The Enhancing Mental and Physical health of Women through Engagement and Retention EMPOWER

通过参与和保留增强女性的身心健康 EMPOWER

• 批准号: 10181040
• 负责人: Bevanne Bean-Mayberry
• 金额: --
• 依托单位: VA GREATER LOS ANGELES HEALTHCARE SYSTEM
• 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 2021-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10181040
• 关键词: Address; Administrator; Adoption; Anxiety; Caring; Clinic; Complex; Effectiveness; Ensure; Evaluation; Exposure to; Female; Future; Gender; Glean; Goals; Growth; Health; Health Priorities; Health Services; Healthcare; Intervention; Link; Los Angeles; Measures; Mental Depression; Mental Health; Methodology; Methods; Minority; Modeling; Organizational Change; Outcome; Patient-Centered Care; Patients; Persons; Phase; Policies; Population; Prediabetes syndrome; Primary Health Care; Process; Productivity; Provider; Qi; Replicating Effective Programs; Research Personnel; Research Project Grants; Resources; Risk Behaviors; Risk Factors; Risk Reduction; Services; Site; System; Veterans; Veterans Health Administration; Woman; Women' s Health; barrier to care; cardiovascular health; cardiovascular risk factor; care fragmentation; cohesion; collaborative care; comorbidity; design; diabetes prevention program; diabetes risk; empowerment; evidence base; experience; gender disparity; health care quality; implementation barriers; implementation evaluation; implementation outcomes; implementation process; implementation research; implementation science; implementation strategy; improved; innovation; insight; male; multidisciplinary; operation; patient oriented; patient-clinician communication; peer; physical conditioning; practice-based research network; preference; programs; research study; screening; shared decision making; success; synergism; tool; uptake

 DESCRIPTION (provided by applicant): Project Background: Women Veterans are the fastest growing segment of Veterans Health Administration (VHA) users. This dramatic growth has created challenges for VHA. Gender disparities persist in cardiovascular (CV) and diabetes risk factor control, and rates of depression, anxiety, and mental health comorbidity are disproportionately high among women Veterans. Furthermore, a high rate of women Veterans' attrition from VA care, along with organizational barriers to care, substantiate that organizational changes are needed in order to engage and retain women Veteran VHA users in evidence-based, patient-centered care. Project Objectives: The Enhancing Mental and Physical health of Women through Engagement and Retention (EMPOWER) QUERI addresses VHA Blueprint for Excellence Strategy 6, by advancing "personalized, proactive, patient-centered" care models, and Transformational Strategy 7.2.g by implementation of innovative care models in women Veterans' health care." The EMPOWER QUERI Program is designed to improve women Veterans' engagement and retention in evidence-based care for three high priority health conditions, i.e., prediabetes, cardiovascular, and mental health. To achieve this impact goal, we propose a cohesive portfolio of projects with the following aims: (1) To use an evidence-based implementation strategy that emphasizes local tailoring of care models, multilevel stakeholder engagement, and systematic evaluation of complex implementation processes in order to enrich organizational capacity for innovations in women Veterans' VHA health care; (2) To implement personalized, proactive, patient-centered innovations in VHA women's health that are acceptable, feasible, satisfactory, relevant, and effective for both providers and patients, thereby encouraging women Veterans' engagement and retention and sustainability of the innovations; and, (3) To generate implementation "playbooks" for our partners that are scalable and serve as guidance for future implementation of a broader array of evidence-based women's health programs and policy. Project Methods: Three projects will be conducted by an experienced multidisciplinary team. "Tailoring VA's Diabetes Prevention Program to Women Veterans' Needs" is a one-year QI project to be conducted in VA Greater Los Angeles women's health clinics. Women Veterans with prediabetes will select an in-person, peer- led or online gender-specific, evidence-based diabetes prevention program to address their risk behaviors and health conditions. "Facilitating Cardiovascular Risk Screening and Risk Reduction in Women Veterans" will increase identification of CV risk among women Veterans, enhance patient/provider communication and shared decision-making about CV risk, and provide a supportive, coordinated health coaching intervention to facilitate women Veterans' engagement and retention in appropriate health services. "Implementation of Tailored Collaborative Care for Women Veterans" will evaluate implementation of an evidence-based collaborative care model tailored to enhance provider- and system-level capabilities to address women Veterans' anxiety and depression treatment needs, thereby improving organizational primary care-mental health integration (PC-MHI) effectiveness and women Veterans' engagement and retention in PC-MHI. Both implementation research studies will use a modified stepped wedge design and will apply the evidence-based Replicating Effective Programs (REP) implementation strategy. Mixed methods implementation evaluations will focus on investigating primary implementation outcomes of adoption, acceptability, feasibility, and reach. Multilevel stakeholder engagement will be prioritized. Program-wide organizational-, provider-, and patient- level measures and tools will be utilized to enhance synergy, productivity, and impact. As a coherent program of women's health implementation research and quality improvement, the proposed EMPOWER QUERI will constitute a major milestone in achieving BPE strategies and realizing women Veterans' engagement and, ultimately, empowerment in our VHA system.

