Center for Healthcare Organization and Implementation Research (CHOIR)

描述(由申请人提供)： 医疗保健组织和实施研究中心(CHIIR)是一个高铁创新研发中心(COIN)，致力于通过开发、研究和应用将被广泛实施和持续的循证实践来改善退伍军人的健康结果。合唱团建立在位于贝德福德退伍军人医院和退伍军人管理局波士顿医疗系统的两个长期且非常成功的HSR&D卓越中心的基础上。与退伍军人管理局的主要利益相关者合作，包括退伍军人新英格兰医疗系统(VISN 1)、患者护理服务办公室-精神健康服务、国家退伍军人无家可归中心、药房福利管理服务和公共卫生办公室，我们建议将我们的研究集中在三个关键领域：1.加强对行为脆弱人群的以康复为导向的护理。我们打算加强退伍军人管理局向以康复为导向的医疗体系的转变，并改善行为脆弱的退伍军人以康复为导向的结果。我们的战略包括调查人员努力解决操作定义中的知识差距，为实施高优先级计划铺开建立科学基础，并调整现有的干预证据，以用于这一行为脆弱的人群。2.用药优化方案。为退伍军人患者提供最佳药物治疗包括退伍军人管理局关于更安全、更有效、更以患者为中心和更具成本效益的处方实践的许多优先事项。现有的工具允许一些能力，以确保患者的药物优化。然而，重要的差距仍然存在。我们将通过研究如何以及为什么开出药物治疗，评估药物治疗的有益和有害结果，以及制定和评估促进更高质量使用药物治疗的实施战略来解决这些差距。3.公共卫生传播(PHC)。传统和新兴媒体和消息传递可用于向退伍军人保健内外的退伍军人传递和交换有关退伍军人系统范围公共卫生优先事项的信息。这些优先事项包括大规模不良事件、部署环境健康风险和健康行为改变。在沟通信息方面仍然存在一个重要的差距，即最大限度地增加退伍军人对退伍军人护理的信任，最大限度地减少对潜在伤害的看法，并鼓励退伍军人的自我管理。我们将努力提供证据基础和工具，就一系列公共卫生问题进行沟通，利用社交媒体和移动健康平台等最佳沟通渠道，创建有效的信息传递，使退伍军人能够优先考虑自己的健康。合唱团的研究将在其他领域进行，包括组织科学、实施科学、长期护理、患者安全、卫生服务基因组学和以患者为中心的沟通。我们还完全致力于培训新一代卫生服务研究人员，强调与运营合作伙伴开发和开展研究的能力，并与退伍军人事务部的其他调查人员合作。通过这些活动，我们打算将科学付诸实践，并促进组织适应，以维持退伍军人在退伍军人保健系统各级中以科学为基础的成果。

DESCRIPTION (provided by applicant): The Center for Healthcare Organization and Implementation Research (CHOIR) is an HSR&D Center of Innovation (COIN) dedicated to improving Veterans' health outcomes by developing, studying, and applying evidence-based practices that will be widely implemented and sustained. CHOIR builds on two long-standing and highly successful HSR&D Centers of Excellence based at the Bedford VA Hospital and the VA Boston Healthcare System. In partnership with key VA stakeholders, including VA New England Healthcare System (VISN 1), the Office of Patient Care Services-Mental Health Services, the National Center on Homelessness Among Veterans, Pharmacy Benefits Management Service, and the Office of Public Health, we propose to focus our research on three critical areas: 1. Enhancing Recovery-Oriented Care for Behaviorally Vulnerable Populations. We intend to enhance the transformation of VA to a recovery-oriented healthcare system, and to improve recovery-oriented outcomes for behaviorally vulnerable Veterans. Our strategy involves investigators working to address a knowledge gap in operational definitions, build a scientific basis for implementing high-priority program rollouts, and adapt existing interventional evidence for use with this behaviorally vulnerable population. 2. Medication Optimization Program. Providing optimal medication treatment to Veteran patients encompasses many VA priorities regarding safer, more effective, more patient-centered, and more cost-efficient prescriptive practices. Existing tools allow some ability to ensure medication optimization for patients. However, important gaps remain. We will address these gaps by examining how and why medication therapy is prescribed, estimating beneficial and harmful outcomes of medication therapy, and developing and evaluating implementation strategies to promote higher-quality use of medication therapies. 3. Public Health Communication (PHC). Traditional and emerging media and messaging may be used to deliver and exchange information about VA system-wide public health priorities to Veterans both inside and outside of VA care. These priorities include large-scale adverse events, deployment environmental health risks, and health behavior change. An important gap remains regarding best practices in communicating information that maximizes Veterans' trust in VA care, minimizes perceptions of potential harm, and encourages Veterans' self-management. We will work to provide an evidence base and tools for communicating about a range of public health issues, utilizing optimal communication channels such as social media and mobile health platforms, to create effective messaging that empowers Veterans to prioritize their health. CHOIR research will be performed in other areas including organization science, implementation science, long-term care, patient safety, health services genomics and patient-centered communication. We are also fully committed to training a new generation of health services researchers, emphasizing capabilities in developing and conducting research with operational partners, and collaborating with other investigators throughout VA. Through these activities, we intend to move science into practice and to facilitate organizational adaptation to sustain science-based gains for Veterans throughout all levels of the VA healthcare system.