Center for Health Enhancement Systems Studies, Industrial and Systems Engineering Department, University of Wisconsin - Madison, Madison, WI 53706, USA.
Implement Sci. 2014 May 29;9:65. doi: 10.1186/1748-5908-9-65.
Healthcare reform in the United States is encouraging Federally Qualified Health Centers and other primary-care practices to integrate treatment for addiction and other behavioral health conditions into their practices. The potential of mobile health technologies to manage addiction and comorbidities such as HIV in these settings is substantial but largely untested. This paper describes a protocol to evaluate the implementation of an E-Health integrated communication technology delivered via mobile phones, called Seva, into primary-care settings. Seva is an evidence-based system of addiction treatment and recovery support for patients and real-time caseload monitoring for clinicians.
METHODS/DESIGN: Our implementation strategy uses three models of organizational change: the Program Planning Model to promote acceptance and sustainability, the NIATx quality improvement model to create a welcoming environment for change, and Rogers's diffusion of innovations research, which facilitates adaptations of innovations to maximize their adoption potential. We will implement Seva and conduct an intensive, mixed-methods assessment at three diverse Federally Qualified Healthcare Centers in the United States. Our non-concurrent multiple-baseline design includes three periods - pretest (ending in four months of implementation preparation), active Seva implementation, and maintenance - with implementation staggered at six-month intervals across sites. The first site will serve as a pilot clinic. We will track the timing of intervention elements and assess study outcomes within each dimension of the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework, including effects on clinicians, patients, and practices. Our mixed-methods approach will include quantitative (e.g., interrupted time-series analysis of treatment attendance, with clinics as the unit of analysis) and qualitative (e.g., staff interviews regarding adaptations to implementation protocol) methods, and assessment of implementation costs.
If implementation is successful, the field will have a proven technology that helps Federally Qualified Health Centers and affiliated organizations provide addiction treatment and recovery support, as well as a proven strategy for implementing the technology. Seva also has the potential to improve core elements of addiction treatment, such as referral and treatment processes. A mobile technology for addiction treatment and accompanying implementation model could provide a cost-effective means to improve the lives of patients with drug and alcohol problems.
ClinicalTrials.gov (NCT01963234).
美国的医疗改革鼓励联邦合格医疗中心和其他初级保健诊所将成瘾治疗和其他行为健康问题的治疗纳入其常规治疗中。移动医疗技术在这些环境中管理成瘾和合并症（如 HIV）的潜力很大，但在很大程度上尚未得到验证。本文介绍了一种评估通过手机提供的电子健康集成通信技术 Seva 在初级保健环境中实施情况的方案。Seva 是一种针对患者的基于证据的成瘾治疗和康复支持系统，以及针对临床医生的实时病例量监测系统。
方法/设计：我们的实施策略使用了三种组织变革模型：计划规划模型以促进接受和可持续性、NIATx 质量改进模型以创建一个欢迎变革的环境，以及罗杰斯的创新扩散研究，这有助于创新的适应以最大限度地发挥其采用潜力。我们将在三个不同的美国联邦合格医疗中心实施 Seva 并进行强化的混合方法评估。我们的非同期多基线设计包括三个阶段 - 预测试（在四个月的实施准备结束时）、Seva 积极实施和维持 - 在六个月的间隔内在各个地点交错实施。第一个地点将作为试点诊所。我们将跟踪干预措施元素的时间安排，并在实施框架的 Reach、Effectiveness、Adoption、Implementation 和 Maintenance 每个维度内评估研究结果，包括对临床医生、患者和实践的影响。我们的混合方法方法将包括定量方法（例如，以诊所为分析单位，对治疗出勤率进行中断时间序列分析）和定性方法（例如，对实施协议适应情况的员工访谈），以及实施成本评估。
如果实施成功，该领域将拥有一种经过验证的技术，帮助联邦合格医疗中心和附属组织提供成瘾治疗和康复支持，以及一种经过验证的技术实施策略。Seva 还有可能改善成瘾治疗的核心要素，例如转介和治疗流程。一种用于成瘾治疗的移动技术和伴随的实施模型可以为改善药物和酒精问题患者的生活提供一种具有成本效益的手段。
ClinicalTrials.gov（NCT01963234）。
Zotero 插件