PrOVE: PeRsonalizing Options through Veteran Engagement

ProOVE：通过退伍军人参与实现个性化选择

• 批准号: 9075231
• 负责人: ANGELA FAGERLIN
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-10-01 至 2020-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9075231
• 关键词: Accounting; Address; Address; Age; Age; Ambulatory Care Facilities; Ambulatory Care Facilities; Benefits and Risks; Benefits and Risks; Businesses; Businesses; Caring; Caring; Chronic; Chronic; Client satisfaction; Client satisfaction; Clinical; Clinical; Clinical Management; Clinical Management; Clinical Trials; Clinical Trials; Collaborations; Collaborations; Communities; Communities; Data; Data; Data Analyses; Decision Support Systems; Decision Support Systems; Development; Development; Diabetes Mellitus; Diabetes Mellitus; Disease; Disease; Effectiveness; Effectiveness; Elements; Elements; Engineering; Engineering; Evaluation; Evaluation; Funding; Funding; Goals; Goals; Guidelines; Guidelines; Health; Health Promotion; Health Promotion; Health Status; Health Status; Healthcare; Healthcare; Homogeneously Staining Region; Individual; Individual; Intelligence; Intelligence; Intervention; Measures; Measures; Medical center; Medical center; Patient Preferences; Patient Preferences; Patient risk; Patient risk; Patients; Patients; Performance; Performance; Personal Satisfaction; Personal Satisfaction; Population Study; Population Study; Prevention; Prevention; Prevention strategy; Prevention strategy; Primary Health Care; Primary Health Care; Provider; Provider; Qi; Quality of Care; Quality of Care; Research; Research; Resources; Resources; Risk; Risk; Risk Factors; Risk Factors; Running; Running; Self Management; Self Management; Services; Services; Site; Site; System; System; Techniques; Techniques; Testing; Testing; Variant; Variant; Veterans; Veterans; Vision; Vision; Weight maintenance regimen; Weight maintenance regimen; Work; Work; base; base; clinical center; disorder prevention; disorder prevention; evidence base; evidence base; experience; experience; health care delivery; health care delivery; implementation research; implementation research; implementation science; implementation science; implementation strategy; improved; improved; individual patient; individualized prevention; individualized prevention; intervention program; lung cancer screening; lung cancer screening; patient engagement; patient oriented; patient oriented; personalized care; personalized care; personalized decision; personalized health care; preference; preference; prevent; prevent; programs; programs; public health relevance; public health relevance; screening; screening program; self-management program; shared decision making; shared decision making; success; success; tool; tool; treatment risk

 DESCRIPTION (provided by applicant): "One size does not fit all" in health care. No two Veterans are alike, nor are any two VA medical centers or community-based outpatient clinics (CBOCs). Decisions in healthcare delivery too often are based on "average" effects. Current guidelines and performance measures often recommend prescribing the same treatments to many different types of patients based on the average result of a clinical trial without considering important differences between patients. This proposed QUERI builds on an extensive body of work by the VA Center for Clinical Management Research (CCMR, a VA HSR&D COIN) and the Diabetes QUERI on individualizing prevention strategies and treatments to improve the effectiveness of care delivered to Veterans. The overall Impact Goal of our proposed QUERI is to improve prevention and management of chronic conditions by supporting Veterans and providers in making personalized healthcare decisions that take into account individual patient risk and preferences. Through this goal we aim to improve appropriateness of care (decrease overuse and underuse), increase Veteran engagement in their health care, and enhance Veteran experiences. This goal aligns directly with the Blueprint for Excellence Strategy Six: Advance healthcare that is personalized, proactive, and patient-driven, and engages and inspires Veterans to their highest possible level of health and well-being. The specific aims for our QUERI program include the following: 1. Implement patient-centered performance management systems that enhance appropriateness of care and incorporate shared decision-making. 2. Implement personalized self-management programs for promoting health and preventing disease. Our QUERI program will include the following projects beginning in year 1: Project #1: This project will include the implementation and evaluation of a shared-decision making tool for lung cancer screening in collaboration with VA's National Center for Health Promotion and Disease Prevention (NCP) and the Office of Primary Care. The evidence-based tool has been developed and pilot tested at the Ann Arbor VAMC and will be disseminated to the eight VAMCs that are currently participating as pilot sites in NCP's national Lung Cancer Screening Demonstration project. Project #2: In this project we will work with NCP and VA's Office of Analytics and Business Intelligence (OABI) to improve dissemination of the new MOVE! guidelines, with the goal of reducing wide local variation in the effectiveness of MOVE! and maximizing personalized weight management support for patients in a group setting. Local QI Initiative: This project will implement and evaluate a performance management tool for improving statin use in the Ann Arbor VAMC that is personalized to individual patient risk factors. Implementation Core: This core will focus on using the Consolidated Framework for Implementation Research (CFIR) to collect and analyze data on context across studies, both for this QUERI and in collaboration with at least five other QUERI programs (if they are funded) to determine the association between context and implementation success. Our implementation strategies for all projects will incorporate systems redesign techniques (in collaboration with VA's Center for Applied Systems Engineering) with use of a tailoring tool (the "Barrier Busters" Tool) that will help local teams chose appropriate implementation strategies based on features of local context.

