CompreHEnsive ViRtual Care for WOmen VEteranS (HEROES)

为女性退伍军人（英雄）提供全面的虚拟护理

• 批准号: 10424861
• 负责人: Jennifer Marie Gierisch
• 金额: --
• 依托单位: DURHAM VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2026-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10424861
• 关键词: Address; Adoption; Age; Area; COVID-19 pandemic; Caregivers; Caring; Chronic Disease; Client satisfaction; Clinic; Clinical; Communication; Communities; Comprehensive Health Care; Data; Data Collection; Discrimination; Effectiveness; Emergency Situation; Evaluation; Exposure to; Face; Goals; Health; Health Personnel; Health care facility; Healthcare; Household Heads; Infrastructure; Interview; Literature; Maps; Menopause; Methodology; Methods; Modality; Modeling; Outcome; Patient Care; Patient-Centered Care; Patients; Peer Review; Persons; Population; Positioning Attribute; Preventive; Primary Health Care; Procedures; Provider; Quality of Care; Reporting; Reproductive Health; Research; Resistance; Resources; Rest; Review Literature; Rural; Rural Health; Science; Services; Source; Structure; Telephone; Time; Translating; Uncertainty; Veterans; Woman; Women' s Health; Women' s Health Services; Women' s Rights; Work; base; black women; care delivery; care providers; career life balance; connected care; design; digital; diversity and equity; ethnic diversity; evidence base; experience; field study; health care delivery; health care service; health disparity; health equity; implementation outcomes; implementation strategy; improved; innovation; male; men; military veteran; novel; online resource; operation; pandemic disease; patient engagement; patient oriented; patient-clinician communication; post-COVID-19; practice-based research network; programs; racial diversity; satisfaction; telehealth; virtual; virtual delivery; virtual healthcare

Background: Women’s health care within the VA is at a pivotal juncture. By 2040, the proportion of Veterans who are women is expected to nearly double, from 9% (2018) to 17%. Distinct from men, women Veterans (WV) are more racially and ethnically diverse, younger, and more likely to be single heads of households; all of which have implications for health care engagement. The shift in age portends increasing women-specific preventive and reproductive health care needs and a growing burden of chronic illnesses. Significance: These shifts in the WV population require the VHA to innovate and adapt to continue to meet WV health care needs. Virtual care will be a part of ongoing health care service changes and innovations, and has shown specific potential for WV. However, we do not know how and when to deploy virtual care to optimize patient engagement and clinical outcomes for WV. Addressing key areas of uncertainty in virtual VHA care deployment for women could accelerate strategic utilization and successful implementation of virtual care for WV, thereby improving patient satisfaction, quality of care, and health outcomes. This project addresses the legislative priorities of the Deborah Sampson Act (H.R.2452); HSRD priorities of women's health, Virtual Care, health equity; and ORD priorities of promoting diversity, equity, and inclusion, as well as leveraging VA research for real-world impact. Innovation and Impact: Our proposal has four key areas of scientific innovation, including: 1) advancing comprehensive, women’s care delivery by completing the first synthesis of qualitative literature around women’s experiences with virtual care; 2) addressing key information gaps identified by a recent VHA virtual care multi-stakeholder think tank; 3) advancing the science of qualitative evidence synthesis through innovative incorporation of stakeholder input; and 4) bridging a methodologic gap for translating implementation strategies into real-world actions. Specific Aims: 1) To identify barriers and facilitators to the adoption and sustainability of appropriate virtual care delivered within comprehensive WHCs; 2) To develop an implementation blueprint for how and when to optimize adoption and sustainability of appropriate virtual care in the context of VA comprehensive women’s health care; and 3) To explore the impact of the novel implementation blueprint on use of appropriate virtual care in comprehensive WHCs using a mixed methods field test design. Methodology: For Aim 1, we will review the qualitative peer-reviewed literature on women’s experiences with virtual care, as well as collect primary qualitative data from marginalized women Veteran populations (eg., Black WV, rural women) and their care providers to fill gaps in existing literature and explore the specific VA context of synchronous virtual care for WV. For Aim 2, we will map barriers and facilitators to relevant strategies and outcomes for implementation, and engage key multi-level stakeholders to define actionable applications of identified strategies within comprehensive WHCs. For Aim 3, we will work with the VA Women’s Health Practice Based Research Network and the Office of Rural Health to identify two comprehensive women’s health clinics with which to conduct an evaluation of the implementation blueprint. primary qualitative interviews and clinical providers of WV health care. Implementation: The product of this work will be a blueprint for when and how to incorporate synchronous virtual care into comprehensive care for WV. We will maintain close communication with our operations partners from the Office of Connected Care, Office of Rural Health, and Women’s Health Services throughout the proposed work and plan iteratively with them for dissemination. Ultimately, this proposed work has the potential to improve effectiveness of, and satisfaction with, comprehensive care for WV within the VA by delivering health care at the right time with the right modality for the clinical situation and patient's needs.

