COMMUNITY PARTNERS IN CARE

描述（由申请人提供）：由于抑郁症的高患病率以及穷人获得高质量护理的机会较少，服务不足的有色人种社区面临着抑郁症疾病的过度负担。虽然存在以证据为基础的抑郁症质量改善项目，但这些项目在服务不足的社区中没有得到充分利用，也没有在支持安全网客户的多个机构中使用。这是社区护理合作伙伴（CPIC）的修订提案，该研究旨在检查社区参与，网络建设干预措施在多机构背景下实施循证质量改善干预措施（PIC/WE Care）的有效性，相对于低强度传播控制条件。从以下方面审查有效性：a)客户获得护理的机会、健康结果和护理质量；B)实施过程和成本；c)提供者和管理者对PIC/WE护理方案的采用以及对抑郁症护理和质量改进工具包的知识和态度。我们建议在洛杉矶南部和好莱坞两个社区进行组水平随机对照试验（RCT）。随机化的单位是参与机构的现场或独立团队。机构将包括社会服务、初级保健和心理健康专业组织。该研究在客户、临床医生和组织层面上是纵向的。将招募机构和提供者，并将其地点随机分配到干预或控制条件。社区会议为研究的所有地点定位，提供控制条件，并在社区参与模式下为实验地点启动规划。将从干预和控制地点招募客户，进行为期一年的结果研究。试验结束后，对照站点接受PIC/WE护理工具包使用方面的延迟培训。我们建议在四年的时间里评估这些项目的实施情况，因为组织有干预（无论是最初与控制条件相比，还是在等待名单中延迟的控制培训）。我们建议采用混合方法，在干预和控制两种条件下，研究在服务不足社区实施循证干预的过程。项目调查员和社区领导人代表了不同的临床和社会科学学科。总的来说，该项目是在社区参与伙伴关系的方式下进行的。

DESCRIPTION (provided by applicant): Underserved communities of color face an excess burden of illness from depression, due to the high prevalence of depression coupled with lower access to quality care among the poor. While evidence-based quality improvement programs for depression exist, these programs are under-utilized in underserved communities and have not been used across multiple agencies supporting safety-net clients. This is a revised proposal for Community Partners in Care (CPIC), a study designed to examine the effectiveness of a community-engagement, network-building intervention to implement evidence-based quality improvement interventions (PIC/WE Care) for depression within a multi-agency context, relative to a low-intensity dissemination control condition. Effectiveness is examined in terms of a) client access to care, health outcomes and quality of care; b) implementation process and costs; c) provider and administrator adoption of PIC/WE Care protocols and knowledge and attitudes concerning depression care and quality improvement toolkits. We propose a group level randomized control trial (RCT) in two Los Angeles Communities, South Los Angeles and Hollywood. The unit of randomization is the site or independent team of a participating agency. Agencies will include social service, primary care, and mental health specialty organizations. The study is longitudinal at the client, clinician, and organizational levels. Agencies and providers will be recruited and their sites randomized to the intervention or control condition. A community conference orients all sites to the study, provides the control condition and initiates planning under a community engagement model for the experimental sites. Clients will be recruited from intervention and control sites into a one-year outcomes study. Following the trial, the control sites receive delayed training in use of PIC/WE Care toolkits. We propose to evaluate uptake of these programs across four years as organizations have the intervention (either initially versus control condition; or in the wait-list delayed training for controls). We propose to use mixed methods to study the process of implementation of evidence-based interventions in underserved communities, under both the intervention and control conditions. The project investigators and community leaders represent diverse clinical and social science disciplines. The project is conducted, overall, under a community participatory partnered approach.