The Enhancing Mental and Physical health of Women through Engagement and Retention EMPOWER

 描述(由申请人提供)： 项目背景：女性退伍军人是退伍军人健康管理局(VHA)用户中增长最快的部分。这种戏剧性的增长给VHA带来了挑战。在心血管(CV)和糖尿病危险因素控制方面，性别差异持续存在，在女性退伍军人中，抑郁、焦虑和心理健康共病的发生率高得不成比例。此外，退伍军人从退伍军人护理中的高流失率，以及护理的组织障碍，证实了需要进行组织变革，以便在以证据为基础、以患者为中心的护理中吸引和留住退伍军人女性使用者。项目目标：通过参与和保留(Empower)QUERI提高女性的身心健康，通过在女性退伍军人健康护理中实施创新的护理模式，解决VHA卓越蓝图战略6，通过推进“个性化、主动性、以患者为中心”的护理模式和转型战略7.2.g。Empower QUERI计划旨在提高女性退伍军人对三种高度优先的健康状况，即糖尿病前期、心血管和精神健康的循证护理的参与度和留存率。为了实现这一影响目标，我们提出了一系列具有凝聚力的项目组合，目标如下：(1)使用基于证据的实施战略，强调护理模式的本地定制、多层次利益相关者参与以及对复杂实施过程的系统评估，以丰富组织在女性退伍军人VHA医疗保健方面的创新能力；(2)在VHA女性健康领域实施个性化、主动性、以患者为中心的创新，这些创新对提供者和患者都是可接受的、可行的、令人满意的、相关的和有效的，从而鼓励女性退伍军人的参与度以及创新的保留和可持续性；以及，(3)为我们的合作伙伴生成可扩展的实施“手册”，作为未来实施更广泛的循证妇女健康计划和政策的指导。项目方法：三个项目将由一个经验丰富的多学科团队进行。“为退伍军人的需求量身定做退伍军人糖尿病预防计划”是一项为期一年的QI项目，将在退伍军人管理局大洛杉矶妇女健康诊所进行。患有前驱糖尿病的女性退伍军人将选择亲自、同行领导或在线、特定性别、基于证据的糖尿病预防计划，以解决她们的危险行为和健康状况。“促进女性退伍军人心血管风险筛查和降低风险”将增加女性退伍军人对心血管风险的识别，加强患者/提供者的沟通和共享关于心血管风险的决策，并提供支持性、协调的健康指导干预措施，以促进女性退伍军人参与和保留适当的健康服务。“实施为女退伍军人量身定制的协作护理”将评估基于证据的协作护理模式的实施情况，该模式旨在增强提供者和系统层面的能力，以满足女性退伍军人的焦虑和抑郁治疗需求，从而改善组织初级保健-心理健康整合(PC-MHI)的有效性，以及女性退伍军人在PC-MHI中的参与度和保留率。这两项实施研究都将使用改进的阶梯式楔形设计，并将应用基于证据的复制有效计划(REP)实施战略。混合方法实施评估将侧重于调查采用的主要实施结果、可接受性、可行性和可达性。将优先考虑多层次的利益相关者参与。将利用组织范围、提供者级别和患者级别的措施和工具来增强协同效应、工作效率和影响。作为妇女健康实施研究和质量改进的一个连贯计划，拟议的Empower QUERI将成为实现BPE战略和实现妇女退伍军人参与并最终在我们的VHA系统中赋权的一个重要里程碑。

 DESCRIPTION (provided by applicant): Project Background: Women Veterans are the fastest growing segment of Veterans Health Administration (VHA) users. This dramatic growth has created challenges for VHA. Gender disparities persist in cardiovascular (CV) and diabetes risk factor control, and rates of depression, anxiety, and mental health comorbidity are disproportionately high among women Veterans. Furthermore, a high rate of women Veterans' attrition from VA care, along with organizational barriers to care, substantiate that organizational changes are needed in order to engage and retain women Veteran VHA users in evidence-based, patient-centered care. Project Objectives: The Enhancing Mental and Physical health of Women through Engagement and Retention (EMPOWER) QUERI addresses VHA Blueprint for Excellence Strategy 6, by advancing "personalized, proactive, patient-centered" care models, and Transformational Strategy 7.2.g by implementation of innovative care models in women Veterans' health care." The EMPOWER QUERI Program is designed to improve women Veterans' engagement and retention in evidence-based care for three high priority health conditions, i.e., prediabetes, cardiovascular, and mental health. To achieve this impact goal, we propose a cohesive portfolio of projects with the following aims: (1) To use an evidence-based implementation strategy that emphasizes local tailoring of care models, multilevel stakeholder engagement, and systematic evaluation of complex implementation processes in order to enrich organizational capacity for innovations in women Veterans' VHA health care; (2) To implement personalized, proactive, patient-centered innovations in VHA women's health that are acceptable, feasible, satisfactory, relevant, and effective for both providers and patients, thereby encouraging women Veterans' engagement and retention and sustainability of the innovations; and, (3) To generate implementation "playbooks" for our partners that are scalable and serve as guidance for future implementation of a broader array of evidence-based women's health programs and policy. Project Methods: Three projects will be conducted by an experienced multidisciplinary team. "Tailoring VA's Diabetes Prevention Program to Women Veterans' Needs" is a one-year QI project to be conducted in VA Greater Los Angeles women's health clinics. Women Veterans with prediabetes will select an in-person, peer- led or online gender-specific, evidence-based diabetes prevention program to address their risk behaviors and health conditions. "Facilitating Cardiovascular Risk Screening and Risk Reduction in Women Veterans" will increase identification of CV risk among women Veterans, enhance patient/provider communication and shared decision-making about CV risk, and provide a supportive, coordinated health coaching intervention to facilitate women Veterans' engagement and retention in appropriate health services. "Implementation of Tailored Collaborative Care for Women Veterans" will evaluate implementation of an evidence-based collaborative care model tailored to enhance provider- and system-level capabilities to address women Veterans' anxiety and depression treatment needs, thereby improving organizational primary care-mental health integration (PC-MHI) effectiveness and women Veterans' engagement and retention in PC-MHI. Both implementation research studies will use a modified stepped wedge design and will apply the evidence-based Replicating Effective Programs (REP) implementation strategy. Mixed methods implementation evaluations will focus on investigating primary implementation outcomes of adoption, acceptability, feasibility, and reach. Multilevel stakeholder engagement will be prioritized. Program-wide organizational-, provider-, and patient- level measures and tools will be utilized to enhance synergy, productivity, and impact. As a coherent program of women's health implementation research and quality improvement, the proposed EMPOWER QUERI will constitute a major milestone in achieving BPE strategies and realizing women Veterans' engagement and, ultimately, empowerment in our VHA system.