This resubmission of a R21 research study will assess how different practices approach implementation of the chronic care model for depression and diabetes with the ultimate goal of developing a tool kit to facilitate implementation. We will relate implementation core components (such as training and coaching activities undertaken by the practices) to patient outcomes (namely, depression improvement in symptoms and blood glucose control). Questions we seek to address include: How can implementation processes are improved? Can implementation processes be "tailored" to practice? The specific aims of this proposal to be carried out in real-world practices are: (1) to assess and compare implementation approaches of the chronic care model across practices mixing both quantitative and qualitative methods;(2) to evaluate the relationship between implementation core components and patient outcomes (depression improvement in symptoms and blood glucose control);and, (3) to develop an implementation tool kit so that implementation strategies can be tailored to the practices, enhancing sustainability of the chronic care model. We will recruit 30 primary care practices in southeastern Pennsylvania involved in the Pennsylvania Primary Care Coalition. With support of this proposal, we seek to describe the practice characteristics associated with implementation and practice change and to develop the components of a tailored approach to implementation based on practice characteristics. The proposed study will directly inform the translation of research to practice by building stakeholder knowledge into the implementation process. Our main patient-level outcomes are depression improvement in symptoms (using the nine-item depression module of the Patient Health Questionnaire (PHQ- 9)) and blood glucose control (using HbA1c). Our goal is to study what implementation core components (facilitative administrative support, selection, preservice training, coaching, staff evaluation, program evaluation, and system support) are adopted and by whom and to develop interventions that are adapted to the practice environment and sustainable. A major goal will be to develop an implementation tool kit consisting of a tailored approach to implementation that will culminate in the submission of an R01 implementation grant. A tailored intervention is more likely to become institutionalized into the routine of the practice than an intervention that imposes upon the practice tools and approaches that were developed elsewhere. If this proposal is funded, we have an opportunity to capitalize on the momentum for innovation in primary care to help close the gap between effectiveness and implementation. The research proposed is consistent with NIMH priorities and directly relevant to objective 4 in the NIMH Strategic Plan;namely, "to help close the gap between the development of new, research-tested interventions and their widespread use by those most in need." This project can have a significant public health impact because efficacious interventions do not improve patient outcomes without good implementation -- both are needed.

Public Health Relevance

This resubmission of a R21 research study will assess how different practices approach implementation of the chronic care model for depression and diabetes with the ultimate goal of developing a toolkit to facilitate implementation. We will relat implementation core components (such as training and coaching activities undertaken by the practices) to patient outcomes (namely, depression improvement in symptoms and blood glucose control). This project can have a significant public health impact because efficacious interventions do not improve patient outcomes without good implementation -- both are needed.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Exploratory/Developmental Grants (R21)
Project #
5R21MH094940-02
Application #
8469582
Study Section
Dissemination and Implementation Research in Health Study Section (DIRH)
Program Officer
Chambers, David A
Project Start
2012-05-15
Project End
2014-04-30
Budget Start
2013-05-01
Budget End
2014-04-30
Support Year
2
Fiscal Year
2013
Total Cost
$192,000
Indirect Cost
$72,000
Name
University of Pennsylvania
Department
Family Medicine
Type
Schools of Medicine
DUNS #
042250712
City
Philadelphia
State
PA
Country
United States
Zip Code
19104
de Vries McClintock, Heather F; Morales, Knashawn H; Small, Dylan S et al. (2015) A brief adherence intervention that improved glycemic control: mediation by patterns of adherence. J Behav Med 38:39-47
de Vries McClintock, Heather F; Morales, Knashawn H; Small, Dylan S et al. (2014) Patterns of Adherence to Oral Hypoglycemic Agents and Glucose Control among Primary Care Patients with Type 2 Diabetes. Behav Med :1-9
Ghesquiere, Angela R; Park, Mijung; Bogner, Hillary R et al. (2014) The effect of recent bereavement on outcomes in a primary care depression intervention study. Am J Geriatr Psychiatry 22:1555-64
Bogner, Hillary R; de Vries, Heather F; Kaye, Elise M et al. (2013) Pilot trial of a licensed practical nurse intervention for hypertension and depression. Fam Med 45:323-9