背景：退伍军人事务部的妇女保健正处于关键时刻。到2040年， 女性预计将增加近一倍，从9%（2018年）增加到17%。区别于男性、女性 (WV)在种族和民族上更加多样化，更年轻，更有可能是单身户主;所有 这对医疗保健的参与有影响。年龄的变化预示着女性特有的 预防和生殖保健需求以及慢性病负担日益加重。意义：这些 西弗吉尼亚州人口的变化要求VHA进行创新和调整，以继续满足西弗吉尼亚州的医疗保健需求。 虚拟医疗将是正在进行的医疗保健服务变革和创新的一部分， 潜在的WV。然而，我们不知道如何以及何时部署虚拟护理以优化患者 WV的参与和临床结果。解决虚拟VHA护理中的关键不确定领域 为妇女部署可以加速战略利用和成功实施虚拟护理， WV，从而提高患者满意度，护理质量和健康结果。该项目解决了 《黛博拉·桑普森法案》（H.R.2452）的立法优先事项;卫生和社会发展部妇女健康优先事项，虚拟护理， 健康公平;和促进多样性，公平和包容性的ORD优先事项，以及利用VA 研究现实世界的影响。创新和影响：我们的提案有四个关键的科学领域 创新，包括：1）通过完成第一次综合报告， 围绕妇女虚拟护理经验的定性文献; 2）解决关键信息差距 由最近的VHA虚拟护理多利益相关者智囊团确定; 3）推进定性科学 通过创新性地纳入利益相关者的投入来进行证据综合;以及4）弥合方法上的差距 将实施战略转化为现实行动。具体目标：（1）确定障碍， 促进在综合性妇幼保健中心内提供的适当虚拟护理的采用和可持续性; 2)制定实施蓝图，说明如何以及何时优化 在VA综合妇女保健背景下适当的虚拟保健; 3）探讨 关于在综合性妇幼保健中心使用混合虚拟护理的新实施蓝图， 方法现场试验设计。方法：对于目标1，我们将回顾定性同行评审文献， 妇女在虚拟护理方面的经验，以及从边缘化妇女那里收集基本的定性数据 退伍军人群体（例如，黑人西弗吉尼亚人、农村妇女）及其护理提供者，以填补现有文献中的空白， 探索WV同步虚拟护理的特定VA背景。对于目标2，我们将绘制障碍图， 促进相关战略和成果的实施，并让关键的多层次利益攸关方参与， 在综合性卫生保健中心内确定已确定战略的可操作应用。对于目标3，我们将与 VA妇女健康实践研究网络和农村卫生办公室确定了两个 综合性妇女健康诊所，与这些诊所一起对实施蓝图进行评估。 主要的定性访谈和WV医疗保健的临床提供者。实现：本产品 工作将是一个蓝图，何时以及如何将同步虚拟护理纳入全面护理， WV我们将与互联医疗办公室的运营合作伙伴保持密切沟通， 农村卫生和妇女卫生服务办公室在整个拟议的工作和计划迭代， 他们为了传播。最终，这项拟议的工作有可能提高效率， 通过与退伍军人管理局在正确的时间提供医疗保健，对退伍军人管理局内西弗吉尼亚州的全面护理感到满意 根据临床情况和患者的需求选择合适的治疗方式。