Optimizing the Implementation of Whole Health Coaching for Veterans with COPD

背景：VHA致力于建立退伍军人所参与的整个医疗保健系统 有能力并有能力通过自我保健实现其对健康和福祉的最佳愿景， 传统的临床护理，以及补充和综合保健服务。这个系统的关键组成部分 是整体健康教练（WH-Coaching），一项将退伍军人与训练有素的专业人员配对的服务， 为制定和实现对个人有意义的健康和福祉目标提供广泛的一对一支持。 WH教练越来越多地融入退伍军人护理，但很少有指导存在的最好的 在指导具有复杂临床症状的退伍军人时， 需求凭借我在定性研究方法和实施科学方面的背景， 来填补我们知识上的空白然而，我仍然需要在理论驱动的评估方面进行额外的培训， 复杂系统方法、定量研究方法、协同设计和实施/混合试验， 成功地完成我的研究和更广泛的职业目标。在进行了指导性的研究和培训之后， 作为一名CDA获奖者，我将朝着成为一名全国公认的VA的职业目标顺利前进 研究人员在实施以病人为中心的护理，以改善福祉和经验的专业知识 照顾有复杂慢性病的退伍军人。 意义/影响：实施全保健系统是VHA和VA的主要优先事项， 反映在VA的2018 -2024财年和2022 -2028财年战略计划，2019年VHA现代化计划，以及 2020年VHA愿景计划。拟议的CDA将为OPCC&CT和VHA提供见解， 在未来几年持续推出WH-Coaching。通过着力优化WH- 为患有COPD的退伍军人提供指导，该研究还准备提高护理质量， 护理，以及这一庞大而重要的患者群体的生活质量。我和病人办公室的合作关系- 中心护理和文化转型（OPCC&CT）是该研究意义的另一个证明。 创新：据我们所知，目前还没有关于现有方法的已发表或未发表的研究， 实施慢性阻塞性肺病退伍军人健康指导和/或改善其实施的最佳实践。 此外，在目标2和目标3中使用现实主义评价和共同设计方法， 新颖啊 具体目的：（1）评估健康指导对医疗服务利用和戒烟的影响 COPD退伍军人的结果。(2)识别退伍军人有效WH教练的障碍和促进因素 COPD。(3)共同设计一个包含最佳实践的工具包，以便WH教练和 患有COPD的退伍军人 方法：在目标1中，我将分析CDW数据，以确定医疗保健利用和吸烟的纵向趋势 在前2个财政年度使用WH-教练的COPD退伍军人国家队列的戒烟结果 年在目标2中，在一个创新的现实主义评估框架的指导下，我将使用观察的组合， 与关键利益相关者（退伍军人、WH教练、临床医生）进行访谈，并进行伪影分析，以了解 哪些因素能够或相反地阻碍退伍军人从6岁的参与中获益 有目的地选择VA站点。在目标3中，我将涉及一组患有COPD的退伍军人，WH教练， 临床医生共同设计了一个工具包，其中包含COPD退伍军人和WH教练的最佳实践， 确保更有效地为这一人群实施健康指导。 接下来的步骤：CDA将通知至少三个IIR：（1）对WH患者报告的结果进行全国调查- （2）专家小组研究，将目标3中开发的工具包扩展到其他复杂的慢性 （3）工具包的混合执行-有效性试验。

Background: VHA has committed to building the Whole Health system of care in which Veterans are empowered and equipped to pursue their best possible vision of health and well-being through self-care, conventional clinical care, and complementary and integrative health services. A key component of this system is Whole Health Coaching (WH-Coaching), a service that pairs Veterans with trained professionals who deliver extended, one-on-one support for setting and achieving personally meaningful health and well-being goals. WH Coaches are being increasingly integrated into Veteran care, yet very little guidance exists on the best practices for using this inherently “whole person” approach when coaching Veterans with complex clinical needs. With my background in qualitative research methods and implementation science, I am well-positioned to fill this gap in our knowledge. However, I still require additional training in theory-driven evaluation and complex systems approaches, quantitative research methods, co-design, and implementation/hybrid trials to succeed in the proposed study and my broader career goals. After pursuing mentored research and training as a CDA awardee, I will be well underway toward my career goal of becoming a nationally recognized VA researcher with expertise in implementing patient-centered care to improve the well-being and experiences with care for Veterans with complex chronic conditions. Significance/Impact: Implementing the Whole Health system of care is a major priority for VHA and VA, as reflected in VA’s FY2018-2024 and FY2022-2028 Strategic Plans, the 2019 VHA Modernization Plan, and the 2020 VHA Vision Plan. The proposed CDA will provide OPCC&CT and VHA with insights that will inform the ongoing rollout of WH-Coaching for years to come. By focusing on optimizing the implementation of WH- Coaching for Veterans with COPD, the study is also poised to improve the quality of care, experiences with care, and the quality of life for this large, important patient population. My partnership with the Office of Patient- centered Care & Cultural Transformation (OPCC&CT) is an additional testament to the study’s significance. Innovation: To our knowledge, there is no published or unpublished research on the existing approaches to implementing WH-Coaching for Veterans with COPD and/or best practices for improving its implementation. Moreover, the use of realist evaluation and co-design approaches in Aims 2 and 3 is methodologically innovative. Specific Aims: (1) Assess the impact of WH-Coaching on healthcare utilization and smoking cessation outcomes for Veterans with COPD. (2) Identify barriers and facilitators of effective WH-Coaching for Veterans with COPD. (3) Co-design a toolkit with best practices for effective partnership between WH Coaches and Veterans with COPD. Methods: In Aim 1, I will analyze CDW data to identify longitudinal trends in healthcare utilization and smoking cessation outcomes for a national cohort of Veterans with COPD who used WH-Coaching in the prior 2 fiscal years. In Aim 2, guided by an innovative realist evaluation framework, I will use a combination of observations, interviews with the key stakeholders (Veterans, WH Coaches, clinicians), and artifact analysis to understand which factors enable or, conversely, hamper Veterans’ ability to derive benefits from participation at 6 purposively selected VA sites. In Aim 3, I will involve a group of Veterans with COPD, WH Coaches, and clinicians in co-designing a toolkit with best practices for Veterans with COPD and WH Coaches who work with them to ensure more effective implementation of WH-Coaching for this population. Next Steps: The CDA will inform at least three IIRs: (1) a national survey of patient-reported outcomes of WH- Coaching; (2) an expert panel study expanding the toolkit developed in Aim 3 to other complex chronic conditions with expert panel input; and (3) a hybrid implementation-effectiveness trial of the toolkit.