基于需求的护理模式对英国医疗服务特征的影响：i-THRIVE国家实施计划

Effect of a needs-based model of care on the characteristics of healthcare services in England: the i-THRIVE National Implementation Programme.

作者信息

Sippy R, Efstathopoulou L, Simes E, Davis M, Howell S, Morris B, Owrid O, Stoll N, Fonagy P, Moore A

机构信息

Department of Psychiatry, University of Cambridge, Cambridge, UK.

Anna Freud, London, UK.

出版信息

Epidemiol Psychiatr Sci. 2025 Mar 26;34:e21. doi: 10.1017/S2045796025000101.

DOI:10.1017/S2045796025000101

PMID:40135635

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11955426/

Abstract

AIMS

Developing integrated mental health services focused on the needs of children and young people is a key policy goal in England. The THRIVE Framework and its implementation programme, i-THRIVE, are widely used in England. This study examines experiences of staff using i-THRIVE, estimates its effectiveness, and assesses how local system working relationships influence programme success.

METHODS

This evaluation uses a quasi-experimental design (10 implementation and 10 comparison sites.) Measurements included staff surveys and assessment of 'THRIVE-like' features of each site. Additional site-level characteristics were collected from health system reports. The effect of i-THRIVE was evaluated using a four-group propensity-score-weighted difference-in-differences model; the moderating effect of system working relationships was evaluated with a difference-in-difference-in-differences model.

RESULTS

Implementation site staff were more likely to report using THRIVE and more knowledgeable of THRIVE principles than comparison site staff. The mean improvement of fidelity scores among i-THRIVE sites was 16.7, and 8.8 among comparison sites; the weighted model did not find a statistically significant difference. However, results show that strong working relationships in the local system significantly enhance the effectiveness of i-THRIVE. Sites with highly effective working relationships showed a notable improvement in 'THRIVE-like' features, with an average increase of 16.41 points (95% confidence interval: 1.69-31.13, P-value: 0.031) over comparison sites. Sites with ineffective working relationships did not benefit from i-THRIVE (-2.76, 95% confidence interval: - 18.25-12.73, P-value: 0.708).

CONCLUSIONS

The findings underscore the importance of working relationship effectiveness in the successful adoption and implementation of multi-agency health policies like i-THRIVE.

摘要

目标

发展以儿童和青少年需求为重点的综合心理健康服务是英国的一项关键政策目标。“茁壮成长”框架及其实施计划“我茁壮成长”在英国被广泛使用。本研究考察了使用“我茁壮成长”的工作人员的经历，评估其有效性，并评估地方系统工作关系如何影响项目的成功。

方法

本评估采用准实验设计（10个实施地点和10个对照地点）。测量方法包括工作人员调查和对每个地点“类茁壮成长”特征的评估。从卫生系统报告中收集了其他地点层面的特征。使用四组倾向得分加权差异模型评估“我茁壮成长”的效果；使用三重差分模型评估系统工作关系的调节作用。

结果

与对照地点的工作人员相比，实施地点的工作人员更有可能报告使用“茁壮成长”，并且对“茁壮成长”原则更了解。“我茁壮成长”地点的保真度得分平均提高了16.7，对照地点为8.8；加权模型未发现统计学上的显著差异。然而，结果表明，地方系统中强大的工作关系显著提高了“我茁壮成长”的有效性。工作关系高效的地点在“类茁壮成长”特征方面有显著改善，比对照地点平均提高了16.41分（95%置信区间：1.69 - 31.13，P值：0.031）。工作关系低效的地点未从“我茁壮成长”中受益（-2.76，95%置信区间：-18.25 - 12.73，P值：0.708）。