Optimizing the Implementation of Whole Health Coaching for Veterans with COPD

背景：VHA致力于建立退伍军人所在的整个保健系统 有能力并有能力通过自我护理来追求健康和幸福的最佳愿景， 常规临床护理，以及补充和综合的卫生服务。该系统的一个关键组件 是一项将退伍军人与训练有素的专业人员配对的服务 为制定和实现个人有意义的健康和福祉目标提供广泛的一对一支持。 WH教练越来越多地融入到退伍军人护理中，但对最好的教练的指导很少 在指导有复杂临床症状的退伍军人时使用这种固有的“整体”方法的实践 需要。以我在定性研究方法和实施科学方面的背景，我处于有利地位 来填补我们知识上的这一空白。然而，我仍然需要在理论驱动的评估和 复杂系统方法、定量研究方法、联合设计和实施/混合试验 成功完成所提议的学习和我更广泛的职业目标。在从事有指导的研究和培训后 作为CDA获得者，我将朝着成为全国公认的退伍军人管理局的职业目标进展顺利 具有实施以患者为中心的护理的专业知识的研究人员，以改善福祉和体验 照顾患有复杂慢性病的退伍军人。 意义/影响：实施整个保健系统是VHA和VA的主要优先事项，因为 反映在退伍军人事务部2018-2024财年和2022-2028财年战略计划、2019年VHA现代化计划和 2020年VHA远景规划。拟议的CDA将为OPCC&CT和VHA提供见解，从而为 在未来几年内持续推出WH-Coach。通过重点优化WH- 为患有慢性阻塞性肺疾病的退伍军人提供指导，这项研究也有望提高护理质量，体验 护理，以及这一庞大而重要的患者群体的生活质量。我和病人办公室的合作关系- 中心关怀和文化转型(OPCC&CT)是对这项研究重要性的另一种证明。 创新：据我们所知，没有关于现有方法的已发表或未发表的研究 为患有慢性阻塞性肺病的退伍军人实施WH-指导和/或改进其实施的最佳做法。 此外，在目标2和目标3中使用现实主义评估和合作设计方法是方法论上的 创新。 具体目标：(1)评估WH辅导对医疗保健利用和戒烟的影响 患有慢性阻塞性肺疾病的退伍军人的结局。(2)确定为退伍军人提供有效的WH培训的障碍和促进者 患有慢性阻塞性肺病。(3)共同设计一个工具包，其中包含最佳实践，以促进WH教练和 患有慢性阻塞性肺病的退伍军人。 方法：在目标1中，我将分析CDW数据，以确定医疗保健利用和吸烟的纵向趋势 在前2个财政年度使用WH训练的COPD退伍军人的全国队列的戒烟结果 好几年了。在目标2中，在创新的现实主义评价框架的指导下，我将结合观察， 与关键利益相关者(退伍军人、WH教练、临床医生)的访谈，以及人工制品分析，以了解 哪些因素使退伍军人能够或相反地阻碍退伍军人从6岁的参与中获益 有目的地选择退伍军人事务部所在地。在目标3中，我将让一群退伍军人和慢性阻塞性肺病、WH教练和 临床医生与COPD退伍军人和WH教练共同设计具有最佳实践的工具包 以确保对这一群体更有效地实施WH-Coach。 下一步：CDA将通知至少三个IIR：(1)对WH患者报告的结果进行全国性调查- 指导；(2)专家小组研究，将在目标3中开发的工具包扩展到其他复杂的慢性疾病 有专家小组投入的条件；以及(3)工具包的执行-效果混合试验。

Background: VHA has committed to building the Whole Health system of care in which Veterans are empowered and equipped to pursue their best possible vision of health and well-being through self-care, conventional clinical care, and complementary and integrative health services. A key component of this system is Whole Health Coaching (WH-Coaching), a service that pairs Veterans with trained professionals who deliver extended, one-on-one support for setting and achieving personally meaningful health and well-being goals. WH Coaches are being increasingly integrated into Veteran care, yet very little guidance exists on the best practices for using this inherently “whole person” approach when coaching Veterans with complex clinical needs. With my background in qualitative research methods and implementation science, I am well-positioned to fill this gap in our knowledge. However, I still require additional training in theory-driven evaluation and complex systems approaches, quantitative research methods, co-design, and implementation/hybrid trials to succeed in the proposed study and my broader career goals. After pursuing mentored research and training as a CDA awardee, I will be well underway toward my career goal of becoming a nationally recognized VA researcher with expertise in implementing patient-centered care to improve the well-being and experiences with care for Veterans with complex chronic conditions. Significance/Impact: Implementing the Whole Health system of care is a major priority for VHA and VA, as reflected in VA’s FY2018-2024 and FY2022-2028 Strategic Plans, the 2019 VHA Modernization Plan, and the 2020 VHA Vision Plan. The proposed CDA will provide OPCC&CT and VHA with insights that will inform the ongoing rollout of WH-Coaching for years to come. By focusing on optimizing the implementation of WH- Coaching for Veterans with COPD, the study is also poised to improve the quality of care, experiences with care, and the quality of life for this large, important patient population. My partnership with the Office of Patient- centered Care & Cultural Transformation (OPCC&CT) is an additional testament to the study’s significance. Innovation: To our knowledge, there is no published or unpublished research on the existing approaches to implementing WH-Coaching for Veterans with COPD and/or best practices for improving its implementation. Moreover, the use of realist evaluation and co-design approaches in Aims 2 and 3 is methodologically innovative. Specific Aims: (1) Assess the impact of WH-Coaching on healthcare utilization and smoking cessation outcomes for Veterans with COPD. (2) Identify barriers and facilitators of effective WH-Coaching for Veterans with COPD. (3) Co-design a toolkit with best practices for effective partnership between WH Coaches and Veterans with COPD. Methods: In Aim 1, I will analyze CDW data to identify longitudinal trends in healthcare utilization and smoking cessation outcomes for a national cohort of Veterans with COPD who used WH-Coaching in the prior 2 fiscal years. In Aim 2, guided by an innovative realist evaluation framework, I will use a combination of observations, interviews with the key stakeholders (Veterans, WH Coaches, clinicians), and artifact analysis to understand which factors enable or, conversely, hamper Veterans’ ability to derive benefits from participation at 6 purposively selected VA sites. In Aim 3, I will involve a group of Veterans with COPD, WH Coaches, and clinicians in co-designing a toolkit with best practices for Veterans with COPD and WH Coaches who work with them to ensure more effective implementation of WH-Coaching for this population. Next Steps: The CDA will inform at least three IIRs: (1) a national survey of patient-reported outcomes of WH- Coaching; (2) an expert panel study expanding the toolkit developed in Aim 3 to other complex chronic conditions with expert panel input; and (3) a hybrid implementation-effectiveness trial of the toolkit.