCM, and then randomize 60 community-based practices from three large behavioral health organizations to receive the BCM package along with training and TA, or the BCM package only. All practices will receive the BCM package, which includes: 1) self-management education scripts, 2) care management protocols, and 3) simplified practice guidelines. In the training/TA arm, selected staff at sites will receive standardized training in the BCM and structured TA via a specialist who will contact site representatives on a regular basis to problem-solve local barriers to BCM implementation. Primary (12-month) outcomes include patient-level fidelity to BCM core elements, clinical status (e.g., symptoms, functioning, quality of life), and REP/BCM cost-effectiveness. Translating effective treatment models from research to practice is a public health priority articulated by the NIH Roadmap. There have been no implementation frameworks applied to health care settings that have successfully demonstrated improved patient outcomes. While training and TA are designed to maximize model fidelity, they can be costly for programs. Yet training and TA may enhance fidelity and buy-in from local practices through consultations on reducing implementation barriers. Determining the marginal benefit of training and TA on improved fidelity and patient outcomes is crucial for making the business case for REP to health care stakeholders, ultimately facilitating translation of evidence-based treatment models to community- based practices.