PrOVE: PeRsonalizing Options through Veteran Engagement

 描述（由申请人提供）： 在卫生保健方面，“不能一刀切”。没有两个退伍军人是一样的，也没有任何两个VA医疗中心或社区门诊诊所（CBOCs）。医疗服务的决策往往基于“平均”效果。目前的指南和性能指标通常建议根据临床试验的平均结果为许多不同类型的患者开具相同的治疗处方，而不考虑患者之间的重要差异。这 拟议的QUERI建立在VA临床管理研究中心（CCMR，VA HSR&D COIN）和糖尿病QUERI关于个性化预防策略和治疗的广泛工作基础上，以提高退伍军人护理的有效性。 我们提出的QUERI的总体影响目标是通过支持退伍军人和提供者做出考虑到个体患者风险和偏好的个性化医疗保健决策来改善慢性病的预防和管理。通过这一目标，我们的目标是提高护理的适当性（减少过度使用和使用不足），增加退伍军人参与他们的医疗保健，并提高退伍军人的经验。这一目标与卓越战略蓝图六直接一致：推进个性化，主动和患者驱动的医疗保健，并吸引和激励退伍军人达到最高的健康和福祉水平。我们的QUERI计划的具体目标包括以下几点：1.实施以患者为中心的绩效管理系统，以提高护理的适当性并纳入共同决策。 2.实施个性化的自我管理计划，以促进健康和预防疾病。 我们的QUERI计划将包括以下项目开始在今年1：项目#1：该项目将包括 与弗吉尼亚州国家健康促进和疾病预防中心（NCP）和初级保健办公室合作，实施和评估肺癌筛查的共享决策工具。循证工具已在安阿伯VAMC开发和试点测试，并将分发给目前作为试点参加NCP国家肺癌筛查示范项目的八个VAMC。 项目二：在这个项目中，我们将与NCP和VA的分析和商业智能办公室（OABI）合作，以改善新的MOVE！的指导方针，以减少广泛的地方变化的有效性，移动！以及最大化对组设置中的患者的个性化体重管理支持。 地方QI倡议：本项目将实施和评价一种性能管理工具，用于改善安阿伯VAMC中他汀类药物的使用，该工具针对个体患者的风险因素进行个性化。 实施核心：该核心将侧重于使用实施研究的综合框架（CFIR）收集和分析跨研究的背景数据，无论是对于本QUERI还是与至少五个其他QUERI项目（如果它们得到资助）合作，以确定背景与实施成功之间的关联。我们所有项目的实施策略将结合系统重新设计技术（与弗吉尼亚州应用系统工程中心合作），使用定制工具（“障碍克星”工具），帮助当地团队根据当地环境的特点选择适当的实施策略。

 DESCRIPTION (provided by applicant): "One size does not fit all" in health care. No two Veterans are alike, nor are any two VA medical centers or community-based outpatient clinics (CBOCs). Decisions in healthcare delivery too often are based on "average" effects. Current guidelines and performance measures often recommend prescribing the same treatments to many different types of patients based on the average result of a clinical trial without considering important differences between patients. This proposed QUERI builds on an extensive body of work by the VA Center for Clinical Management Research (CCMR, a VA HSR&D COIN) and the Diabetes QUERI on individualizing prevention strategies and treatments to improve the effectiveness of care delivered to Veterans. The overall Impact Goal of our proposed QUERI is to improve prevention and management of chronic conditions by supporting Veterans and providers in making personalized healthcare decisions that take into account individual patient risk and preferences. Through this goal we aim to improve appropriateness of care (decrease overuse and underuse), increase Veteran engagement in their health care, and enhance Veteran experiences. This goal aligns directly with the Blueprint for Excellence Strategy Six: Advance healthcare that is personalized, proactive, and patient-driven, and engages and inspires Veterans to their highest possible level of health and well-being. The specific aims for our QUERI program include the following: 1. Implement patient-centered performance management systems that enhance appropriateness of care and incorporate shared decision-making. 2. Implement personalized self-management programs for promoting health and preventing disease. Our QUERI program will include the following projects beginning in year 1: Project #1: This project will include the implementation and evaluation of a shared-decision making tool for lung cancer screening in collaboration with VA's National Center for Health Promotion and Disease Prevention (NCP) and the Office of Primary Care. The evidence-based tool has been developed and pilot tested at the Ann Arbor VAMC and will be disseminated to the eight VAMCs that are currently participating as pilot sites in NCP's national Lung Cancer Screening Demonstration project. Project #2: In this project we will work with NCP and VA's Office of Analytics and Business Intelligence (OABI) to improve dissemination of the new MOVE! guidelines, with the goal of reducing wide local variation in the effectiveness of MOVE! and maximizing personalized weight management support for patients in a group setting. Local QI Initiative: This project will implement and evaluate a performance management tool for improving statin use in the Ann Arbor VAMC that is personalized to individual patient risk factors. Implementation Core: This core will focus on using the Consolidated Framework for Implementation Research (CFIR) to collect and analyze data on context across studies, both for this QUERI and in collaboration with at least five other QUERI programs (if they are funded) to determine the association between context and implementation success. Our implementation strategies for all projects will incorporate systems redesign techniques (in collaboration with VA's Center for Applied Systems Engineering) with use of a tailoring tool (the "Barrier Busters" Tool) that will help local teams chose appropriate implementation strategies based on features of local context.