Health Services Research and Development (HSR&D), Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas 72114, USA.
Popul Health Manag. 2009 Apr;12(2):69-79. doi: 10.1089/pop.2008.0023.
Numerous studies have demonstrated that collaborative care (care management) for depression improves outcomes, yet few clinics have implemented this evidence-based practice. To promote adoption of this best practice, our objective was to describe the steps needed to tailor collaborative care models for local needs, resources, and priorities while maintaining fidelity to the evidence base. Based on lessons learned from 2 multisite Veterans Affairs implementation studies conducted in 2 different clinical, organizational, and geographic contexts, we describe in detail the steps needed to adapt an evidence-based collaborative care program for depression for local context while maintaining highly fidelity to the research evidence. These steps represent a detailed checklist of decisions and action items that can be used as a tool to plan the implementation of a collaborative care model for depression. We also identify other tools (eg, decision support systems, suicide risk assessment) and resources (eg, training materials) that will support implementation efforts. These implementation tools should help clinicians and administrators develop informed strategies for rolling out collaborative care models for depression.
许多研究表明，针对抑郁症的协作式护理（护理管理）可以改善治疗效果，但很少有诊所实施这种基于证据的实践。为了促进这种最佳实践的应用，我们的目标是描述根据当地需求、资源和优先事项调整协作式护理模式所需的步骤，同时保持对证据基础的忠实性。基于在两个不同临床、组织和地理背景下进行的两项退伍军人事务多地点实施研究中吸取的经验教训，我们详细描述了为适应当地情况而调整基于证据的协作式抑郁症护理计划所需的步骤，同时保持对研究证据的高度忠实性。这些步骤代表了一份详细的决策和行动项目清单，可作为规划抑郁症协作式护理模式实施的工具。我们还确定了其他工具（例如决策支持系统、自杀风险评估）和资源（例如培训材料），这些工具将支持实施工作。这些实施工具应帮助临床医生和管理人员制定出推出抑郁症协作式护理模式的明智策略。
