Optimizing Function and Independence QUERI

背景：优化函数和独立性QUERI（"函数"）的总体目标 QUERI "）旨在实施和评估循证临床项目， 在脆弱的退伍军人的功能和独立性。功能状态（例如，个人的能力， 执行正常的日常活动，履行日常角色，并保持健康和福祉）是一种 生活质量的重要决定因素。与健康有关的功能障碍往往会导致 残疾，这是卫生保健利用率和成本的重要驱动因素。退伍军人面临的风险 功能衰退构成了一个具有独特需求的弱势退伍军人群体， 因此，VA卓越蓝图（BPE）的VA国家优先组。 方法：功能QUERI将进行三个不同但相关的项目，旨在实现 循证计划，在整个护理的退伍军人在功能风险的连续性 衰落和丧失独立性。执行项目1的重点是预防残疾 通过受监督的住院患者步行计划， （STRIDE）.地方质量改善项目2的重点是改善患者的功能， 通过扩大物理治疗的可及性来治疗症状性膝关节骨关节炎 护理交付（膝关节OA的PT组）。项目3的重点是促进 功能能力和避免养老院安置通过照顾者培训时， 家庭护理服务（HI-FIVES）。这些临床方案解决三个高 我们的国家合作伙伴在国家办事处确定的临床护理方面的优先差距， 老年病学和延续护理、物理医学和康复服务，以及 照顾者支持计划。这一人群临床护理缺口的一个主要原因是贫困 参与其活动的许多跨学科提供者之间的沟通和协调 在乎采用新的方案需要许多不同服务部门的支持和合作 线，一刀切的方法很少有效。QUERI函数将使用 实施战略的重点是促进临床计划的灵活性，以适应当地 环境（复制有效的程序）和提高提供商的性能 团队（团队）。QUERI功能工作计划的总体目标是： 1.调整新的实施干预措施，以促进团队准备就绪（ECOECT） 在各种VA临床环境中; 2.实施并评估三个临床项目：STRIDE、膝关节OA组PT和HI- 五，填补了目前临床护理的差距，为退伍军人在功能下降的风险; 3.检查跨项目实施过程中的团队和团队流程的影响; 4.为VA临床项目开发团队建设和准备工具包， QUERI功能实施活动的结果。 预期影响：通过我们的实施战略和对团队的关注，我们直接 解决BPE和myVA的优先事项，促进研究结果迅速转化为 实践和提高员工敬业度和体验。函数QUERI将实现 通过提供循证临床服务，对VHA内的护理产生直接影响 有残疾风险的退伍军人。我们的长期影响将是提高VA的能力， 通过开发团队建设和准备的工具包， 对加强循证方案的吸收的影响。

Background: The overall goal of the Optimizing Function and Independence QUERI (“Function QUERI”) is to implement and evaluate evidence-based clinical programs focused on maximizing function and independence in vulnerable Veterans. Functional status (e.g., individual’s ability to perform normal daily activities, fulfill usual roles, and maintain health and well-being) is an essential determinant of quality of life. Health-related functional impairments often lead to disability, which is a significant driver of health care utilization and costs. Veterans at risk for functional decline constitute a large group of vulnerable Veterans with unique needs, and therefore a VA Blueprint for Excellence (BPE) national priority group for VA. Methods: Function QUERI will conduct three distinct but related projects aimed at implementing evidence-based programs across the continuum of care for Veterans at risk for functional decline and loss of independence. Implementation Project 1 focuses on prevention of disability related to immobility during hospitalization through a supervised inpatient walking program (STRIDE). Local Quality Improvement Project 2 focuses on improving function in patients with symptomatic knee osteoarthritis through expanded access to Physical Therapy in group-based care delivery (Group PT for Knee OA). Implementation Project 3 focuses on promoting functional ability and avoiding nursing home placement through caregiver training at the time of patient referral for home care services (HI-FIVES). These clinical programs address three high priority gaps in clinical care identified by our national partners in the National Offices of Geriatrics and Extended Care, Physical Medicine and Rehabilitation Services, and the Caregiver Support Program. A major reason for clinical care gaps in this population is poor communication and coordination among the many interdisciplinary providers involved in their care. Adopting new programs requires buy-in and cooperation among many different service lines, and a one-size fits all approach is rarely effective. Function QUERI will utilize implementation strategies focused on promoting flexibility of clinical programs to fit local environments (Replicating Effective Programs) and enhancing the performance of provider teams (CONNECT). The overall goals of Function QUERI program of work are to: 1. Adapt a novel implementation intervention to promote team readiness (CONNECT) for use in a diverse mix of VA clinical settings; 2. Implement and evaluate three clinical programs, STRIDE, Group PT for Knee OA, and HI- FIVES, that fill gaps in current clinical care for Veterans at risk for functional decline; 3. Examine the impact of CONNECT and team processes on implementation across projects; 4. Develop a Team Building and Readiness Toolkit for VA clinical programs to synthesize findings from Function QUERI implementation activities. Anticipated Impact: Through our implementation strategies and focus on teams, we directly address BPE and myVA priorities of promoting rapid translation of research findings into practice and improving employee engagement and experience. Function QUERI will achieve an immediate impact on care within VHA by providing access to evidence-based clinical services for Veterans at risk of disability. Our long-term impact will be to enhance VA’s capacity for clinical innovation through the development of a toolkit for Team Building and Readiness for Implication to enhance uptake of evidence-based programs.