Reproductive Planning for Women Veterans

 描述（由申请人提供）： 背景丽莎Callegari，医学博士，公共卫生硕士是一个博士后HSR&D研究员在弗吉尼亚州普吉特湾，弗吉尼亚州工作人员妇科医生，并在华盛顿大学妇产科助理教授。Callegari的研究反映了她致力于解决女性退伍军人的生殖保健需求。拟议的职业发展奖（CDA-2）将为Callegari博士提供深入的培训和技能，她需要成功地作为一个独立的卫生服务研究人员设计和测试干预措施，以改善妇女退伍军人的生殖保健。职业发展Callegari博士提出的CDA-2将采用创新战略，包括生殖规划和共同决策，以解决妇女退伍军人生殖健康服务的差距。与平民相比，女性退伍军人患有慢性疾病和心理健康疾病的比例更高。这些合并症，再加上女性退伍军人中记录的避孕率低，导致计划外怀孕和不良妊娠结局的风险增加。生育计划讨论促进了对怀孕和避孕药具使用的积极计划，但在实践中很少发生。指导生殖计划讨论的一种新方法是使用基于共同决策原则的决策辅助工具。决策辅助通过将患者的医疗保健决策与他们的价值观和偏好相结合来提高决策质量。虽然决策辅助工具已有效地用于其他生殖健康决定，但尚未为生殖规划制定任何决策辅助工具。本CDA-2建议设计和测试VA初级保健中的生殖计划决策辅助干预，以提高生殖计划决策质量和避孕方法的使用。具体而言，该CDA-2旨在：1）使用定性方法确定女性退伍军人和VA初级保健医生的生殖计划决策需求; 2）开发，完善和试点测试生殖计划决策辅助工具; 3）进行一项双中心随机对照试验（RCT），以测试决策辅助工具对决策质量的影响（决策冲突，知识，决策自我效能和决策满意度）和避孕结果相比，生殖计划信息。还将调查实施的障碍和促进因素，以促进下游实施， 干预是有效的。卡莱加里博士将获得的经验 拟议的研究将补充结构化培训的定性方法，决策科学和决策辅助开发，随机对照试验设计和实施科学。Callegari博士将在她的导师和顾问团队的指导和监督下进行研究，该团队包括卫生服务干预方面的专家（Karin纳尔逊，医学博士，MSHS），分享决策和决策助手（大卫阿特伯恩，医学博士，公共卫生硕士和苏珊娜布罗德尼，博士），生殖健康和定性方法（Sonya Borrero，医学博士，理学硕士和Alison汉密尔顿，博士，公共卫生硕士），随机对照试验设计（盖勒Reiber，博士和Eleanor Bimla施瓦茨，医学博士，理学硕士），实施科学（Alison汉密尔顿，博士，公共卫生硕士）和生殖健康政策（劳里Zephyrin，医学博士，公共卫生硕士，MBA）。冲击该CDA-2将使Callegari博士能够与VA妇女健康研究和共同决策的领导者合作，设计和测试以患者为中心的干预措施，以改善生殖决策和生殖保健服务的质量。拟议的研究，结合导师和培训计划，将促进Callegari博士成功过渡到一个独立的VA卫生服务研究员，致力于促进妇女退伍军人的健康。

 DESCRIPTION (provided by applicant): BACKGROUND. Lisa Callegari, MD, MPH is a postdoctoral HSR&D fellow at VA Puget Sound, a VA Staff Gynecologist, and an Assistant Professor of Obstetrics & Gynecology at the University of Washington. Since beginning her fellowship in 2012, Dr. Callegari's research has reflected her commitment to addressing the reproductive health care needs of women Veterans. The proposed Career Development Award (CDA-2) will provide Dr. Callegari with the in-depth training and skills she needs to succeed as an independent health services researcher designing and testing interventions to improve reproductive health care for women Veterans. CAREER DEVELOPMENT PLAN. Dr. Callegari's proposed CDA-2 will employ innovative strategies, including reproductive planning and shared decision making, to address gaps in reproductive health services for women Veterans. Compared to civilians, women Veterans have higher rates of chronic medical and mental health illness. These comorbidities, in combination with low rates of documented contraception among women Veterans, result in increased risks of unplanned pregnancy and poor pregnancy outcomes. Reproductive planning discussions promote proactive planning for pregnancy and contraceptive use, yet rarely occur in practice. One novel approach to guide reproductive planning discussions is use of a decision aid based on shared decision making principles. Decision aids improve decision quality by aligning patients' health care decisions with their values and preferences. While decision aids have been used effectively for other reproductive health decisions, no decision aid has been developed for reproductive planning. This CDA-2 proposes to design and test a reproductive planning decision aid intervention in VA primary care to improve reproductive planning decision quality and use of contraception. Specifically, this CDA-2 aims to: 1) determine reproductive planning decision needs among women Veterans and VA primary care physicians using qualitative methods; 2) develop, refine, and pilot test a reproductive planning decision aid; and 3) conduct a two-site randomized controlled trial (RCT) to test the effect of the decision aid on decision quality (decisional conflict, knowledge, decision self-efficacy and decision satisfaction) and contraceptive outcomes, compared to reproductive planning information only. Barriers and facilitators to implementation will also be investigated to facilitate downstream implementation if the intervention is found to be effective. The experience Dr. Callegari will gain in conducting the proposed research will be supplemented with structured training in qualitative methods, decision science and decision aid development, RCT design, and implementation science. Dr. Callegari will conduct her research under the guidance and supervision of her mentorship and consultant team, which includes experts in health services interventions (Karin Nelson, MD, MSHS), shared decision making and decision aides (David Arterburn, MD, MPH and Suzanne Brodney, PhD), reproductive health and qualitative methods (Sonya Borrero, MD, MS and Alison Hamilton, PhD, MPH), RCT designs (Gayle Reiber, PhD and Eleanor Bimla Schwarz, MD, MS), implementation science (Alison Hamilton, PhD, MPH), and reproductive health policy (Laurie Zephyrin, MD, MPH, MBA). IMPACT. This CDA-2 will enable Dr. Callegari to collaborate with leaders in VA women's health research and shared decision making to design and test a patient centered intervention that improves reproductive decisions and the quality of reproductive health care services. The research proposed, in combination with the mentorship and training plan, will facilitate Dr. Callegari's successful transition to an independent VA health services researcher with a career dedicated to advancing the health of women Veterans.