Implementing mHealth for Schizophrenia in Community Mental Health Settings

项目摘要 精神分裂症谱系障碍（SSD）是一个主要的公共卫生问题。循证疾病 管理干预可以延长恢复期，改善SSD患者的预后， 这些很少在社区精神卫生诊所（CMHC）提供，大多数患有 SSD接受护理。广泛可用的移动的技术可以帮助克服 CMHC，扩大循证精神卫生保健的范围，并提供急需的疾病 管理技能和资源的人与SSD，无论他们可能在哪里。 FOCUS是一个移动的健康（mHealth）疾病管理系统，专为患有 SSD。一系列对10个州500多名SSD参与者进行的研究表明， FOCUS是可行的、可用的、吸引人的和有效的。CMHC临床医生和管理人员表达了强烈的 有兴趣将FOCUS集成到他们的产品和工作流程中。虽然FOCUS已经准备好部署， 如何在现实世界的社区护理环境中最好地实施移动医疗干预措施尚不清楚。 两种实践促进策略可能适用于在CMHC中实施FOCUS：外部 促进（EF）和内部促进（IF）方法。我们建议进行一次有效性比较 比较FOCUS EF与IF实施的前瞻性群集随机混合3型试验 干预华盛顿州的20家CMHC。具体来说，我们的目标是1。评价和比较 执行成果; 2.检查版主（即，对变革的准备、文化、城市与农村状况） 和中介（吸收能力）的实施效果;和3.评估和比较患者结局， 包括干预作用机制的评价。我们将研究是否实施 策略对患者参与度、精神症状严重程度和疾病管理的影响不同 容量该项目涉及国家精神卫生研究所的几个战略优先事项，其目标具有高度创新性， 调查小组的组成、数据收集战略、干预和执行模式，以及 研究设计.本研究采用NIMH实验治疗方法，并评估提出的 实施和患者结果的行动机制。在微观层面，这项研究将有助于 确定哪些策略可以促进，增强或阻碍FOCUS的吸收和临床效果。在 宏观层面，研究结果将对移动健康的成功实施产生更广泛的影响 未来几年的干预措施。随着多个NIMH资助的mHealth和eHealth开发和临床 目前正在进行的试验，现在是审查实施战略的适当时机， 这是现实世界采用最有前途的数字干预措施的方式。

PROJECT SUMMARY Schizophrenia spectrum disorders (SSD) are a major public health concern. Evidence-based illness management interventions can extend the recovery periods and improve the outcomes of people with SSD but these are seldom available at community mental health clinics (CMHCs) where the majority of individuals with SSD receive care. Widely available mobile technologies can help overcome the capacity constraints of CMHCs, expand the reach of evidence-based mental healthcare, and provide much needed illness management skills and resources for people with SSD, wherever they may be. FOCUS is a Mobile Health (mHealth) illness-management system specifically designed for people with SSD. A series of studies conducted with over 500 participants with SSD across ten states has shown that FOCUS is feasible, usable, engaging, and effective. CMHC clinicians and administrators express a strong interest in integrating FOCUS into their offerings and workflow. While FOCUS is well-poised for deployment, how best to implement mHealth interventions in real-world community care settings is unclear. Two Practice Facilitation strategies may be suitable for implementation of FOCUS in CMHCs: External Facilitation (EF) and Internal Facilitation (IF) approaches. We propose to conduct a comparative effectiveness prospective cluster randomized hybrid type 3 trial to compare EF vs. IF implementation of the FOCUS intervention in 20 CMHCs in Washington State. Specifically, we aim to 1. Evaluate and compare implementation outcomes; 2. Examine moderators (i.e., readiness for change, culture, urban vs. rural status) and mediators (absorptive capacity) of implementation effects; and 3. Evaluate and compare patient outcomes, including evaluation of intervention mechanism of action. We will examine whether the implementation strategies differentially affect patient engagement, psychiatric symptom severity, and illness management capacity. The project addresses several NIMH strategic priorities and is highly innovative in its objectives, composition of the investigative team, data collection strategy, intervention and implementation models, and study design. The study adopts the NIMH experimental therapeutics approach and evaluates proposed mechanisms of action for both implementation and patient outcomes. At a micro-level, the study will help determine which strategies may facilitate, enhance, or hinder the uptake and clinical effects of FOCUS. At a macro-level, study findings will have broader implications for successful implementation of mHealth interventions in the years ahead. With multiple NIMH-funded mHealth and eHealth development and clinical trials currently underway, now is the opportune time to examine implementation strategies that will help pave the way for real-world uptake of the digital interventions that emerge as most promising.