Center of INovation for Complex Chronic Healthcare (CINCCH)

描述（由申请人提供）： 该中心的使命在复杂的慢性医疗保健（CINCCH）是改善医疗保健和结果的退伍军人与复杂的慢性疾病。我们将通过研究，指导和职业发展与业务和临床合作伙伴的合作来实现这一目标。具有复杂慢性医疗保健需求的退伍军人包括患有多种慢性疾病的退伍军人（例如，具有神经病症和继发病症的患者）或具有复杂社交情况和/或使用多种保健系统的具有一种或多种病症的患者（例如，双重医疗保险和VA用户）。为了改善具有复杂慢性医疗保健需求的退伍军人的护理和结果，CINCCH研究人员将参与活动，以加强以患者为中心和循证护理的提供，并确定新的有效的医疗保健模式。CINCCH的重点研究领域是：1）通过新的护理模式改善以患者为中心的护理，2）改善神经系统疾病患者的护理服务。 第一个重点研究领域直接涉及关键的VA转型举措：提供以患者为中心的护理和使用新的医疗保健模式提供护理，例如通过技术。 为了实现这一目标，CINCCH研究人员将进行研究，以i）测试提供以患者为中心的护理的新方法（例如，通过远程保健）和二）加强以病人为中心的病人-提供者沟通（如创新的病人和提供者培训）。这些项目旨在开发和评估战略，创新和工具，以确保护理以患者为中心，并对患者的结果产生可衡量的影响。第二个重点研究领域将针对患有神经系统疾病的退伍军人，如脊髓损伤和障碍（SCI/D），创伤性脑损伤和帕金森病。这些退伍军人通常有复杂的慢性护理需求，因为他们经历了继发于神经系统疾病（如SCI/D相关的压疮）和/或跨提供者和环境的护理协调问题。为了实现这一目标，我们将开展研究，以i）表征、预防和改善与神经系统疾病相关的继发性疾病的管理，ii）改善护理的可及性和协调，iii）改善预防和控制医疗相关感染的医疗实践。 为了实现这些目标，CINCCH将与以患者为中心的护理和文化转型办公室（OPCC&CT）和SCI/D服务合作。与OPCC&CT的合作伙伴关系将是确保COIN的研究推进VA转型计划的关键。与SCI/D Services的合作关系代表了与CINCCH调查人员的长期和富有成效的关系，该关系在过去14年中与SCI QUERI一起发展，SCI QUERI也位于弗吉尼亚州海因斯，包括许多将参与COIN的调查人员。这一伙伴关系将确保在这一脆弱的退伍军人群体中实施关键调查结果。 总的来说，通过创新的研究和关键的合作伙伴关系，CINCCH将建立在近30年的经验和成就的研究人员从我们的VA HSR&D计划进行研究，将继续在努力改善我们的退伍军人的医疗保健的最前沿。

DESCRIPTION (provided by applicant): The mission of the Center for INnovation in Complex Chronic Healthcare (CINCCH) is to improve health care and outcomes for Veterans with complex chronic illnesses. We will accomplish this through research, mentorship and career development with the collaboration of operational and clinical partners. Veterans with complex chronic healthcare needs include those with multiple chronic illnesses (e.g., patients with neurological conditions and secondary conditions) or those with one or more condition who have complicated social situations and/or use multiple healthcare systems (e.g., dual Medicare and VA users). To improve care and outcomes for Veterans with complex chronic healthcare needs, CINCCH investigators will engage in activities to enhance the provision of patient-centered and evidence-based care and to identify new effective models of healthcare delivery. The Focused Areas for Research for CINCCH are to: 1) Improve patient-centeredness of care through new models of care and 2) Improve delivery of care for patients with neurological conditions. The first focused area of research directly addresses key VA transformational initiatives: provision of patient-centered care and use of new healthcare models for care delivery such as through technology. To achieve this goal, CINCCH investigators will conduct research to i) test new ways to deliver patient- centered care (e.g., through telehealth) and ii) enhance patient-centeredness of patient-provider communication (such as innovative patient and provider training). These projects are designed to develop and evaluate strategies, innovations and tools that ensure care is patient-centered and that have a measurable impact on patient outcomes. The second focused area of research will target Veterans with neurological conditions such as spinal cord injury and disorder (SCI/D), traumatic brain injury, and Parkinson's disease. These Veterans often have complex chronic care needs because they experience conditions secondary to their neurological condition (such as SCI/D-related pressure ulcers) and/or issues of coordination of care across providers and settings. To achieve this goal, we will conduct research to i) characterize, prevent, and improve management of secondary conditions associated with neurological conditions, ii) improve access to and coordination of care, and iii) improve healthcare practice in prevention and control of healthcare associated infections. To achieve these goals, CINCCH will partner with the Office of Patient Centered Care and Cultural Transformation (OPCC&CT) and with SCI/D Services. The partnership with the OPCC&CT will be key in ensuring that the COIN's research advances the VA's transformational initiatives. The partnership with SCI/D Services represents a long-standing and fruitful relationship with CINCCH investigators that has developed over the past 14 years in conjunction with the SCI QUERI, which is also based at Hines VA and includes many of the investigators who will participate in the COIN. This partnership will ensure implementation of key findings in this vulnerable population of Veterans. Overall, through innovative research and key partnerships, CINCCH will build on almost 30 years of experience and accomplishments by investigators from our VA HSR&D program to conduct research that will remain at the forefront of efforts to improve health care for our Veterans.