Massachusetts General Hospital, The Mongan Institute, Harvard Medical School, Boston, MA, USA.
Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
Adm Policy Ment Health. 2022 Nov;49(6):1031-1046. doi: 10.1007/s10488-022-01215-0. Epub 2022 Aug 20.
Despite widespread use of learning collaboratives, few randomized trials have evaluated their effectiveness as a strategy for implementing evidence based practices. This randomized trial evaluated the effectiveness of a virtual learning collaborative (VLC) in the implementation of a health promotion program for persons with serious mental illness (SMI) aimed at reducing cardiovascular risk reduction in routine mental health settings, compared to routine technical assistance (TA).
Fifty-five mental health provider organizations were recruited to participate in a Hybrid Type 3 cluster randomized implementation-effectiveness trial of the InSHAPE health promotion program for persons with SMI. Sites were stratified by size and randomized prior to implementation to an 18-month group-based VLC with monthly learning sessions or individual site TA with four scheduled conference calls over 18 months. Primary implementation and service outcomes were InSHAPE program fidelity, participation, and reach. Primary clinical outcomes were weight loss, cardiorespiratory fitness, and cardiovascular risk reduction (≥ 5% weight loss or > 50 m increase on the 6-Minute Walk Test). Program fidelity was assessed at 6, 12, and 24 months; program participation and participant-level outcomes were assessed at 3, 6, 9, and 12 months.
VLC (N = 27) and TA (N = 28) sites were similar in organizational characteristics (all p > 0.05). At 12-month follow-up mean program fidelity score was higher in VLC compared to TA (90.5 vs. 79.1; p = 0.002), with over double the proportion with good fidelity (VLC = 73.9% vs. TA = 34.8%; p = 0.009). Over half of individuals in both VLC and TA achieved cardiovascular risk-reduction at 6-month follow-up (VLC: 51.0%; TA: 53.5%; p = 0.517) and at 12-month follow-up (62% VLC and TA; p = 0.912). At 12-month follow-up VLC compared to TA was associated with greater participation (VLC 69.5% vs. TA 56.4% attending at least 50% of sessions, p = 0.002); larger caseloads (VLC = 16 vs. TA = 11; p = 0.024); greater reach consisting of 45% greater number of participants receiving InSHAPE (VLC = 368 vs. TA = 253), and 58% greater number of participants achieving cardiovascular risk reduction (VLC = 150 vs. TA = 95).
Virtual learning collaboratives compared to routine technical assistance as an implementation strategy for evidence-based health promotion promote greater intervention fidelity, greater levels of intervention participation, greater reach, and a greater number of participants achieving clinically significant risk reduction outcomes, while achieving similarly high levels of intervention effectiveness for participants who completed at least 6 months of the program.
尽管学习协作已被广泛应用，但很少有随机试验评估其作为实施循证实践策略的有效性。本随机试验评估了虚拟学习协作（VLC）在实施针对严重精神疾病（SMI）患者的健康促进计划方面的有效性，该计划旨在减少常规精神卫生环境中的心血管风险，与常规技术援助（TA）相比。
招募了 55 个心理健康服务提供者组织参与 InSHAPE 健康促进计划的混合 3 型 3 级集群随机实施效果试验，该计划针对 SMI 患者。根据规模对站点进行分层，并在实施前随机分为基于群组的为期 18 个月的 VLC，每月进行学习会议，或在 18 个月内进行四次预定的电话会议。主要实施和服务结果是 InSHAPE 计划的保真度、参与度和覆盖范围。主要临床结果是体重减轻、心肺健康和心血管风险降低（体重减轻≥5%或 6 分钟步行测试增加≥50m）。在 6、12 和 24 个月时评估计划保真度；在 3、6、9 和 12 个月时评估计划参与度和参与者水平结果。
VLC（n=27）和 TA（n=28）站点在组织特征方面相似（均 p>0.05）。在 12 个月的随访中，VLC 的平均计划保真度评分高于 TA（90.5 对 79.1；p=0.002），具有良好保真度的比例高出两倍（VLC=73.9%对 TA=34.8%；p=0.009）。在 6 个月的随访中，VLC 和 TA 中超过一半的个体达到了心血管风险降低（VLC：51.0%；TA：53.5%；p=0.517）和 12 个月的随访（VLC：62%和 TA；p=0.912）。在 12 个月的随访中，VLC 与 TA 相比，参与度更高（VLC 69.5%对 TA 56.4%至少参加了 50%的会议，p=0.002）；更大的患者人数（VLC=16 对 TA=11；p=0.024）；更大的覆盖范围，参与者人数增加了 45%（VLC=368 对 TA=253），达到心血管风险降低的参与者人数增加了 58%（VLC=150 对 TA=95）。
与常规技术援助相比，虚拟学习协作作为循证健康促进的实施策略，可以提高干预的保真度、参与度、覆盖面和达到临床显著风险降低结果的参与者人数，同时为至少完成 6 个月计划的参与者实现类似的高水平干预效果。
