QUERI for Team-Based Behavioral Health

 描述(由申请人提供)： 1)预期对退伍军人医疗保健的影响使用共同的促进技术和共同措施，这项QUERI计划将加强对有行为健康状况的退伍军人的基于团队的护理，并为其提供信息。具体地说，我们将促进退伍军人管理局了解如何通过使用实施促进战略来改善基于团队的行为卫生保健，并预期退伍军人的结果会有所改善。数据将与VHA和VA/非VA共享医疗中的医疗相关。2)项目背景VHA最近的几项国家倡议强调以团队为基础的护理，包括以患者为中心的护理团队(PACT)、初级护理心理健康整合(PC-MHI)和行为健康跨学科计划(BHIP)团队。基于团队的护理也发生在VHA的实体之外，因为最近颁布的退伍军人选择法案要求退伍军人更好地了解退伍军人如何体验由非退伍军人社区提供者提供的护理或由VHA和非VHA提供者共享的护理。3)项目目标我们的计划影响目标是：改善对有行为健康状况的退伍军人的团队护理的协调性、质量、公平性和结果。我们广义地定义基于团队的护理包括通过跨学科的退伍军人管理局临床团队提供的跨学科的护理，以及由退伍军人管理局和非退伍军人管理局提供的护理。总体方案目标包括：目标1：了解(通过严格评估)和加强(通过促进)在跨学科退伍军人治疗团队中接受治疗的退伍军人以及退伍军人和退伍军人社区服务提供者之间共享护理的协调、质量、公平和结果。目标2：推进(通过促进)基于测量的护理交付战略，以增强退伍军人的个性化、主动性和患者驱动型护理。目标3：通过开发、评估和改进新的工具和资源来促进实施科学，以支持使用便利化来实施响应退伍军人管理局优先事项的临床计划/实践。4)项目方法通过密集的战略规划过程，我们确定了一套高度协调和集成的项目，以实现我们的计划目标，推进实施科学，并在临床计划和政策实施方面解决系统优先事项。计划项目的重点包括：1)在VISN 20实施远程健康的质量改进项目；2)基于循证协作式慢性护理模型在后来的采用者地点实施BHIP团队；3)改进PC-MHI团队中患者报告结果的使用；3)加强对退伍军人从退伍军人事务部和非退伍军人事务部获得的行为健康护理的协调和质量的理解；以及5)在PACT团队中实施同行专家，以回应白宫的行政行动。我们的实施核心综合了横切的科学主题、设计元素和在我们项目中应用的措施。项目将收集与组织背景、团队发展、与健康相关的生活质量和退伍军人满意度有关的共同衡量标准，我们将在项目中汇总这些数据，以产生方案一级的结论：a)背景因素对执行成功和促进强度的影响；以及b)执行促进对 重新瞄准领域、团队发展和老将成果。我们还将开发一个新的执行便利化忠实工具，并编制一份最新的执行便利化培训手册，供退伍军人管理局业务和研究人员使用。

 DESCRIPTION (provided by applicant): 1) Anticipated impacts on Veteran's healthcare Using common facilitation techniques and common measures, this QUERI program will enhance and inform team-based care for Veterans with behavioral health conditions. Specifically, we will advance VA's knowledge of how team-based behavioral health care can be improved through use of implementation facilitation strategies, with anticipated improvements in Veteran outcomes. Data will be relevant to care within VHA and VA/non-VA shared care. 2) Project background Team-based care is emphasized in several recent VHA national initiatives, including Patient-Aligned Care Teams (PACT), Primary Care Mental Health Integration (PC-MHI), and Behavioral Health Interdisciplinary Program (BHIP) teams. Team-based care also occurs beyond the bricks and mortar of VHA, as recent enactment of the Veterans Choice Act requires VA to better understand how Veterans experience care delivered by non-VA community providers or that is shared between VHA and non-VHA providers. 3) Project objectives Our Program Impact Goal is to: Improve coordination, quality, equity, and outcomes of team-based care for Veterans with behavioral health conditions. We define team-based care broadly to include care provided through interdisciplinary VA clinical teams, across disciplines, as well as care of Veterans shared by VA and non-VA providers. Overall program aims include: Aim 1: Understand (through rigorous evaluation) and enhance (through facilitation) coordination, quality, equity and outcomes of care for Veterans treated within interdisciplinary VA treatment teams and via shared care across VA and non-VA community service providers. Aim 2: Advance (through facilitation) measurement-based care delivery strategies that enhance personalized, proactive, and patient-driven care for Veterans. Aim 3: Advance implementation science by developing, evaluating and refining new tools and resources to support use of facilitation to implement clinical programs/practices that are responsive to VA priorities. 4) Project methods Through an intensive strategic planning process, we identified a suite of highly coordinated and integrated projects to achieve our program aims, advance implementation science, and address system priorities in terms of clinical program and policy implementation. Foci of program projects include: 1) a quality improvement project implementing telemental health in VISN 20; 2) implementing BHIP teams in later adopter sites based on evidence-based collaborative chronic care models; 3) improving use of patient reported outcome measures within PC-MHI teams; 3); 4) enhancing understanding of Veteran perspectives on coordination and quality of behavioral health care received from VA and non-VA providers; and 5) implementing peer specialists in PACT teams in response to a White House executive action. Our Implementation Core synthesizes cross-cutting scientific themes, design elements, and measures applied across our projects. Projects will collect common measures pertaining to organizational context, team development, health-related quality-of-life and Veteran satisfaction, and we will aggregate these data across projects to produce program-level findings on: a) influence of contextual factors on implementation success and facilitation intensity; and b) effects of implementation facilitation on RE-AIM domains, team development and Veteran outcomes. We will also develop a new implementation facilitation fidelity tool and produce an updated Implementation Facilitation Training Manual for use by VA operations and researchers.