Collaborative Specialty Care for Gulf War Illness

海湾战争退伍军人（GWVs）应该获得的护理与他们所提供的护理之间存在质量差距 接收。我们的数据显示，70%患有海湾战争疾病（GWI）的GWVs没有接受治疗建议 他们的GWI和78%的人对他们的护理不太满意。缩小这一质量鸿沟至关重要。退伍军人管理局 美国和国防部已经投资数亿美元开发新的治疗方法，包括第二大 一项针对GWVs的临床试验发现，健康指导和解决问题的治疗都能减少残疾 关于GWI如果没有有效的医疗模式来实施这些治疗，GWVs将不会受益。在 目前的护理模式，GWVs通过VA的初级护理患者对齐护理团队在当地接受护理 （PACTs）。退伍军人管理局战争相关疾病和伤害研究中心（WRIISC）支持当前的护理模式， 通过国民教育，增加当地对管理GWI所需技能和治疗方法的了解 在困难的案件上进行电子协商。WRIISC和其他利益相关者 目前正在质疑提高GWI的技能和治疗的当地知识是否足以解决 质量鸿沟，或者如果GWI过于复杂，无法在没有额外支持的情况下在初级保健中进行治疗， GWI的专家。GWI的一个潜在有用的护理模式是协作专业护理， 与PACTs一起协同治疗患者。当地的PACT是团队的领导者， 为患者提供一些直接护理（通过远程医疗），并与PACT就其他问题进行咨询。 照顾方面。协作专科护理对其他复杂病症有效（例如，抑郁症）， 超过40项研究证明了它的功效。该提案的目标是进行混合1型随机化 GWV与GWI的有效性/实施试验（n=220）。我们的主要目标是确定 与电子咨询相比，远程CSC的有效性。在远程CSC中，我们的专业供应商团队将提供 健康辅导和解决问题的治疗GWVs，并建议PACT使每月 镇痛药的优化。在电子咨询中，专业提供者团队将提出一次性建议 根据《消除对妇女一切形式歧视公约》，妇女选民在当地接受健康指导和解决问题的治疗， 优化.我们的第二个目标是了解执行结果。此信息将用于 指导未来的随机（通过VISN）多中心实施研究。在整个过程中， 将召集业务合作伙伴，以确保研究结果能够直接和立即 改善护理。确定最佳的护理模式，将研究转化为实践，为GWI的GWVs是一个 VA海湾战争战略计划的关键目标和本申请书的具体目标。

There is a quality chasm between the care Gulf War Veterans (GWVs) should receive and the care they do receive. Our data show 70% of GWVs with Gulf War Illness (GWI) do not receive treatment recommendations for their GWI and 78% are NOT very satisfied with their care. Reducing this quality chasm is essential. The VA and DoD have invested hundreds of millions of dollars to develop new treatments, including the second largest clinical trial for GWVs which is finding health coaching and problem-solving treatment both reduce the disability of GWI. Without effective models of healthcare to implement these treatments, GWVs will not benefit. In the current model of care, GWVs receive care locally through VA’s primary care patient aligned care teams (PACTs). The VA War Related Illness and Injury Study Center (WRIISC) supports the current model of care by increasing local knowledge of the skills and treatments needed to manage GWI through national education efforts and electronic consultation (e-consultation) on difficult cases. The WRIISC and other stakeholders are currently questioning whether improving local knowledge of skills and treatments for GWI is enough to address the quality chasm, or if GWI is too complex to be treated in primary care without additional support from specialists in GWI. A potentially useful model of care for GWI is collaborative specialty care where specialists work with PACTs to synergistically treat patients. The local PACT is the lead of the team with the specialist providing some direct care to the patient (through tele-health) and also consulting with the PACT about other aspects of care. Collaborative specialty care is effective for other complex conditions (e.g., depression) with over 40 studies documenting its efficacy. The goal of this proposal is to conduct a hybrid type 1 randomized effectiveness/implementation trial for GWVs with GWI (n=220). Our primary aim is to determine the effectiveness of tele-CSC as compared to e-consultation. In tele-CSC, our specialty provider team will deliver health coaching and problem-solving treatment to GWVs and recommend the PACT make monthly optimization of analgesics. In e-consultation the specialty provider team will make a onetime recommendation to the PACT that the GWV locally receive health coaching and problem-solving treatment and analgesic optimization. Our secondary aim is to understand implementation outcomes. This information will be used to guide a future randomized (by VISN) multi-site implementation study. Throughout, an advisory committee of operations partners will be convened to ensure that the results of the study are able to directly and immediately improve care. Determining the best model of care to translate research into practice for GWVs with GWI is a key goal of the VA Gulf War Strategic Plan and a specific aim of this Request for Applications.