组织实施战略对维持基于测量的社区心理健康护理的影响
Nathaniel J Williams1, Gregory A Aarons1, Mark G Ehrhart1
1School of Social Work, Boise State University, Boise, Idaho (Williams, Esp); Department of Psychiatry, University of California, San Diego School of Medicine, La Jolla (Aarons, Sklar, Carandang, Brookman-Frazee); Department of Psychology, University of Central Florida, Orlando (Ehrhart); Ballmer Institute for Children's Behavioral Health, University of Oregon, Portland (Vega); School of Social Policy and Practice, University of Pennsylvania, Philadelphia (Marcus).
领导力和组织变革实施 (LOCI) 战略改善了青少年心理健康服务的基于测量护理 (MBC) 忠实度. 然而,改善的完成率和临床结果并没有持续长期.
科学领域:
- 心理健康服务研究 心理健康服务研究
- 实施科学 实施科学
- 改善医疗保健质量 改善医疗保健质量
背景情况:
- 在社区心理健康环境中,坚持以证据为基础的干预措施仍然是一个挑战.
- 此前,WISDOM (Working to Implement and Sustain Digital Outcome Measures) 试验已经证明了组织战略在改善基于测量的护理 (MBC) 实施方面的有效性.
- 智慧试验的第二阶段旨在评估该策略对MBC维持的长期影响.
研究的目的:
- 评估领导力和组织变革实施 (LOCI) 战略对青少年心理健康服务中维持基于测量的护理 (MBC) 的影响.
- 检查LOCI策略对MBC完成率,青少年症状改善和MBC忠诚度在培训后13-26个月的影响.
主要方法:
- 一个随机试验涉及21个门诊心理健康诊所,其中11个被分配给LOCI策略加培训,10个仅接受培训.
- 第二阶段检查了452名年轻人的结局,他们在临床医生MBC培训13-26个月后开始接受治疗.
- 主要结局包括MBC完成率,青少年症状改善和MBC忠实度.
主要成果:
- 在LOCI和对照组之间,没有观察到MBC完成率或青少年症状改善的显著差异.
- 然而,在接受MBC的年轻人中,LOCI站点 (24%) 的忠诚度明显高于对照站点 (1%) (p=0.003).
- 当使用MBC时,LOCI策略维持了优越的MBC忠实度,但没有优越的完成率或临床结果.
结论:
- LOCI战略有效地维持了青少年心理健康服务中基于测量的护理 (MBC) 的更高保真度.
- 没有达到维持优异的MBC完成率和临床结果,这表明需要进一步干预.
- 长期维持MBC可能需要战略来解决监管和偿还环境以及基础设施的发展.
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