Complementary and Integrative Health Evaluation Center (CIHEC)

补充综合健康评估中心 (CIHEC)

• 批准号: 9395218
• 负责人: STEPHANIE L TAYLOR
• 金额: --
• 依托单位: VA GREATER LOS ANGELES HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-04-01 至 2024-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9395218
• 关键词: Academy; Academy; Acupuncture Therapy; Acupuncture Therapy; Address; Address; Adverse effects; Attention; Attention; Businesses; Businesses; Caring; Caring; Clinical; Clinical; Collection; Collection; Complementary Health; Data; Data; Data Collection; Data Collection; Dimensions; Dimensions; Ear Acupuncture; Ear Acupuncture; Effectiveness; Effectiveness; Evaluation; Evaluation; Face; Face; Funding; Funding; Goals; Goals; Health; Health; Health Care Costs; Health Care Costs; Health Policy; Health Policy; Healthcare; Healthcare; Homogeneously Staining Region; Hybrids; Hybrids; Institutes; Institutes; Integrative Medicine; Integrative Medicine; Intelligence; Intelligence; Learning; Learning; Medical; Medical; Medicine; Medicine; Meditation; Meditation; Methods; Methods; Military Personnel; Military Personnel; National Health Services; National Health Services; Opioid; Opioid; Outcome; Pain; Pain; Pain management; Pain management; Patient Care; Patient Care; Patient Outcomes Assessments; Patient Outcomes Assessments; Patient-Centered Care; Patient-Centered Care; Patients; Patients; Policies; Policies; Procedures; Procedures; Process; Process; Promoting Action on Research Implementation in Health Services framework; Protocols documentation; Protocols documentation; Ramp; Ramp; Randomized Controlled Trials; Randomized Controlled Trials; Recovery; Recovery; Reporting; Reporting; Research; Research; Sampling; Sampling; Scanning; Scanning; Self Management; Self Management; Services; Site; Site; Surgeon; Surgeon; Surveys; Surveys; Tai Ji; Tai Ji; Testing; Testing; Veterans; Veterans; Work; Work; Yoga; Yoga; addiction; addiction; base; base; care systems; clinical care; clinical care; design; design; effectiveness testing; evidence base; evidence base; experience; experience; health care delivery; health care delivery; health practice; health practice; implementation barriers; implementation efforts; implementation evaluation; implementation facilitation; implementation outcomes; implementation science; implementation science; implementation strategy; implementation study; improved; improved; informant; informant; insight; insight; meetings; meetings; mindfulness meditation; mindfulness meditation; operation; operation; point of care; point of care; population health; population health; preference; preference; programs; programs; response; response; routine care; routine care; side effect; treatment as usual; treatment as usual

Project Background: Complementary and integrative health (CIH) such as acupuncture, mindfulness meditation and yoga are emerging as safe, non-pharmacologic options to improve health with few side effects. The VA Evidence Synthesis Program reports the evidence on some CIH as “promising” for certain health conditions that are highly prevalent in Veterans. But the CIH research is almost exclusively on non-Veterans and does not involve patient reported outcomes (PROs). CIH is a national priority for the VA, as it is the focus of a White House request to the VA and a Congressional Act that passed last month, and is specifically included in the 2015 MyVA Integrated Plan, the Blueprint for Excellence, and the Office of Patient Care Services' 2016 PACT Pain Roadmap. Our multi-site qualitative examination of CIH found many reports of unmet Veteran demand for CIH. CIH is reportedly provided in most VHA medical facilities, but usually in very limited capacity due to significant implementation barriers. Project Objectives: In partnership with VHA Office of Patient Centered Care and Cultural Transformation (OPCC&CT), CIHEC's overarching goal is to improve Veterans' health and experiences of care, through increased availability and use of evidence-based CIH. OPCC&CT/CIHEC's specific evaluation goals are to: 1) Improve OPCC&CT's understanding of the details of CIH provision at VHA medical facilities nationally; 2) Improve OPCC&CT's understanding of Veteran preference for and utilization of CIH; 3) Establish procedures for collecting CIH- related PROs in clinical care settings; 4) Examine the effectiveness of CIH on Veterans' health; and 5) Advance implementation science by comparing facilitation strategies across care settings and informing QUERI collaborative efforts to refine facilitation approaches. Project Methods: We propose four projects developed in concert with OPCC&CT. Environmental Scan is a key informant online survey of all CIH service delivery points of contact in the VHA, supplemented with an administrative data extraction, to learn details of what, when, where, and by whom CIH is being delivered. Veteran Preference for and Utilization of CIH will collect data on Veteran demand for and utilization of CIH via the Veteran Insights Panel of 3200 Veterans. Our other two projects are guided by the integrated PARIHS framework and use and test evidence-based facilitation implementation strategies. PRIMIER-I improves the implementation of CIH patient reported outcome (PRO) data collection in usual care settings by developing and evaluating facilitation strategies for changing clinical work flow processes and collecting PROs at the point of care. Battlefield Acupuncture (BFA) is a hybrid type III implementation study that will a) examine the barriers and facilitators to implementing the VA's National Pain Management Program's auricular acupuncture protocol (BFA); b) examine existing and newly developed implementation strategies among a random sample of low-reach sites to examine implementation outcomes and c) test the effectiveness of BFA by collecting Veterans' PROs. We also will integrate our facilitation strategy findings and collaborate with QUERI Programs and operational partners to disseminate findings and contribute to implementation science on facilitation. Our work is guided by input from the OPCC&CT's national Veteran Advisory Council.

