CompreHEnsive ViRtual Care for WOmen VEteranS (HEROES)

背景：退伍军人事务部内的妇女保健正处于关键时刻。到2040年，退伍军人的比例 女性比例预计将增加近一倍，从2018年的9%增至17%。与男性不同，女性退伍军人 (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度有影响。年龄的变化预示着越来越多的女性 预防和生殖保健需要和日益沉重的慢性病负担。意义：这些 世界卫生组织人口的转变要求VHA进行创新和调整，以继续满足世界卫生组织的卫生保健需求。 虚拟医疗将成为正在进行的医疗服务变革和创新的一部分，并已显示出具体的 WV的潜力。然而，我们不知道如何以及何时部署虚拟医疗来优化患者 WV的参与度和临床结果。解决虚拟VHA护理中的主要不确定性领域 对妇女的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。该项目针对的是 《黛博拉·桑普森法案》的立法优先事项(H.R.2452)；HSRD的妇女健康优先事项、虚拟保健、 卫生公平；以及促进多样性、公平和包容性以及利用退伍军人管理局的ORD优先事项 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)通过完成第一次合成，推进全面的妇女保健提供 关于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虚拟护理多方利益相关者智库确定；3)推动质量科学 通过创新地纳入利益相关者的意见来合成证据；以及4)弥合方法上的差距 将执行战略转化为现实世界的行动。具体目标：1)识别障碍和 促进在综合性世界卫生保健中心内提供适当的虚拟护理并保持其可持续性； 2)为如何以及何时优化采用和可持续发展制定实施蓝图 在退伍军人事务部全面妇女保健的背景下提供适当的虚拟保健；以及3)探讨其影响 关于在综合WHC中使用适当的虚拟护理的新的实施蓝图 方法现场试验设计。方法：对于目标1，我们将回顾定性的同行评议文献 妇女在虚拟护理方面的经验，以及从边缘化妇女那里收集初步质量数据 退伍军人群体(例如，西弗吉尼亚黑人、农村妇女)及其护理提供者，以填补现有文献和 探索WV同步虚拟护理的具体VA背景。对于目标2，我们将绘制障碍图并 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 在全面的WHC中定义已确定的战略的可操作应用。对于目标3，我们将与 退伍军人事务部基于妇女健康实践的研究网络和农村卫生办公室确定了两个 综合妇女保健诊所，用来对执行蓝图进行评估。 WV卫生保健的初级定性访谈和临床提供者。实施：这一点的产物 工作将是何时以及如何将同步虚拟护理纳入全面护理的蓝图 西雅图。我们将与互联关怀办公室的运营合作伙伴保持密切沟通， 农村保健和妇女保健服务办公室在整个拟议工作和计划中反复 以供传播。归根结底，这项拟议的工作有可能提高 通过在适当的时间提供医疗保健，在退伍军人管理局内为WV提供全面的护理 根据临床情况和患者的需要选择合适的方式。

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.