Methodology

The Methodology Core for the Center for Perioperative Mental Health engages a transdisciplinary team to accelerate the implementation and evaluation of patient-centered mental health intervention bundled in real-world perioperative care.

In particular, the Methodology Core, led by Dr. Joanna Abraham and Professor Philip Miller, supports the activities of the center by:

  • adapting an intervention bundle based on patient preference and needs for implementation in three surgical contexts,
  • creating a robust informatics infrastructure to deliver and manage the intervention bundle, and
  • supporting the R34 and R03 studies through three aims:
Aim 1: Establish an infrastructure to plan, adapt, implement, and evaluate patient-centered mental health intervention bundles for depression and anxiety in three older surgical patient populations.

Implementation Science sub-core

We will use a collaborative planning approach to support adaptation and implementation of our proposed intervention bundle within each surgical patient population/setting. The collaborative planning approach will incorporate diverse perspectives from and experiences of various stakeholders along the perioperative care continuum (including patients, their caregivers, clinicians, patitne experience hospital staff, hospital information services, intervention developers.) This will also foster a shared decision making process between patients and interventionists to ensure that the intervention bundles are appropriately adapted based on patients’ mental health needs and their preferences across the perioperative period.

To guide Aim 1, we have developed a conceptual framework that integrates:

i. the Consolidated Framework for Implementation Research (CFIR) to identify barriers and facilitators in each setting and inform how we will adapt the intervention bundle based on patient preferences, characteristics, and needs;

ii. the Iterative Decision-Making for Evaluation of Adaptations (IDEA) to assess the adaptation needs and guile the implementation process;

iii. the Framework for Reporting Adaptations and Modifications-Expanded (FRAME) to track adaptations to intervention and implementation strategies, and

iv. Research Effectiveness Adoption Implementation and Maintenance (RE-AIM) to assess implementation and dissemination potential for future scale-up.

The implementation science sub-core is led by Drs. Baumann, Politi, and Prusaczyk, who have significant expertise in stakeholder-engaged, patient-centered implementation studies of clinical interventions.

Aim 2: Develop and maintain a comprehensive informatics infrastructure to support data collection, management, and use.

Informatics sub-core

We will develop an integrated informatics infrastructure to support patient identification, engagement, data collection, exchange, and storage. This infrastructure will be supported by appropriate data security and privacy protections for seamless integration of data within and across R34 projects. In addition, we will build EHR-based decision alerts to identify patients early, collect patient-reported outcomes, and monitor participant engagement. This sub-core is led by Drs. Kannampallil and Abraham, who have extensive experience creating and managing hospital informatics infrastructure and EHR-based applications.

Aim 3: Launch an integrated research operations infrastructure comprised of qualitative and quantitative method units to provide traiing, supervision, consultation, and project management.

Research Operations Sub-Core
We will create a research operations infrastructure with two units representing qualitative and quantitative methods.

Qualitative methods unit: We will assist with collaborative planning, adatation, and qualitatitve assessment of the proposed intervention implementation process in real-world care settings using participant interviews and shadowing methods. This unit will be led by Abraham who has significant expertise in qualitative and ethnographic methods in healthcare settings.

Quantitative methods unit: We will assist with study designs, data collection instruments, methods and clinical outcomes, power analyses, a randomization system to ensure appropriate design implementation, and statistical analysis of primary and secondary clinical outcomes. This unit is led by Professor Miller, who has a strong track record in leading the biostatistics core for several large federally-funded studies and centers. In addition, to understand the anticipated impact of the Methodology Core and the overall research program, we will develop:

a. process-based evaluation metrics using the Methodology Core and its services (e.g., process measures such as resources for mental health intervention implementation, decision tools and reports; patient, clinician and institutional stakeholder perceptions of the intervention bundles), and

b. product-based evaluation metrics such as research outcomes including publications and presentations.