Optimizing the Implementation of Whole Health Coaching for Veterans with COPD

背景：退伍军人管理局致力于建立退伍军人保健的整体卫生系统

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 Innovation: To our knowledge, there is no published or unpublished research on the existing approaches to implementing WH-Coaching for Veterans with COPD and/or best practices for improving its implementation.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.