Indianapolis Interventions and Practice Research Infrastructure Program

描述(由申请人提供)：在过去的几年里，多项研究报告了综合护理管理模式的可喜结果，以改善初级保健环境中患有精神疾病的老年人的护理。然而，国家咨询精神卫生委员会的老龄化研究工作组(2006年)报告说，“在了解影响老年精神疾病采用的因素之前，不太可能实施老年精神疾病的综合病例管理……需要进行传播和实施研究，以解决这些问题和许多其他问题，通过建立一个知识库，了解精神卫生保健信息和新做法如何在特定环境中传输和翻译，以供卫生保健服务使用，从而弥合临床研究和日常实践之间的差距。”NIMH在过去30年的研究确定，初级保健是大多数精神疾病患者接受护理的场所。在这项修订后的申请中，我们建议在精神病学、初级保健和老年病学的交叉点上建立我们的研究经验，建立一个IP-RISP来研究初级保健中老年人的抑郁和认知障碍。印第安纳波利斯IP-RISP将通过与我们的研究团队合作，与一个以城市社区为基础的医疗保健系统合作，推动实施科学的发展，该系统服务于弱势老年人，包括高比例的非裔美国人。此外，在初级保健范围内建立一个精神卫生服务研究实验室，使人们有机会研究并存的医疗条件(例如心血管疾病)如何影响护理的过程和结果。我们的合作伙伴关系旨在确定将知识转化为常规临床实践的障碍和促进者。根据与我们的社区合作伙伴的需求评估，我们建议两个试点项目：(A)创建和评估综合电子医疗记录，以支持患有抑郁症或认知障碍的老年人的临床护理和研究；以及(B)为患有抑郁症和/或认知障碍的老年人实施协作护理模式，并将心血管疾病的护理纳入其中。

DESCRIPTION (provided by applicant): Over the past few years, multiple studies have reported promising results from integrated care management models to improve the care of older adults with mental illness in primary care settings. The National Advisory Mental Health Council's Workgroup on Aging Research (2006) reported, however, that "integrated case management for mental illness in old age is unlikely to be implemented until the factors that affect its adoption are understood.... Dissemination and implementation research to address these issues and many others is needed to bridge the gap between clinical research and everyday practice by building a knowledge base about how mental health care information and new practices are transmitted and translated for health care service use in specific settings." NIMH research over the past 30 years has identified primary care as the site of care where most patients with mental illness receive care. In this revised application, we propose to build on our research experience at the intersection of psychiatry, primary care, and geriatrics by establishing an IP-RISP for the study of depression and cognitive impairment among older adults in primary care. The Indianapolis IP-RISP will advance implementation science by partnering our research team with an urban community-based health care system serving vulnerable older adults, including a high proportion of African Americans. In addition, building a laboratory for mental health services research within primary care allows opportunities to study how comorbid medical conditions (e.g. cardiovascular disease) affect the process and outcomes of care. Our partnership is designed to identify barriers and facilitators to translating knowledge into routine clinical practice. Based on an needs assessment with our community partner, we are proposing two pilot projects: (a) create and evaluate an integrated electronic medical record to support clinical care and research for older adults with depression or cognitive impairment; and (b) implement a collaborative care model for older adults with depression, cognitive impairment, or both and also integrate the care of cardiovascular disease.