INTEGRATE-D: A pilot-test of implementation strategies to support integration of medical and psychosocial care for people with Type II Diabetes

项目摘要 2016年，美国糖尿病协会（ADA）首次发布了关于整合 为II型糖尿病患者提供医疗和心理社会护理（“综合护理”）， 常见的心理和行为健康问题（MH/BH）。这一里程碑式的成就有可能 大大改善了病人的健康。在美国，有3000万人患有DMII，大多数人接受 初级保健机构的护理。通过实施ADA的建议，初级保健实践将有助于 患者更好地管理他们的MH/BH需求，满足DMII管理的推荐目标，并减少 不良后果的风险。为了实施ADA建议，实践必须开发新技能，动员 治疗资源，确定护理差距，并采用支持系统检测的工具和程序， MH/BH状态。使这些建议成为实践的常规部分是一个重大的变化， 了解如何最好地实施ADA建议，并在真实的世界中测试其有效性。 该提案以先前的一系列研究为基础， 战略-称为INTEGRATE-D -以支持实施ADA建议的实践， 综合性DMII护理，包括系统性筛查和治疗心理社会（例如，抑郁症） 需要的INTEGRATE-D结合了以下循证实施策略：（1）电子健康 基于记录（EHR）的支持-帮助使EHR的使用与ADA建议保持一致， 抑郁、焦虑、糖尿病困扰、认知障碍和自我管理，并支持识别 并跟踪患者治疗和目标的进展;（2）审计和反馈-包括协助 访问临床相关、可操作的数据报告的实践，以告知测量和识别 DMII和行为卫生保健方面的护理差距;（3）技能建设资源-包括ADA培训- 建议的护理;以及（4）促进-帮助实施上述策略和实践改变 需要将护理与ADA建议保持一致。本研究的目标是：目标1：完善INTEGRATE-D 通过纳入利益相关者的偏好进行干预。与初级保健主要利益攸关方合作 和专家，汇编和完善INTEGRATE-D干预措施中的一揽子实施战略。 目标2：证明可行性和可接受性。进行混合的方法，前，后试点比较两个 接受INTEGRATE-D干预的实践与接受培训材料的两个控制实践 只.根据试点结果以及专家和主要利益相关者的意见，我们将完善INTEGRATE-D，并 设计一个务实的实践为基础的试验，以研究其有效性，实施和传播能力， 不同的做法。

PROJECT SUMMARY In 2016, the American Diabetes Association (ADA) published its first-ever recommendations for integrating medical and psychosocial care (“integrated care”) for patients with Type II Diabetes Mellitus (DMII) and common mental and behavioral health (MH/BH) problems. This landmark achievement has the potential to greatly improve patient health. In the United States, 30 million people live with DMII, and the majority receive care in primary care settings. By implementing the ADA recommendations, primary care practices will help patients better manage their MH/BH needs, meet recommended goals for DMII management, and reduce the risk of adverse outcomes. To implement ADA recommendations, practices must develop new skills, mobilize treatment resources, identify care gaps, and adopt tools and processes that support systematic detection of MH/BH status. Making these recommendations a routine part of practice is a major change, and it is critical to understand how best to implement the ADA recommendations and test their effectiveness in the real world. The proposal builds on a series of prior studies to develop and pilot test a package of implementation strategies – called INTEGRATE-D – to support practices in implementing the ADA recommendations for integrated DMII care, which involves systematic screening for and treatment of psychosocial (e.g., depression) need. INTEGRATE-D combines the following evidence-based implementation strategies: (1) electronic health record (EHR)-based support – to help align EHR use with ADA recommendations and enable screening for depression, anxiety, diabetes distress, cognitive impairment, and self-management, and support identifying and tracking progress on patient treatments and goals; (2) Audit and feedback – which involves assisting practices in accessing clinically relevant, actionable data reports to inform measurement and identification of care gaps in DMII and behavioral health care; (3) Skill-building resources – including training on ADA- recommended care; and (4) Facilitation – to help implement the above strategies and the practice changes needed to align care with ADA recommendations. The study aims are: Aim 1: Refine the INTEGRATE-D intervention by incorporating preferences of stakeholders. In partnership with primary care key stakeholders and experts, compile and refine the package of implementation strategies in the INTEGRATE-D intervention. Aim 2: Demonstrate feasibility and acceptability. Conduct a mixed method, pre-post pilot comparing two practices that receive the INTEGRATE-D intervention to two control practices that receive training materials only. Based on pilot findings and input from experts and key stakeholders, we will refine INTEGRATE-D, and design a pragmatic practice-based trial to study its effectiveness, implementation and ability to spread among diverse practices.