 描述(由申请人提供)： 在医疗保健领域，“一刀切并不适合所有人”。没有两个退伍军人是相同的，任何两个退伍军人医疗中心或社区门诊(CBOC)也是如此。在提供医疗保健时，太多的决策都是基于“平均”效果。目前的指南和绩效衡量标准通常建议根据临床试验的平均结果对许多不同类型的患者开出相同的治疗处方，而不考虑患者之间的重要差异。这 拟议的QUERI建立在退伍军人临床管理研究中心(CCMR，VA HSR&D硬币)和糖尿病QUERI关于个性化预防策略和治疗以提高向退伍军人提供护理的有效性的广泛工作的基础上。我们建议的QUERI的总体影响目标是通过支持退伍军人和提供者做出考虑患者个人风险和偏好的个性化医疗决策，改善慢性病的预防和管理。通过这一目标，我们的目标是改善护理的适当性(减少过度使用和使用不足)，增加退伍军人对其医疗保健的参与度，并改善退伍军人的体验。这一目标与卓越蓝图战略六直接一致：推进个性化、主动性和以患者为导向的医疗保健，并让退伍军人参与并激励他们达到尽可能高的健康和福祉水平。我们QUERI计划的具体目标包括：1.实施以患者为中心的绩效管理系统，提高护理的适当性，并纳入共享决策。2.实施个性化自我管理计划，促进健康，预防疾病。我们的QUERI计划将从第一年开始包括以下项目：项目#1：该项目将包括 与退伍军人事务部国家健康促进和疾病预防中心(NCP)和初级保健办公室合作，实施和评估肺癌筛查共享决策工具。该循证工具已在Ann Arbor VAMC开发并进行了试点测试，并将分发给目前作为NCP全国肺癌筛查示范项目试验点参与的八个VAMC。项目2：在这个项目中，我们将与NCP和退伍军人管理局分析和商业智能办公室(OABI)合作，改善新举措的传播！指导方针，目的是减少大范围局部变异的效果！以及在群体设置中最大化对患者的个性化体重管理支持。本地QI计划：该项目将实施和评估一种绩效管理工具，以改善Ann Arbor VAMC中他汀类药物的使用，该工具针对单个患者的风险因素进行个性化设置。实施核心：这一核心将侧重于使用实施研究综合框架(CFIR)来收集和分析跨研究的背景数据，包括本QUERI以及与至少五个其他QUERI计划(如果它们得到资助)的合作，以确定背景与实施成功之间的关联。我们所有项目的实施战略将结合系统重新设计技术(与退伍军人管理局应用系统工程中心合作)，并使用定制工具(“障碍破坏者”工具)，帮助当地团队根据当地环境的特点选择适当的实施战略。