地方参与系统动力学以增加基于证据的成瘾和心理保健的覆盖面
参与式系统动力学与审计和反馈:实施变化机制的集群随机试验,以扩大循证成瘾和心理保健的范围
研究概览
详细说明
研究类型
注册 (估计的)
阶段
- 不适用
联系人和位置
学习地点
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California
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Palo Alto、California、美国、94304
- VA Palo Alto Health Care System
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参与标准
资格标准
适合学习的年龄
接受健康志愿者
描述
纳入标准诊所:
- VA 部门和基于社区的门诊诊所 (CBOC) 或地区 VA 卫生系统的“诊所”
- 必须低于整体 VA 质量中位数(由改进和学习战略分析或 SAIL 评估),其中包括 8 项 SAIL 措施中的 3 项与四种基于证据的心理疗法和三种基于证据的抑郁症、创伤后应激障碍和阿片类药物疗法相关使用障碍。
排除标准诊所:
- 2018年数据少于12个月的诊所
- 已经参与退伍军人护理办公室 (OVACS) 基线质量改进计划的诊所。
- VA Cerner 电子健康记录 (EHR) 实施推广将在项目期间进行的诊所(退伍军人综合服务网络 (VISN) 20、21、22 和 7)
- 平均每月为少于 122 名独特患者提供服务的诊所
- 没有心理健康或成瘾服务提供者现场多学科团队的诊所(最低要求:1 名精神科医生、1 名心理学家、1 名现场社会工作者)
学习计划
研究是如何设计的?
设计细节
- 主要用途:卫生服务研究
- 分配:随机化
- 介入模型:并行分配
- 屏蔽:无(打开标签)
武器和干预
参与者组/臂 |
干预/治疗 |
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实验性的:参与性系统动力学(PSD)
分配给PSD的12个诊所
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参与式系统动力学是一种促进医疗保健质量改进或循证实践实施策略,包括一线成瘾和心理健康人员运行诊所改进策略的模拟,以找到扩大循证心理治疗和循证药物治疗范围的最佳方法.
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实验性的:审核和反馈(AF)
分配给AF的12个诊所
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审计和反馈是一种医疗保健质量改进或循证实践实施策略,包括一线成瘾和心理健康人员审查临床护理团队数据,以找到扩大循证心理治疗和循证药物治疗范围的最佳方法。
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研究衡量的是什么?
主要结果指标
结果测量 |
措施说明 |
大体时间 |
|---|---|---|
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被诊断患有酒精使用障碍、抑郁症、阿片类药物使用障碍或创伤后应激障碍并满足循证心理治疗和药物治疗开始和疗程测量的患者比例除以具有这些诊断的患者总数
大体时间:循证实践达到的前/后 12 个月期间平均值(24 个月的总观察)
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循证实践的开始由循证心理治疗模板或摄入后循证药物治疗处方指示。
适当的课程是基于接受足够数量的基于证据的心理治疗课程以成为“完成者”(通常为 8 次)或足够补充指南推荐的每种药物的充分试验(因药物而异)。
数据是根据来自 VA 公司数据仓库 (CDW) 的电子健康记录数据收集的。
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循证实践达到的前/后 12 个月期间平均值(24 个月的总观察)
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在具有相关 CPT 代码的会话期间完成的循证实践模板的比例
大体时间:循证实践达到的前/后 12 个月期间平均值(24 个月的总观察)
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我们将研究 5 种循证心理疗法:3 种针对抑郁症(认知行为疗法 (CBT-D)、接纳与承诺疗法 (ACT) 和人际心理疗法 (IPT))和 2 种针对 PTSD(长时间暴露 (PE) 和认知处理)治疗(CPT))。
数据是根据来自公司数据仓库 (CDW) 的电子健康记录数据收集的。
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循证实践达到的前/后 12 个月期间平均值(24 个月的总观察)
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与相关 CPT 代码放在 VA 药房和会话中的处方组合的比例
大体时间:循证实践达到的前/后 12 个月期间平均值(24 个月的总观察)
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我们将研究 8 种循证药物疗法:2 种针对抑郁症(新抗抑郁药开始时连续治疗 84 天和 180 天),2 种针对阿片类药物使用障碍 (OUD)(美沙酮和丁丙诺啡),4 种针对酒精使用障碍 (AUD)(阿坎酸、双硫仑、纳曲酮和托吡酯)。
数据是根据来自公司数据仓库 (CDW) 的电子健康记录数据收集的。
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循证实践达到的前/后 12 个月期间平均值(24 个月的总观察)
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次要结果测量
结果测量 |
措施说明 |
大体时间 |
|---|---|---|
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人口统计措施
大体时间:在基线和 6 个月
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4 项评估种族(西班牙裔、拉丁裔、拉丁裔或拉丁裔)、种族(美洲印第安人/阿拉斯加原住民、亚洲人、夏威夷原住民或其他太平洋岛民、黑人或非裔美国人、白人、不止一个种族)和性别(男性、女性,非二元)受访者的身份。 所有项目都包含“不想说”选项。 根据 NIH 报告标准确定的人口统计指标类别。 |
