Damush HSR&D Research Career Scientist Award Application

背景：新的政策和医疗保健流程不断推出到临床工作人员的第一线 VHA内的临床条件和多种设置的供应商。对这项投资的了解较少 VHA医疗保健组织需要纳入基于证据的实施策略，以实现系统性 实施.此外，实施科学直到最近才开始确定一套实施方案。 战略布局需要进行研究，以阐明针对以下情况制定的干预策略的适当剂量： 当地环境，以修改提供者的行为和患者的行为和护理系统， 实施.通过Precision Monitoring（PRIS-M QUERI Center）to Transform Care计划， 开展以下实施评价：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 护理团队行为和流程以及退伍军人行为和满意度; 3）确定实施情况 战略，包括所需的投资和激活VHA提供者，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， 参与医疗保健系统来管理他们的健康。方法：随着我们核心VHA的持续投入， 业务合作伙伴，我们正在通过核心研究和质量改进项目实现这些目标 涵盖多种条件和护理环境。我们的项目侧重于：1）国家执行 农村VHA的TeleStroke，2）测试远程保健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）决策支持，以取消不适当的颈动脉超声 图像排序，和4）远程机器人在农村VHA的区域实施。这些项目得到了 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;以及标准化使用实施措施、方法和分析 接近。我们的总体实施战略侧重于激活个人和团体使用数据 我们使用CFIR框架来规划跨项目的数据收集和分析， 确定影响人们如何使用数据进行转型的核心实施战略和环境因素 在乎主要合作伙伴包括专科护理办公室、农村卫生办公室、远程保健办公室、 Roudebush VAMC和VA应用系统工程中心。我们开发了一个专业的 视频建模多学科VA医疗保健团队，该团队使用数据激活跨 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， 目标设定、反思和评估，我们正在促进提供者行为的改变和团队合作 activation.此外，我们采用外部促进策略来指导VHA领域的临床团队。在 此外，我对病人自我管理计划的研究试图达到退伍军人，他们是 参与医疗保健系统，以促进他们的最佳健康和功能。我正在驾驶 心脏康复，为患有脑血管事件的退伍军人提供辅助恢复计划， 其他条件。预期影响：我们的项目评估正在解决重要的实施问题， 关于如何最好地激活提供者、医疗保健团队和退伍军人以改善医疗保健服务的问题 以及临床条件和环境下的结果。我们期望展示我们的有效性， 执行战略，并阐明根据当地情况调整和适当剂量的 在VHA系统内实现可持续实施的战略， 医疗保健系统。此外，我的以退伍军人为中心的患者计划可以帮助退伍军人参与 他们的护理提供者，从而提高退伍军人的满意度和护理结果。

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.