利用“实现成果”促进退伍军人事务部无家可归者项目中循证实践的应用：一项实施支持策略的整群随机试验
Using Getting To Outcomes to facilitate the use of an evidence-based practice in VA homeless programs: a cluster-randomized trial of an implementation support strategy.
作者信息
Chinman Matthew, McCarthy Sharon, Hannah Gordon, Byrne Thomas Hugh, Smelson David A
机构信息
VISN 4 Mental Illness Research and Clinical Center and the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
RAND Corporation, Pittsburgh, PA, USA.
出版信息
Implement Sci. 2017 Mar 9;12(1):34. doi: 10.1186/s13012-017-0565-0.
BACKGROUND
Incorporating evidence-based integrated treatment for dual disorders into typical care settings has been challenging, especially among those serving Veterans who are homeless. This paper presents an evaluation of an effort to incorporate an evidence-based, dual disorder treatment called Maintaining Independence and Sobriety Through Systems Integration, Outreach, and Networking-Veterans Edition (MISSION-Vet) into case management teams serving Veterans who are homeless, using an implementation strategy called Getting To Outcomes (GTO).
METHODS
This Hybrid Type III, cluster-randomized controlled trial assessed the impact of GTO over and above MISSION-Vet Implementation as Usual (IU). Both conditions received standard MISSION-Vet training and manuals. The GTO group received an implementation manual, training, technical assistance, and data feedback. The study occurred in teams at three large VA Medical Centers over 2 years. Within each team, existing sub-teams (case managers and Veterans they serve) were the clusters randomly assigned. The trial assessed MISSION-Vet services delivered and collected via administrative data and implementation barriers and facilitators, via semi-structured interview.
RESULTS
No case managers in the IU group initiated MISSION-Vet while 68% in the GTO group did. Seven percent of Veterans with case managers in the GTO group received at least one MISSION-Vet session. Most case managers appreciated the MISSION-Vet materials and felt the GTO planning meetings supported using MISSION-Vet. Case manager interviews also showed that MISSION-Vet could be confusing; there was little involvement from leadership after their initial agreement to participate; the data feedback system had a number of difficulties; and case managers did not have the resources to implement all aspects of MISSION-Vet.
CONCLUSIONS
This project shows that GTO-like support can help launch new practices but that multiple implementation facilitators are needed for successful execution of a complex evidence-based program like MISSION-Vet.
TRIAL REGISTRATION
ClinicalTrials.gov NCT01430741.
背景
将循证综合治疗双相障碍纳入常规护理环境一直具有挑战性，尤其是在为无家可归的退伍军人提供服务的人群中。本文介绍了一项评估，该评估旨在将一种名为“通过系统整合、外展和网络实现独立与清醒——退伍军人版”（MISSION-Vet）的循证双相障碍治疗方法纳入为无家可归退伍军人服务的个案管理团队，采用一种名为“实现成果”（GTO）的实施策略。
方法
这项III型混合、整群随机对照试验评估了GTO相对于常规MISSION-Vet实施（IU）的额外影响。两种情况都接受了标准的MISSION-Vet培训和手册。GTO组接受了实施手册、培训、技术援助和数据反馈。该研究在3个大型退伍军人医疗中心的团队中进行，为期2年。在每个团队中，现有的子团队（个案管理员及其服务的退伍军人）是随机分配的集群。该试验评估了通过行政数据提供和收集的MISSION-Vet服务，以及通过半结构化访谈评估的实施障碍和促进因素。
结果
IU组中没有个案管理员启动MISSION-Vet，而GTO组中有68%的个案管理员启动了该治疗。在GTO组中有个案管理员的退伍军人中，7%接受了至少一次MISSION-Vet治疗。大多数个案管理员赞赏MISSION-Vet材料，并认为GTO规划会议支持使用MISSION-Vet。个案管理员访谈还表明，MISSION-Vet可能会令人困惑；领导层在最初同意参与后几乎没有参与；数据反馈系统存在一些困难；个案管理员没有资源实施MISSION-Vet的所有方面。
结论
该项目表明，类似GTO的支持可以帮助启动新的实践，但对于像MISSION-Vet这样复杂的循证项目的成功实施，需要多个实施促进因素。
试验注册
ClinicalTrials.gov NCT01430741。
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