在基线和 6 个月
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通过干预措施的可接受性 (AIM) 评估的干预可接受程度 [后跟描述中的量表信息]
大体时间:6个月时
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在包含 4 个项目的调查中评估团队对 PSD 和 AF 的看法差异程度。 量表:1-5,以 1 分递增(1 = 完全不同意,2 = 不同意,3 = 既不同意也不反对,4 = 同意,5 = 完全同意) |
6个月时
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由干预适当性措施 (IAM) 评估的干预适当程度 [后跟描述中的量表信息]
大体时间:6个月时
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在包含 4 个项目的调查中评估团队对 PSD 和 AF 的看法差异的程度。 量表:1-5,以 1 分递增(1 = 完全不同意,2 = 不同意,3 = 既不同意也不反对,4 = 同意,5 = 完全同意) |
6个月时
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通过干预措施的可行性评估的干预可行性程度(FIM)[其次是描述中的规模信息]
大体时间:6个月时
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在包含 4 个项目的调查中评估团队对 PSD 和 AF 的看法差异程度。 量表:1-5,以 1 分递增(1 = 完全不同意,2 = 不同意,3 = 既不同意也不反对,4 = 同意,5 = 完全同意) |
6个月时
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Patient Aligned Care 团队职业倦怠测量 (PACT) [后跟描述中的规模信息]
大体时间:在基线和 6 个月
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4 项描述性调查中的工作满意度和倦怠质量,采用基于 VA 团队的初级保健措施,跟踪 1) 多年的团队经验,2) 在多个团队中工作,3) 团队人员的流动/变化, 4) team overwork, and the single item 5) 自我报告的倦怠(敏感性83.2%,特异性87.4%) (问题 1)在 # 年内回答(问题 2-3)是或否(问题 4-5)等级:1-5,以 1 分递增(1 = 从不,2 = 很少,3 = 有时,4 = 非常通常,5 = 总是) |
在基线和 6 个月
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学习型组织调查 (LOS-27) [后跟描述中的规模信息]
大体时间:在基线和 6 个月
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工作场所的心理安全使用基于学习型组织传统的 27 项调查,并在 VA 验证期间证明具有良好的心理测量特性,该验证评估 7 个临床环境因素:a) 支持性学习环境(包括心理安全),b) 领导力加强学习,c) 实验,d) 培训,e) 知识获取,f) 反思时间,以及 g) 绩效监控 (问题 1-23)量表:0-4,以 1 分递增(0 = 从不,4 = 总是)(问题 24-27)量表:0 到 7,以 1 分递增(0 = 非常不准确,7 = 非常准确准确的) |
在基线和 6 个月
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团队决策问卷 (TDMQ) [后跟描述中的量表信息]
大体时间:6个月时
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工作场所的团队动态使用经过验证的四因素量表调查来评估团队干预对团队决策、支持学习和开发优质服务的影响 等级:1-7,以 1 分递增,包括 N/A(N/A = 不适用,1 = 完全不适用,2 = 在很小程度上,3 = 在很小程度上,4 = 在中等程度上, 5 = 在很大程度上,6 = 在很大程度上,7 = 在很大程度上) |
6个月时
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系统思维量表 (STS) [后跟描述中的量表信息]
大体时间:在基线和 6 个月
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在工作场所使用系统思维以及识别、理解和综合相互作用和相互依存关系的能力,包括行动和组成部分如何相互加强或抵消。 量表:1-5,以 1 分递增(1 = 从不,2 = 很少,3 = 有时,4 = 经常,5 = 大部分时间) |
在基线和 6 个月
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Systems Thinking Codebook and Session Observations [后跟描述中的规模信息]
大体时间:6个月以上
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观察语言/解释中的系统思考,以及展示系统思考技能(能力)的表现,以四种结构衡量:复杂、反馈、行为、时间 等级:1-4 级,以 1 分递增(1 = 在最简单的水平上展示了结构,4 = 在最复杂的水平上完全展示了结构) |
6个月以上
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主持人忠实于干预指南和变革理论
大体时间:6个月以上
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通过针对会话学习目标、“关键思想”和“定义”的 AF/PSD 协调员脚本进行定性检查来审查保真度,包括跟踪 AF/PSD 会话活动(以分钟为单位)在这些组件上的比例。
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6个月以上
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合作者和调查者
调查人员
- 首席研究员:Lindsey E Zimmerman, PhD、National Center for PTSD, Dissemination & Training Division
出版物和有用的链接
一般刊物
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