 描述（由申请人提供）： 项目背景：女性退伍军人是退伍军人健康管理局（VHA）用户增长最快的部分。这种急剧增长给VHA带来了挑战。在心血管（CV）和糖尿病风险因素控制方面，性别差异持续存在，女性退伍军人中抑郁、焦虑和心理健康共病的发生率高得不成比例。此外，退伍军人护理的女性退伍军人流失率很高，沿着护理的组织障碍，证实需要进行组织变革，以吸引和留住女性退伍军人VHA用户，以证据为基础，以患者为中心的护理。项目目标：通过参与和留用增强妇女身心健康（增强能力）QUERI通过推进“个性化、积极主动、以患者为中心”的护理模式，解决了退伍军人管理局卓越战略蓝图6，并通过在退伍军人保健中实施创新护理模式，解决了转型战略7.2.g。“EMPOWER QUERI计划旨在改善女性退伍军人对三种高优先级健康状况的循证护理的参与和保留，即，糖尿病前期、心血管和心理健康。为了实现这一影响目标，我们提出了一个有凝聚力的项目组合，其目标如下：（1）使用基于证据的实施策略，强调当地定制的护理模式，多层次的利益相关者参与，以及对复杂实施过程的系统评估，以丰富退伍军人VHA医疗保健创新的组织能力;（2）在退伍军人管理局妇女健康方面实施个性化、积极主动、以患者为中心的创新，这些创新对提供者和患者都是可接受的、可行的、令人满意的、相关的和有效的，从而鼓励退伍军人参与和保留创新，并使创新具有可持续性;以及（3）为我们的合作伙伴制定可扩展的实施“剧本”，并作为今后实施更广泛的循证妇女健康方案和政策的指导。项目方法：三个项目将由一个经验丰富的多学科团队进行。“根据退伍军人妇女的需要调整退伍军人事务部的糖尿病预防计划”是一个为期一年的QI项目，将在退伍军人事务部大洛杉矶妇女健康诊所进行。患有前驱糖尿病的女性退伍军人将选择一个面对面的，同伴主导的或在线的性别特异性的，以证据为基础的糖尿病预防计划，以解决他们的风险行为和健康状况。“促进女性退伍军人心血管风险筛查和风险降低”将增加女性退伍军人中心血管风险的识别，加强患者/提供者关于心血管风险的沟通和共同决策，并提供支持性，协调的健康指导干预，以促进女性退伍军人参与和保留适当的健康服务。“为女性退伍军人量身定制的协作护理的实施”将评估基于证据的协作护理模式的实施，该模式旨在增强提供者和系统层面的能力，以满足女性退伍军人的焦虑和抑郁治疗需求，从而提高组织初级保健心理健康整合（PC-MHI）的有效性和女性退伍军人在PC-MHI中的参与和保留。这两项实施研究将采用改进的阶梯式楔形设计，并将采用循证复制有效方案（REP）实施战略。混合方法实施评价将侧重于调查采用、可接受性、可行性和覆盖面等主要实施成果。将优先考虑多层次利益攸关方的参与。将利用整个项目的组织、提供者和患者层面的措施和工具来增强协同作用、生产力和影响。作为妇女健康实施研究和质量改进的一个连贯方案，拟议的增强能力QUERI将成为实现BPE战略和实现退伍军人参与以及最终增强我们VHA系统权能的一个重要里程碑。

项目成果

The Diabetes Prevention Program for Underserved Populations: A Brief Review of Strategies in the Real World.

• DOI: 10.2337/ds19-0007
• 发表时间: 2019-11-01
• 期刊: Diabetes spectrum : a publication of the American Diabetes Association
• 作者: AuYoung, Mona;Moin, Tannaz;Damschroder, Laura J
• 通讯作者: Damschroder, Laura J

Tailoring an evidence-based lifestyle intervention to meet the needs of women Veterans with prediabetes.

调整基于证据的生活方式干预措施，以满足患有糖尿病前期的退伍军人的需求。

• DOI: 10.1080/03630242.2019.1710892
• 发表时间: 2020-08
• 期刊: Women & health
• 影响因子: 1.6
• 作者: Dyer KE;Moreau JL PhD, MPH;Finley E PhD, MPH;Bean-Mayberry B MD, MHS;Farmer MM;Bernet D MS, RDN;Kress A MS, RD, LDN;Lewis JL;Batuman FK MD, FACP;Haskell SG;Hamilton AB PhD, MPH;Moin T MD, MBA, MSHS
• 通讯作者: Moin T MD, MBA, MSHS

Enhancing Mental and Physical Health of Women through Engagement and Retention (EMPOWER): a protocol for a program of research.

• DOI: 10.1186/s13012-017-0658-9
• 发表时间: 2017-11-07
• 期刊: Implementation science : IS
• 作者: Hamilton AB;Farmer MM;Moin T;Finley EP;Lang AJ;Oishi SM;Huynh AK;Zuchowski J;Haskell SG;Bean-Mayberry B
• 通讯作者: Bean-Mayberry B