项目背景： 针灸、正念冥想和瑜伽等补充和综合健康 (CIH) 正在成为改善健康的安全、非药物选择，且副作用很少。退伍军人管理局的证据 综合计划报告称，某些 CIH 的证据对于某些健康状况“有希望”，这些健康状况是 在退伍军人中非常普遍。但 CIH 的研究几乎完全针对非退伍军人，不涉及 患者报告结果（PRO）。 CIH 是 VA 的国家优先事项，因为它是白宫的重点 向 VA 提出的请求以及上个月通过的一项国会法案，并明确包含在 2015 年法案中 MyVA 综合计划、卓越蓝图以及患者护理服务办公室 2016 年 PACT Pain 路线图。我们对 CIH 进行的多地点定性检查发现许多关于退伍军人需求未得到满足的报告 CIH。据报道，大多数 VHA 医疗机构都提供 CIH，但由于以下原因通常能力非常有限： 重大的实施障碍。 项目目标： CIHEC 与 VHA 以患者为中心的护理和文化转型办公室 (OPCC&CT) 合作 总体目标是通过增加可用性和使用来改善退伍军人的健康和护理体验 循证 CIH 的研究。 OPCC&CT/CIHEC的具体评估目标是： 1) 改进OPCC&CT的 了解全国 VHA 医疗机构提供 CIH 的详细信息； 2) 改进OPCC&CT 了解退伍军人对 CIH 的偏好和利用； 3) 建立收集 CIH 的程序 临床护理环境中的相关 PRO； 4）检查CIH对退伍军人健康的有效性；和 5) 通过比较不同护理机构的促进策略并提供信息来推进实施科学 QUERI 协作努力完善便利方法。 项目方法： 我们提议与 OPCC&CT 合作开发四个项目。环境扫描是关键信息 对 VHA 中所有 CIH 服务提供联系点进行在线调查，并辅以管理数据 提取，以了解 CIH 的交付内容、时间、地点以及由谁交付的详细信息。退伍军人偏好 CIH 的利用将通过退伍军人洞察收集有关退伍军人对 CIH 的需求和利用的数据 由 3200 名退伍军人组成的小组。我们的另外两个项目以综合 PARIHS 框架为指导，并使用和 测试基于证据的便利化实施策略。 PRIMIER-I 改进了 CIH 的实施 通过制定和评估便利化，在常规护理环境中收集患者报告结果 (PRO) 数据 改变临床工作流程和在护理点收集 PRO 的策略。战场 针灸 (BFA) 是一项混合型 III 实施研究，它将 a) 检查针灸治疗的障碍和促进因素 实施 VA 国家疼痛管理计划的耳针治疗方案 (BFA)； b) 在低覆盖范围站点的随机样本中检查现有和新制定的实施策略 检查实施结果；c) 通过收集退伍军人的 PRO 来测试 BFA 的有效性。我们 还将整合我们的促进战略发现并与 QUERI 计划和运营部门合作 合作伙伴传播调查结果并为实施科学促进做出贡献。我们的工作遵循 OPCC&CT 国家退伍军人咨询委员会的意见。