Center for Healthcare Organization and Implementation Research (CHOIR)

描述（由申请人提供）： 医疗保健组织和实施研究中心（CHOIR）是一个HSR & D创新中心（COIN），致力于通过开发，研究和应用将被广泛实施和持续的循证实践来改善退伍军人的健康结果。合唱团建立在两个长期和非常成功的HSR & D卓越中心的基础上，在贝德福德弗吉尼亚州医院和弗吉尼亚州波士顿医疗保健系统。在与关键的VA利益相关者，包括VA新英格兰医疗保健系统（VISN 1），病人护理服务-心理健康服务，退伍军人无家可归的国家中心，药房福利管理服务办公室和公共卫生办公室的伙伴关系，我们建议把我们的研究集中在三个关键领域： 1.加强对行为弱势群体的康复护理。我们打算加强退伍军人事务部向以恢复为导向的医疗保健系统的转变，并改善行为脆弱的退伍军人的恢复导向的结果。我们的战略涉及研究人员努力解决操作定义中的知识差距，为实施高优先级计划的推出建立科学基础，并调整现有的干预证据，以用于这一行为脆弱人群。 2.药物优化计划。为退伍军人患者提供最佳药物治疗包括许多VA优先事项，涉及更安全，更有效，更以患者为中心，更具成本效益的处方实践。现有的工具允许一定的能力，以确保患者的药物优化。 然而，仍然存在重大差距。我们将通过研究如何以及为什么药物治疗是规定的，估计药物治疗的有益和有害的结果，并制定和评估实施战略，以促进更高质量的使用药物治疗来解决这些差距。 3.公共卫生传播。传统和新兴媒体和信息可以用来提供和交流有关VA全系统的公共卫生优先事项的信息，退伍军人内外VA护理。这些优先事项包括大规模不良事件、部署环境健康风险和健康行为改变。一个重要的差距仍然是最佳做法，在沟通信息，最大限度地提高退伍军人的信任在VA护理，最大限度地减少对潜在伤害的看法，并鼓励退伍军人的自我管理。我们将努力提供一个证据基础和工具，用于沟通一系列公共卫生问题，利用社交媒体和移动的健康平台等最佳沟通渠道，创建有效的信息，使退伍军人能够优先考虑他们的健康。 合唱团的研究将在其他领域进行，包括组织科学，实施科学，长期护理，病人安全，健康服务基因组学和以病人为中心的沟通。我们还完全致力于培训新一代的卫生服务研究人员，强调开发和开展研究与业务合作伙伴的能力，并与整个VA的其他调查人员合作。通过这些活动，我们打算将科学付诸实践，并促进组织适应，以维持整个VA医疗保健系统各级退伍军人的科学为基础的收益。

DESCRIPTION (provided by applicant): The Center for Healthcare Organization and Implementation Research (CHOIR) is an HSR&D Center of Innovation (COIN) dedicated to improving Veterans' health outcomes by developing, studying, and applying evidence-based practices that will be widely implemented and sustained. CHOIR builds on two long-standing and highly successful HSR&D Centers of Excellence based at the Bedford VA Hospital and the VA Boston Healthcare System. In partnership with key VA stakeholders, including VA New England Healthcare System (VISN 1), the Office of Patient Care Services-Mental Health Services, the National Center on Homelessness Among Veterans, Pharmacy Benefits Management Service, and the Office of Public Health, we propose to focus our research on three critical areas: 1. Enhancing Recovery-Oriented Care for Behaviorally Vulnerable Populations. We intend to enhance the transformation of VA to a recovery-oriented healthcare system, and to improve recovery-oriented outcomes for behaviorally vulnerable Veterans. Our strategy involves investigators working to address a knowledge gap in operational definitions, build a scientific basis for implementing high-priority program rollouts, and adapt existing interventional evidence for use with this behaviorally vulnerable population. 2. Medication Optimization Program. Providing optimal medication treatment to Veteran patients encompasses many VA priorities regarding safer, more effective, more patient-centered, and more cost-efficient prescriptive practices. Existing tools allow some ability to ensure medication optimization for patients. However, important gaps remain. We will address these gaps by examining how and why medication therapy is prescribed, estimating beneficial and harmful outcomes of medication therapy, and developing and evaluating implementation strategies to promote higher-quality use of medication therapies. 3. Public Health Communication (PHC). Traditional and emerging media and messaging may be used to deliver and exchange information about VA system-wide public health priorities to Veterans both inside and outside of VA care. These priorities include large-scale adverse events, deployment environmental health risks, and health behavior change. An important gap remains regarding best practices in communicating information that maximizes Veterans' trust in VA care, minimizes perceptions of potential harm, and encourages Veterans' self-management. We will work to provide an evidence base and tools for communicating about a range of public health issues, utilizing optimal communication channels such as social media and mobile health platforms, to create effective messaging that empowers Veterans to prioritize their health. CHOIR research will be performed in other areas including organization science, implementation science, long-term care, patient safety, health services genomics and patient-centered communication. We are also fully committed to training a new generation of health services researchers, emphasizing capabilities in developing and conducting research with operational partners, and collaborating with other investigators throughout VA. Through these activities, we intend to move science into practice and to facilitate organizational adaptation to sustain science-based gains for Veterans throughout all levels of the VA healthcare system.