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Damush HSR&D Research Career Scientist Award Application

达穆什高铁

基本信息

批准号：
9553939
负责人：
TERESA M. DAMUSH
金额：
--
依托单位：
RLR VA MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-04-01 至 2024-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9553939
关键词：
Acute Acute Address Address Adjuvant Adjuvant Area Area Award Award Back Pain Back Pain Behavior Behavior Behavior Therapy Behavior Therapy Cardiac rehabilitation Cardiac rehabilitation Caring Caring Chronic Disease Chronic Disease Client satisfaction Client satisfaction Clinical Clinical County County Data Data Data Analyses Data Analyses Data Collection Data Collection Department of Defense Department of Defense Development Development Dose Dose Effectiveness Effectiveness Emergency Medicine Emergency Medicine Engineering Engineering Enrollment Enrollment Evaluation Evaluation Event Event Evidence based practice Evidence based practice Feedback Feedback Goals Goals Health Health Health Services Health Services Healthcare Healthcare Healthcare Systems Healthcare Systems Hospital safety Hospital safety Hospitals Hospitals Individual Individual Internal Medicine Internal Medicine Intervention Intervention Investments Investments Italy Italy Joints Joints Journals Journals Lead Lead Link Link Low Back Pain Low Back Pain Measures Measures Medical Care Team Medical Care Team Mentors Mentors Methods Methods Midwestern United States Midwestern United States Modeling Modeling Monitor Monitor Musculoskeletal Pain Musculoskeletal Pain Neurologic Deficit Neurologic Deficit Neurologist Neurologist Neurology Neurology Nursing Staff Nursing Staff Outcome Outcome Pain Pain Patient-Focused Outcomes Patient-Focused Outcomes Patients Patients Performance Performance Policies Policies Population Population Process Process Provider Provider Psychologist Psychologist Public Health Public Health Publications Publications Publishing Publishing Quality of Care Quality of Care Recovery Recovery Recovery of Function Recovery of Function Reporting Reporting Research Research Research Personnel Research Personnel Rural Rural Rural Health Rural Health Sampling Sampling Scientist Scientist Self Management Self Management Services Services Standardization Standardization Stroke Stroke Symptoms Symptoms System System Telerobotics Telerobotics Testing Testing Training Training Transient Ischemic Attack Transient Ischemic Attack Translations Translations Ultrasonography Ultrasonography Veterans Veterans Work Work acute stroke acute stroke appropriate dose base base behavioral outcome behavioral outcome care outcomes care outcomes care providers care providers care systems care systems career career cerebrovascular cerebrovascular clinical practice clinical practice contextual factors contextual factors design design electronic data electronic data evidence base evidence base formative assessment formative assessment health administration health administration health care delivery health care delivery health care service organization health related quality of life health related quality of life implementation research implementation research implementation science implementation science implementation strategy implementation strategy improved improved medical specialties medical specialties multidisciplinary multidisciplinary operation operation patient oriented patient oriented peer support peer support programs programs response response satisfaction satisfaction self-management program self-management program stroke recovery stroke recovery telehealth telehealth therapy development therapy development tool tool usability usability virtual virtual

项目摘要

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.

背景：新的政策和医疗流程不断推广到临床工作人员的前线以及跨临床条件和 VHA 内多种设置的提供者。对这项投资知之甚少 VHA 医疗机构需要纳入基于证据的实施策略，以实现系统化执行。此外，实施科学最近才开始确定一套实施方案策略。需要研究来阐明针对不同情况量身定制的干预策略的适当剂量根据当地情况，以可持续的方式改变提供者的行为和患者的行为以及护理系统执行。通过精准监测（PRIS-M QUERI 中心）转变护理计划，我们进行以下实施评估： 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效果关于护理团队的行为和流程以及退伍军人的行为和满意度； 3）确定实施战略，包括激活 VHA 提供者、领导者和领导者所需的投资和背景因素退伍军人利用数据来改变和改善护理和患者的治疗结果； 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 的持续投入运营合作伙伴，我们正在通过核心研究和质量改进项目来实现这些目标涵盖多种条件和护理环境。我们的项目重点是：1）国家实施 TeleStroke 在农村 VHA 中的应用，2) 测试远程医疗模块和电子质量措施，以快速提高短暂性脑缺血发作 (TIA) 护理，3) 为消除不适当的颈动脉超声提供决策支持图像排序，以及 4) 在农村 VHA 中远程机器人的区域实施。这些项目得到了支持我领导的实施和数据核心适用于所有项目，以促进数据的有效使用；新工具的可用性测试；实施措施、方法和分析的标准化使用接近。我们的总体实施策略侧重于激活个人和团体使用数据为了转变护理方式，我们使用 CFIR 框架来规划跨项目的数据收集和分析，以确定影响人们如何使用数据进行转型的核心实施策略和背景因素关心。主要合作伙伴包括专业护理办公室、农村卫生办公室、远程医疗办公室、 Roudebush VAMC 和 VA 应用系统工程中心。我们开发了专业的视频对多学科 VA 医疗保健团队进行建模，该团队使用数据来激活跨学科的提供者变更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修正和团队激活。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，我对患者自我管理计划的研究试图帮助退伍军人到达他们想要的地方参与医疗保健系统以促进他们的最佳健康和功能。我正在试点适应心脏康复为患有脑血管事件的退伍军人提供辅助康复计划其他条件。预期影响：我们的项目评估正在解决重要的实施问题有关如何最好地激励提供者、医疗团队和退伍军人改善医疗服务的问题以及跨临床条件和环境的结果。我们期望展示我们的有效性实施战略以及根据当地情况进行调整和适当剂量的说明在 VHA 系统内实现可持续实施并应用于其他领域的策略医疗保健系统。此外，我以退伍军人为中心的患者计划可能会帮助退伍军人参与提供者的护理，从而提高退伍军人的满意度和护理结果。