Implementation of VA Womens Health Patient Aligned Care Teams WH-PACTs

实施 VA 妇女健康患者协调护理团队 WH-PACT

• 批准号: 8399383
• 负责人: ELIZABETH M YANO
• 金额: --
• 依托单位: VA GREATER LOS ANGELES HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-03-01 至 2017-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8399383
• 关键词: Achievement; Address; Attention; Attitude; Awareness; Caring; Chronic Disease; Clinic; Clinical; Clinical Trials Design; Contracts; Data; Development; Dietitian; Discipline of obstetrics; Effectiveness; Enrollment; Environment; Evaluation; Gender; Goals; Gynecology; Health Resources; Health Status; Healthcare; Home environment; Hospitals; Improve Access; Individual; Interview; Investments; Knowledge; Link; Medical; Methods; Military Personnel; Minority; Modeling; Neighborhoods; Nurses; Outcome; Patients; Pharmacists; Prevention; Primary Health Care; Privacy; Process; Provider; Quality of Care; Randomized; Research; Research Personnel; Resources; Role; Safety; Services; Site; Social Workers; Societies; Specialist; Structure; Surveys; Testing; Training; Translating; Veterans; Visit; Woman; Women' s Health; Work; base; behavior change; care delivery; chronic care model; cost; evidence base; experience; health care delivery; improved; male; medical specialties; meetings; named group; patient oriented; randomized trial; satisfaction; tool

DESCRIPTION (provided by applicant): Project Background: Women Veterans' numerical minority in VA healthcare settings has created logistical challenges to delivering gender-sensitive comprehensive services. These challenges have only grown as more WVs have enrolled in VA care. The quality of care they receive continues to lag behind that of male veterans, while gender sensitivity, including adequate attention to privacy/safety and awareness of WVs' military roles and experiences, is often lacking. On-site availability of gender-specific services has also not kept pace, with WVs more likely to be outsourced for gender-specific care now than they were ten years ago. Further, while the proportion of VA facilities having WH clinics has increased, 44% of them do not deliver comprehensive primary care (PC) services, instead focusing only on gender-specific exams. Lack of gender-sensitive, comprehensive WH care delivery has also demonstrated consequences for patient ratings of access, continuity and coordination, and technical quality. Project Objectives: We aim to assess the effectiveness of EBQI methods for developing a WH-PACT model using a cluster randomized trial design (Aim #1); examine impacts of receipt of WH-PACT concordant care on women veterans' outcomes (Aim #2); evaluate processes of EBQI-supported WH-PACT implementation (Aim #3); and develop implementation and evaluation tools for use in EBQI-supported WH-PACT model adaptation, implementation, sustainability and spread to additional VA facilities (Aim #4). Project Methods: EBQI is a systematic approach to developing a multi-level research-clinical partnership approach to engaging local organizational senior leaders and QI teams in adapting and implementing new care models in the context of prior evidence, local practice context, and provider behavior change methods, with researchers providing technical support and practice facilitation. In a cluster randomized trial, we will evaluate WH-PACT model achievement using patient, provider and practice surveys, in addition to analyses of secondary data, in addition to intermediate changes in provider, staff and team knowledge and attitudes. We will also explore impacts of receipt of WH-PACT care on quality of chronic disease care and prevention, health status, utilization and costs. Using mixed methods, we will assess pre-post EBQI practice context; document EBQI methods and their relationship to provider/staff and team actions/attitudes; document WH-PACT implementation; and examine barriers/facilitators to EBQI-supported WH-PACT implementation through a combination of semi-structured interviews and monthly formative progress narratives and administrative data.

描述（由申请人提供）： 项目背景：退伍军人在退伍军人管理局医疗机构中的人数少数，对提供对性别问题有敏感认识的综合服务造成了后勤挑战。这些挑战只会随着越来越多的妇女加入退伍军人事务部的护理而增加。他们得到的护理质量仍然落后于男性退伍军人，而对性别问题的敏感性，包括对隐私/安全的充分关注以及对退伍军人的军事作用和经历的认识，往往缺乏。现场提供的针对性别的服务也没有跟上步伐，妇女志愿者现在比十年前更有可能外包针对性别的护理。此外，虽然拥有WH诊所的退伍军人事务机构的比例有所增加，但其中44%的机构不提供全面的初级保健服务，而只注重针对性别的检查。缺乏对性别问题有敏感认识的全面的妇女保健服务也对患者的可获得性、连续性和协调性以及技术质量的评级产生了影响。项目目标：我们的目标是评估EBQI方法的有效性，以开发一个WH-PACT模型，使用一个集群随机试验设计（目标#1）;检查的影响，接受WH-PACT一致的护理对妇女退伍军人的结果（目标#2）;评估过程中EBQI支持的WH-PACT实施（目标#3）;开发实施和评估工具，用于EBQI支持的WH-PACT模型适应、实施、可持续性和向其他VA设施的推广（目标4）。项目方法：EBQI是一种系统的方法，用于开发多层次的研究-临床合作伙伴关系方法，以使当地组织高级领导和QI团队在先前证据，当地实践背景和提供者行为改变方法的背景下适应和实施新的护理模式，研究人员提供技术支持和实践促进。在一项随机分组试验中，我们将使用患者，提供者和实践调查评估WH-PACT模型的成就，除了分析二级数据，以及提供者，工作人员和团队知识和态度的中间变化。我们还将探讨接受WH-PACT护理对慢性病护理和预防质量、健康状况、利用率和成本的影响。使用混合的方法，我们将评估前后EBQI实践背景;记录EBQI方法及其与提供者/工作人员和团队行动/态度的关系;记录WH-PACT实施情况;并通过半结构化访谈和每月形成性进展叙述和行政数据的组合，检查EBQI支持的WH-PACT实施的障碍/促进因素。