QUERI for Team-Based Behavioral Health

 描述（由申请人提供）： 1)预期对退伍军人的医疗保健的影响使用共同的促进技术和共同的措施，这个QUERI计划将加强和告知团队为基础的护理退伍军人的行为健康状况。具体来说，我们将推进VA的知识，如何以团队为基础的行为医疗保健可以通过使用实施促进战略，与退伍军人的结果预期改善。数据将与VHA和VA/非VA共享护理中的护理相关。2)最近几个VHA国家倡议强调了基于团队的护理，包括患者对齐护理团队（PACT），初级保健心理健康整合（PC-MHI）和行为健康跨学科计划（BHIP）团队。基于团队的护理也发生在VHA的砖块和灰泥之外，因为最近颁布的《退伍军人选择法》要求退伍军人管理局更好地了解退伍军人如何体验非退伍军人管理局社区提供者提供的护理，或者VHA和非VHA提供者之间共享的护理。3)项目目标我们的计划影响目标是：改善协调，质量，公平，以及为有行为健康状况的退伍军人提供团队护理的结果。我们广泛地定义了基于团队的护理，包括通过跨学科的VA临床团队提供的护理，跨学科，以及VA和非VA提供者共享的退伍军人护理。总体方案目标包括：目标1：了解（通过严格的评估）和加强（通过促进）协调，质量，公平和照顾退伍军人的跨学科VA治疗团队内治疗的结果，并通过跨VA和非VA社区服务提供者的共享护理。 目标二：推进（通过促进）基于测量的护理提供策略，增强个性化，主动性和患者驱动的退伍军人护理。 目标3：通过开发、评估和完善新的工具和资源来推进实施科学，以支持使用促进来实施响应VA优先事项的临床计划/实践。4)通过密集的战略规划过程中，我们确定了一套高度协调和综合的项目，以实现我们的计划目标，推进实施科学，并解决系统的优先事项，在临床计划和政策实施。计划项目的重点包括：1）在VISN 20中实施远程健康的质量改进项目; 2）在基于循证合作慢性病护理模式的后期采用者网站中实施BHIP团队; 3）在PC-MHI团队中改进患者报告结果措施的使用; 3）4）增强对退伍军人对退伍军人管理局和非退伍军人管理局提供者提供的行为医疗保健的协调和质量的看法的理解;以及5）在PACT团队中部署同行专家，以回应白宫的行政行动。 我们的实施核心综合了跨领域的科学主题，设计元素和应用于我们项目的措施。项目将收集与组织背景、团队发展、健康相关的生活质量和退伍军人满意度有关的共同措施，我们将汇总项目间的这些数据，以产生项目层面的结果：a）背景因素对实施成功和促进强度的影响;以及B）实施促进对 RE-AIM领域、团队发展和退伍军人成果。我们还将开发一个新的执行促进保真度工具，并制作一个更新的执行促进培训手册，供退伍军人事务部业务和研究人员使用。

 DESCRIPTION (provided by applicant): 1) Anticipated impacts on Veteran's healthcare Using common facilitation techniques and common measures, this QUERI program will enhance and inform team-based care for Veterans with behavioral health conditions. Specifically, we will advance VA's knowledge of how team-based behavioral health care can be improved through use of implementation facilitation strategies, with anticipated improvements in Veteran outcomes. Data will be relevant to care within VHA and VA/non-VA shared care. 2) Project background Team-based care is emphasized in several recent VHA national initiatives, including Patient-Aligned Care Teams (PACT), Primary Care Mental Health Integration (PC-MHI), and Behavioral Health Interdisciplinary Program (BHIP) teams. Team-based care also occurs beyond the bricks and mortar of VHA, as recent enactment of the Veterans Choice Act requires VA to better understand how Veterans experience care delivered by non-VA community providers or that is shared between VHA and non-VHA providers. 3) Project objectives Our Program Impact Goal is to: Improve coordination, quality, equity, and outcomes of team-based care for Veterans with behavioral health conditions. We define team-based care broadly to include care provided through interdisciplinary VA clinical teams, across disciplines, as well as care of Veterans shared by VA and non-VA providers. Overall program aims include: Aim 1: Understand (through rigorous evaluation) and enhance (through facilitation) coordination, quality, equity and outcomes of care for Veterans treated within interdisciplinary VA treatment teams and via shared care across VA and non-VA community service providers. Aim 2: Advance (through facilitation) measurement-based care delivery strategies that enhance personalized, proactive, and patient-driven care for Veterans. Aim 3: Advance implementation science by developing, evaluating and refining new tools and resources to support use of facilitation to implement clinical programs/practices that are responsive to VA priorities. 4) Project methods Through an intensive strategic planning process, we identified a suite of highly coordinated and integrated projects to achieve our program aims, advance implementation science, and address system priorities in terms of clinical program and policy implementation. Foci of program projects include: 1) a quality improvement project implementing telemental health in VISN 20; 2) implementing BHIP teams in later adopter sites based on evidence-based collaborative chronic care models; 3) improving use of patient reported outcome measures within PC-MHI teams; 3); 4) enhancing understanding of Veteran perspectives on coordination and quality of behavioral health care received from VA and non-VA providers; and 5) implementing peer specialists in PACT teams in response to a White House executive action. Our Implementation Core synthesizes cross-cutting scientific themes, design elements, and measures applied across our projects. Projects will collect common measures pertaining to organizational context, team development, health-related quality-of-life and Veteran satisfaction, and we will aggregate these data across projects to produce program-level findings on: a) influence of contextual factors on implementation success and facilitation intensity; and b) effects of implementation facilitation on RE-AIM domains, team development and Veteran outcomes. We will also develop a new implementation facilitation fidelity tool and produce an updated Implementation Facilitation Training Manual for use by VA operations and researchers.