Damush HSR&D Research Career Scientist Award Application

背景：新政策和医疗保健流程不断向临床工作人员一线推出 以及VHA内不同临床条件和多个环境的供应商。人们对这项投资知之甚少 VHA医疗组织需要纳入基于证据的实施战略，以实现系统化 实施。此外，实现科学只是在最近才开始确定一套实现 战略。需要进行研究来阐明干预策略的适当剂量 以可持续的方式改变提供者和患者的行为和护理体系的地方背景 实施。通过精密监测(PRIS-M QUERI中心)转变关怀计划，我们正在 开展以下实施评估：1)开展可扩展的临床质量改进项目 将电子数据与提供商的行动和报告联系起来；2)调查提供可操作数据的影响 关于关怀团队行为和过程以及退伍军人行为和满意度；3)确定实施 战略，包括需要的投资和激活VHA提供商、领导者和 退伍军人使用数据来转变和改善护理和患者结果；以及4)激活退伍军人患者以 参与医疗保健系统，以管理他们的健康。方法：通过我们的核心VHA的持续投入 运营伙伴，我们正在通过核心研究和质量改进项目实现这些目标 涵盖多种病症和护理环境。我们的项目重点是：1)在全国范围内实施 农村VHA远程卒中，2)测试远程医疗模块和电子质量措施，以提高快速 短暂性脑缺血发作(TIA)护理，3)停用不适当颈动脉超声的决策支持 图像订购，以及4)在农村地区实施远程机器人技术。这些项目由 我领导的实施和数据核心，在所有项目中工作，以促进数据的有效使用； 新工具的可用性测试；以及实施措施、方法和分析的标准化使用 接近了。我们的总体实施战略侧重于激活个人和团体使用数据 为了转变CARE，我们使用CFIR框架来规划跨项目的数据收集和分析，以 确定影响人们如何使用数据进行转型的核心实施战略和背景因素 关心。主要合作伙伴包括专科护理办公室、农村保健办公室、远程保健办公室、 和退伍军人事务部应用系统工程中心。我们已经开发出一种专业的 视频建模多学科退伍军人医疗保健团队，该团队使用数据在以下方面激活提供商变更 以数据驱动的方式提供服务，以提高护理质量和提供者/患者满意度。使用规划功能， 目标设定，以及反思和评估，我们正在推动供应商行为调整和团队 激活。此外，我们还采用外部促进战略来指导VHA领域的临床团队。在……里面 此外，我对病人自我管理计划的研究试图接触到退伍军人 参与医疗保健系统，以促进他们的最佳健康和功能。我正在试行改编自 为有脑血管事件的退伍军人提供心脏康复到分娩辅助恢复计划 其他条件。预期影响：我们的项目评估正在处理重要的实施 关于如何最好地激活提供者、医疗团队和退伍军人以改善医疗保健提供的问题 以及不同临床条件和环境的结果。我们期待着展示我们的 实施战略也阐明了因地制宜和适当的 在VHA系统内实现可持续实施的战略，并将其应用于其他 医疗保健系统。此外，我的以退伍军人为中心的患者计划可能有助于退伍军人参与 为退伍军人提供护理，从而提高退伍军人满意度和护理结果。

Background: New policies and healthcare processes are constantly rolling out to the front lines of clinical staff and providers across clinical conditions and multiple settings within VHA. Less is known about the investment needed into evidence based implementation strategies by VHA healthcare organizations to achieve systematic implementation. Moreover, implementation science has only recently begun to identify a set of implementation strategies. Research is needed to elucidate upon the appropriate dose of the intervention strategy tailored to the local context to modify provider behaviors' and patients' behaviors and systems of care with sustainable implementation. Through the Precision Monitoring (PRIS-M QUERI Center) to Transform Care program we are conducting the following implementation evaluations: 1) Conduct scalable clinical quality improvement projects that link electronic data to provider actions and reporting; 2) Investigate the effects of providing actionable data on care team behaviors and processes and Veteran behaviors and satisfaction; 3) Identify the implementation strategies including the investment needed in and contextual factors that activate VHA providers, leaders, and Veterans to use data to transform and improve care and patient outcomes; and 4) activate Veteran patients to engage in the healthcare system to manage their health. Methods: With the ongoing input of our core VHA Operational partners, we are accomplishing these aims via core research and quality improvement projects that cover multiple conditions and care settings. Our projects focus on: 1) national implementation of TeleStroke in rural VHA, 2) testing telehealth modules and electronic quality measures for improving rapid transient ischemic attack (TIA) care, 3) decision support to deimplement inappropriate carotid ultrasound image ordering, and 4) regional implementation of TeleRobotics in rural VHA. These projects are supported by an Implementation and Data Core that I lead which works across all projects to facilitate efficient use of data; usability testing of new tools; and standardized use of implementation measures, methods, and analytic approaches. Our overarching implementation strategy focuses on activating individuals and groups to use data to transform care, and we use the CFIR framework to plan data collection and analyses across projects to identify core implementation strategies and contextual factors that impact how people use data to transform care. Key partners include the Office of Specialty Care, the Office of Rural Health, the Office of Telehealth, the Roudebush VAMC, and the VA Center for Applied Systems Engineering. We have developed a professional video modeling a multidisciplinary VA healthcare team which uses data to activate provider changes across services in a data driven way to improve the quality of care, and provider/patient satisfaction. Using Planning, Goal Setting, and Reflection and Evaluation, we are promoting provider behavior modification and team activation. Moreover, we employ the strategy of external facilitation to guide clinical teams in the VHA field. In addition, my research on patient self-management programs attempts to reach Veterans where they are to engage in the healthcare system to promote their optimal health and functioning. I am piloting the adaptation of cardiac rehabilitation to delivery adjuvant recovery programs for Veterans with cerebrovascular events and other conditions. Anticipated impacts: Our project evaluations are addressing the important implementation questions about how best to activate providers, healthcare teams, and Veterans to improve healthcare delivery and outcomes across clinical conditions and settings. We anticipate demonstrating the effectiveness of our implementation strategies as well elucidating upon the tailoring to the local contexts and the adequate dose of the strategies to achieve sustainable implementation within the VHA system with applications to other healthcare systems. Moreover, my Veteran centered patient programs may help Veterans to engage with providers of their care and thus improving Veteran satisfaction and outcomes of care.