Implementing Health Care Interventions for Hispanics with Serious Mental Illness

描述(由申请人提供)：与患有严重精神疾病(SMI；例如精神分裂症)的白人占多数的人相比，患有SMI的少数族裔患心血管疾病(CVD)的风险更高。虽然有希望的治疗方法(如护理管理者干预)可以改善重度精神障碍患者的健康，但人们对使这些干预措施在文化上与患有重度精神障碍的拉美裔人相关并促进其在公共精神卫生系统中的使用的过程关注很少。这一指导研究科学家发展奖(K01)的目标是使候选人做好准备，成为实施研究的独立调查员，以解决患有SMI的服务不足的少数群体在身体保健方面面临的差异。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，重点是将基于社区的参与性研究(CBPR)方法作为翻译策略；2)开发针对SMI患者的身心健康护理整合方面的专业知识；3)掌握使用干预图谱和定性方法为干预研究提供信息的新技能；以及4)获得临床试验方法学和纵向数据分析方面的培训。该应用程序集成了课程工作、来自知名研究人员的指导和指导研究活动。该研究计划使用一个协作性干预计划框架，该框架融合了CBPR和干预映射的原则，以修改和评估现有护理管理者干预的可行性和可接受性。这项为期12个月的干预措施侧重于改善患者的积极性，以及门诊精神卫生诊所和初级保健之间的医疗护理协调。拟议的项目采用了候选人培训计划支持的多阶段办法。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，以了解和审查干预措施并进行初步修改。在第二阶段，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。在第三阶段，第二阶段的结果被用来进一步修改干预措施，制定实施计划，并就修改后的干预措施培训两名护理经理。第四阶段包括为期12个月的开放式试点研究(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，阶段5将侧重于分析试点研究数据和准备R01提案。该研究计划将为随后的R01提供试点数据，以进行随机对照试验，以测试改进干预的有效性和实施情况。 公共卫生相关性：本K01课程为候选人准备开发一项独立的研究计划，重点是在公共精神卫生系统中实施综合的身心健康服务，以改善服务不足的患有SMI的少数族裔的身体健康和健康状况。该项目响应了NIMH战略计划的目标3和4，该战略计划呼吁开发更好的干预措施，纳入不同精神病患者的需求，并确保将研究成果转化为临床实践，以加强NIMH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.