We purpose to develop and sustain an Implementation Partnership that will focus on the adoption of evidence-based practices by rural Community Health Centers. We will use Evidence-Based Quality Improcement (EBQI) methods to foster a participatory research partnership with (Community Health Center patients and providers) devoted to the adaption, adoption, and evaluation of evidence-based practices. The capacity building goals of the Community Health partners are to: 1) cultivate and institutionalize a capacity for EBQI in partnership with research faculty;2) assess and develop an internal capacity for evaluating the implementation of evidence-based practices;3) develop an internal capacity to successfully apply for an external funding to finance the sustained implementation of evidence-based practices. The clinical goals of the partnership are to implement evidence-based practices for bipolar disorder and alcohol use disorders in rural primary care clinics. The scientific goals of the partnership are to: 1) identify, understand, and overcme barriers to developing and maintaining a partnership devoted to the implementation of evidence-based practices in rural Community Health Centers;and 2) develop, refine, and manualize an EBQI Guide for rural Community Health Centers. METHODS - Building on our implementation research experience in the Department of Veterans Affairs'Mental Health Quality Enhancement Research Initiative, we will collaborate with Community Health Center patients and providers to adapt evidence-based practices for bipolar disorder and alcohol use disorders. Using the RE-AIM evaluation framework, we will evaluate the impact of implementation on patient level and organizational level outcomes. A framework, we will evaluate the impact of Implementation Partnership and the EBCJI process will also be conducted in order to improve the structure/process of the Implementation Partnership and to refine EBQI methods in real time. A summative evaluation will assess the sustainability of the evidence-based practices.
Community Health Centers are the nation's largest primary care network, providing services to over 15 million Americans living in medically underserved rural communities (53%) and inner-city neighborhoods (47%). Implementation if evidence-based practices improves clinical outcomes, yet adoption rates are low. Findings and products from the proposed Implementation Partnership will have relevance to hundreds of clinics and millions of patients, and could promote the sustained adoption of evidence-based practices across rural America.