McGinty Emma Elizabeth, Thompson David, Murphy Karly A, Stuart Elizabeth A, Wang Nae-Yuh, Dalcin Arlene, Mace Elizabeth, Gennusa Joseph V, Daumit Gail L
Johns Hopkins University Bloomberg School of Public Health, 624 N. Broadway, Room 359, Baltimore, MD, 21205, USA.
Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD, 21202, USA.
Implement Sci Commun. 2021 Mar 4;2(1):26. doi: 10.1186/s43058-021-00129-6.
People with serious mental illnesses (SMI) such as schizophrenia and bipolar disorder experience excess mortality driven in large part by high rates of poorly controlled and under-treated cardiovascular risk factors. In the USA, integrated "behavioral health home" models in which specialty mental health organizations coordinate and manage physical health care for people with SMI are designed to improve guideline-concordant cardiovascular care for this group. Such models have been shown to improve cardiovascular care for clients with SMI in randomized clinical trials, but real-world implementation has fallen short. Key implementation barriers include lack of alignment of specialty mental health program culture and physical health care coordination and management for clients with SMI and lack of structured protocols for conducting effective physical health care coordination and management in the specialty mental health program context. This protocol describes a pilot study of an implementation intervention designed to overcome these barriers.
This pilot study uses a single-group, pre/post-study design to examine the effects of an adapted Comprehensive Unit Safety Program (CUSP) implementation strategy designed to support behavioral health home programs in conducting effective cardiovascular care coordination and management for clients with SMI. The CUSP strategy, which was originally designed to improve inpatient safety, includes provider training, expert facilitation, and implementation of a five-step quality improvement process. We will examine the acceptability, appropriateness, and feasibility of the implementation strategy and how this strategy influences mental health organization culture; specialty mental health providers' self-efficacy to conduct evidence-based cardiovascular care coordination and management; and receipt of guideline-concordant care for hypertension, dyslipidemia, and diabetes mellitus among people with SMI.
While we apply CUSP to the implementation of evidence-based hypertension, dyslipidemia, and diabetes care, this implementation strategy could be used in the future to support the delivery of other types of evidence-based care, such as smoking cessation treatment, in behavioral health home programs. CUSP is designed to be fully integrated into organizations, sustained indefinitely, and used to continually improve evidence-based practice delivery.
ClinicalTrials.gov, NCT04696653 . Registered on January 6, 2021.
患有精神分裂症和双相情感障碍等严重精神疾病（SMI）的人群死亡率过高，这在很大程度上是由心血管危险因素控制不佳和治疗不足所致。在美国，综合“行为健康之家”模式中，专业心理健康组织为患有严重精神疾病的人群协调和管理身体保健，旨在改善该群体符合指南的心血管护理。在随机临床试验中，此类模式已被证明可改善患有严重精神疾病患者的心血管护理，但在实际应用中却未达预期。关键实施障碍包括专业心理健康项目文化与患有严重精神疾病患者的身体保健协调和管理不一致，以及在专业心理健康项目背景下缺乏进行有效身体保健协调和管理的结构化方案。本方案描述了一项旨在克服这些障碍的实施干预试点研究。
本试点研究采用单组前后研究设计，以检验一种经过调整的综合单元安全计划（CUSP）实施策略的效果，该策略旨在支持行为健康之家项目为患有严重精神疾病的患者进行有效的心血管护理协调和管理。CUSP策略最初旨在提高住院安全性，包括提供者培训、专家协助以及实施五步质量改进流程。我们将检验实施策略的可接受性、适宜性和可行性，以及该策略如何影响心理健康组织文化；专业心理健康提供者进行循证心血管护理协调和管理的自我效能；以及患有严重精神疾病的人群中高血压、血脂异常和糖尿病患者接受符合指南护理的情况。
虽然我们将CUSP应用于循证高血压、血脂异常和糖尿病护理的实施，但这种实施策略未来可用于支持行为健康之家项目中其他类型循证护理的提供，如戒烟治疗。CUSP旨在完全融入组织，无限期持续，并用于不断改进循证实践的提供。
ClinicalTrials.gov，NCT04696653。于2021年1月6日注册。
