Optimizing Function and Independence QUERI

背景：优化函数和独立查询(“函数”)的总体目标 QUERI“)是实施和评估以循证为基础的临床计划，重点是最大化 易受伤害退伍军人的功能和独立性。功能状态(例如，个人的能力 进行正常的日常活动，履行日常角色，并保持健康和福祉)是一种 生活质量的基本决定因素。与健康相关的功能障碍通常会导致 残疾，这是卫生保健利用率和成本的一个重要驱动因素。退伍军人面临着 功能衰退构成了一大群有独特需求的脆弱退伍军人，以及 因此，退伍军人管理局设立了退伍军人管理局卓越蓝图(BPE)国家优先小组。 方法：Function QUERI将进行三个不同但相关的项目，旨在实现 为有功能性疾病风险的退伍军人提供持续护理的循证计划 独立的衰落和丧失。执行项目1侧重于预防残疾 通过有监督的住院患者步行计划与住院期间的不能动有关 (大步)。局部质量改善项目2专注于改善糖尿病患者的功能 通过扩大以团体为基础的物理治疗的途径获得症状性膝骨性关节炎 护理分娩(膝骨性关节炎的PT组)。实施项目3侧重于促进 功能能力和避免在护理时通过护理者培训安置养老院 转介病人接受家庭护理服务(HI-Five)。这些临床计划解决了三个高 我们的国家合作伙伴在国家办事处确定的临床护理优先差距 老年医学和长期护理、物理医学和康复服务，以及 护理者支持计划。造成这一人群临床护理缺口的一个主要原因是贫困 多个跨学科提供商之间的沟通和协调 关心。采用新计划需要许多不同服务之间的买入和合作 线条，一刀切的方法很少有效。函数QUERI将利用 实施战略侧重于促进临床方案的灵活性以适应当地情况 环境(复制有效的程序)和提高提供商的绩效 团队(连接)。Function QUERI工作计划的总体目标是： 1.采用新的实施干预措施，促进团队做好使用准备(连接) 在不同的退伍军人事务部临床环境中； 2.实施和评估三个临床方案，STRIDE、膝关节OA的PT组和HI- 五，填补了目前对有功能衰退风险的退伍军人的临床护理空白； 3.检查连接和团队流程对跨项目实施的影响； 4.为VA临床项目开发团队建设和准备工具包，以综合 功能QUERI实施活动的结果。 预期影响：通过我们的实施战略和对团队的关注，我们直接 解决BPE和MyVA的优先事项，促进研究成果快速转化为 实践并改善员工敬业度和体验。函数QUERI将实现 通过提供循证临床服务对VHA内的护理产生直接影响 对于有残疾风险的退伍军人。我们的长期影响将是增强退伍军人管理局 通过开发团队建设和准备工具包进行临床创新 对加强循证计划的采纳的影响。

Background: The overall goal of the Optimizing Function and Independence QUERI (“Function QUERI”) is to implement and evaluate evidence-based clinical programs focused on maximizing function and independence in vulnerable Veterans. Functional status (e.g., individual’s ability to perform normal daily activities, fulfill usual roles, and maintain health and well-being) is an essential determinant of quality of life. Health-related functional impairments often lead to disability, which is a significant driver of health care utilization and costs. Veterans at risk for functional decline constitute a large group of vulnerable Veterans with unique needs, and therefore a VA Blueprint for Excellence (BPE) national priority group for VA. Methods: Function QUERI will conduct three distinct but related projects aimed at implementing evidence-based programs across the continuum of care for Veterans at risk for functional decline and loss of independence. Implementation Project 1 focuses on prevention of disability related to immobility during hospitalization through a supervised inpatient walking program (STRIDE). Local Quality Improvement Project 2 focuses on improving function in patients with symptomatic knee osteoarthritis through expanded access to Physical Therapy in group-based care delivery (Group PT for Knee OA). Implementation Project 3 focuses on promoting functional ability and avoiding nursing home placement through caregiver training at the time of patient referral for home care services (HI-FIVES). These clinical programs address three high priority gaps in clinical care identified by our national partners in the National Offices of Geriatrics and Extended Care, Physical Medicine and Rehabilitation Services, and the Caregiver Support Program. A major reason for clinical care gaps in this population is poor communication and coordination among the many interdisciplinary providers involved in their care. Adopting new programs requires buy-in and cooperation among many different service lines, and a one-size fits all approach is rarely effective. Function QUERI will utilize implementation strategies focused on promoting flexibility of clinical programs to fit local environments (Replicating Effective Programs) and enhancing the performance of provider teams (CONNECT). The overall goals of Function QUERI program of work are to: 1. Adapt a novel implementation intervention to promote team readiness (CONNECT) for use in a diverse mix of VA clinical settings; 2. Implement and evaluate three clinical programs, STRIDE, Group PT for Knee OA, and HI- FIVES, that fill gaps in current clinical care for Veterans at risk for functional decline; 3. Examine the impact of CONNECT and team processes on implementation across projects; 4. Develop a Team Building and Readiness Toolkit for VA clinical programs to synthesize findings from Function QUERI implementation activities. Anticipated Impact: Through our implementation strategies and focus on teams, we directly address BPE and myVA priorities of promoting rapid translation of research findings into practice and improving employee engagement and experience. Function QUERI will achieve an immediate impact on care within VHA by providing access to evidence-based clinical services for Veterans at risk of disability. Our long-term impact will be to enhance VA’s capacity for clinical innovation through the development of a toolkit for Team Building and Readiness for Implication to enhance uptake of evidence-based programs.