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

描述(由申请人提供)： 项目背景：退伍军人人数在退伍军人中占少数，这给提供对性别问题有敏感认识的综合服务带来了后勤挑战。随着更多的WV加入退伍军人管理局的护理，这些挑战只会变得越来越大。他们接受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认识，包括对隐私/安全的充分关注以及对WVS的军事角色和经历的认识，往往缺乏。现场提供的针对性别的服务也没有跟上步伐，与十年前相比，WVS现在更有可能被外包进行针对性别的护理。此外，尽管有WH诊所的退伍军人管理局机构的比例有所增加，但其中44%的机构没有提供全面的初级保健(PC)服务，而是只专注于针对性别的检查。缺乏对性别问题有敏感认识的、全面的卫生保健服务，也对患者在获取、连续性和协调性以及技术质量方面的评级产生了影响。项目目标：我们的目标是评估采用整群随机试验设计(目标1)开发WH-PACT模型的EBQI方法的有效性；检查接受WH-PACT协调护理对女性退伍军人结局的影响(目标2)；评估EBQI支持的WH-PACT实施过程(目标3)；以及开发实施和评估工具，用于EBQI支持的WH-PACT模型的适应、实施、可持续性和推广到更多的退伍军人设施(目标4)。项目方法：EBQI是一种系统的方法，旨在开发多层次的研究-临床伙伴关系方法，以动员当地组织高级领导人和QI团队在先前证据、当地实践背景和提供者行为变化方法的背景下适应和实施新的护理模式，并由研究人员提供技术支持和实践促进。在一项群组随机试验中，我们将使用患者、提供者和实践调查，以及对辅助数据的分析，以及提供者、员工和团队知识和态度的中间变化，来评估WH-PACT模型的成就。我们还将探讨接受WH-PACT护理对慢性病护理和预防的质量、健康状况、利用率和成本的影响。我们将使用混合方法，评估EBQI后的实践背景；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的实施；并通过半结构化访谈和每月形成进展说明和行政数据相结合的方式，审查EBQI支持的WH-PACT实施的障碍/促进者。

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.