Implementing Health Care Interventions for Hispanics with Serious Mental Illness

描述（由申请人提供）：与大多数患有严重精神疾病的白人（SMI;例如，精神分裂症），患有精神分裂症的种族/少数民族患心血管疾病（CVD）的风险更高。虽然有希望的治疗（例如，尽管存在着改善重度精神障碍患者健康的护理管理者干预措施，但对使这些干预措施在文化上与患有重度精神障碍的西班牙裔人相关并促进其在公共精神卫生系统中的使用的过程的关注有限。该指导研究科学家发展奖（K 01）的目的是准备候选人成为实施研究的独立调查员，以解决服务不足的少数民族所面临的身体保健方面的差异。由Lewis-Fernandez博士和Druss博士领导的指导团队将指导候选人实现以下培训目标：1）获得实施研究方面的培训，重点是以社区为基础的参与性研究（CBPR）方法作为转化战略; 2）发展关于SMI患者身心健康护理一体化的专业知识; 3）获得使用干预绘图和定性方法为干预研究提供信息的新技能; 4）获得临床试验方法和纵向数据分析的培训。该应用程序集成了课程工作，导师从既定的调查，并指导研究活动。该研究计划使用协作干预规划框架，融合了CBPR和干预映射的原则，以修改和评估现有护理经理干预的可行性和可接受性。这项为期12个月的干预措施的重点是提高患者的积极性，以及门诊心理健康诊所和初级保健之间的医疗协调。拟议的项目采用多阶段办法，并得到候选人培训计划的支持。在第一阶段，将组建一个由研究人员和利益相关者组成的社区咨询委员会，以学习和审查干预措施，并进行初步修改。在第2阶段，将使用定性方法-患者焦点小组和利益相关者访谈-以确保所有利益相关者都能接受修改。在第3阶段，第2阶段的结果用于进一步修改干预措施，制定实施计划，并对两名护理经理进行修改后的干预措施培训。第四阶段包括一项为期12个月的开放性试点研究（N = 30），以评估改良干预措施的可行性和可接受性，并探讨其效果。最后，第5阶段将侧重于分析初步研究数据和编制R 01提案。该研究计划将为后续R 01提供试点数据，以进行随机对照试验，以测试改良干预措施的有效性和实施情况。 公共卫生相关性：这K 01准备候选人开发研究的独立计划，重点是在公共精神卫生系统中实施综合的身心健康服务，以改善身体健康和服务不足的少数民族与SMI的健康。该项目响应了国家精神卫生研究所战略计划的目标3和4，其中要求制定更好的干预措施，将不同精神病患者的需求纳入其中，并确保将研究结果转化为临床实践，以加强国家精神卫生研究所的公共卫生使命。

DESCRIPTION (provided by applicant): Compared to majority whites with serious mental illness (SMI; e.g., schizophrenia), racial/ethnic minorities with SMI are at higher risk for cardiovascular disease (CVD). Although promising treatments (e.g., care manager interventions) exist to improve the health of people with SMI, limited attention has been paid to the process of making these interventions culturally relevant to Hispanics with SMI and to promote their use in the public mental health system. The objective of this Mentored Research Scientist Development Award (K01) is to prepare the candidate to become an independent investigator in implementation research to address the disparities in physical health care faced by underserved minorities with SMI. A mentoring team, led by Drs. Lewis-Fernandez and Druss, will guide the candidate in achieving the following training objectives: 1) obtain training in implementation research, focusing on community-based participatory research (CBPR) approaches as a translational strategy; 2) develop expertise on the integration of physical and mental health care for people with SMI; 3) acquire new skills in using intervention mapping and qualitative methods to inform intervention research; and 4) obtain training in clinical trial methodology and longitudinal data analysis. The application integrates course work, mentorship from established investigators, and mentored research activities. The research plan uses a collaborative intervention planning framework that blends principles of CBPR and intervention mapping to modify and assess the feasibility and acceptability of an existing care manager intervention. This 12-month intervention focuses on improving patient activation and the coordination of medical care between outpatient mental health clinics and primary care. The proposed project uses a multiphase approach supported by the candidate's training plan. In Phase 1, a community advisory board composed of researchers and stakeholders will be assembled to learn and review the intervention and make initial modifications. During Phase 2, qualitative methods - patient focus groups and stakeholder interviews - will be used to ensure that the modifications are acceptable to all stakeholders. In Phase 3, results from Phase 2 are used to further modify the intervention, develop an implementation plan, and train two care managers on the modified intervention. Phase 4 consists of a 12-month open pilot study (N = 30) to assess the feasibility and acceptability of the modified intervention and explore its effect. Lastly, Phase 5 will focus on analysis of pilot study data and preparation of an R01 proposal. The research plan will yield pilot data for a subsequent R01 to conduct a randomized controlled trial to test the effectiveness and implementation of the modified intervention. PUBLIC HEALTH RELEVANCE: This K01 prepares the candidate to develop an independent program of research focused on the implementation of integrated physical and mental health services in the public mental health system to improve the physical health and wellness of underserved minorities with SMI. This project responds to objectives 3 and 4 of the NIMH Strategic Plan which call for the development of better interventions that incorporate the needs of diverse people with mental illness and ensures the translation of research findings into clinical practice to enhance NIMH's public health mission.