Patient-centered Strategies to Engage Veterans in Behavioral Health Services

以患者为中心的策略让退伍军人参与行为健康服务

• 批准号: 10175013
• 负责人: Jessica Yelena Breland
• 金额: --
• 依托单位: VETERANS ADMIN PALO ALTO HEALTH CARE SYS
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-10-01 至 2021-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10175013
• 关键词: Address; American; Behavioral; Belief; Body Weight decreased; Caring; Cessation of life; Chronic; Clinic; Collaborations; Country; Data; Databases; Diabetes Mellitus; Disease; Doctor of Philosophy; Ensure; Evaluation; Gender; Goals; Grant; Health; Health Promotion; Health Services; Health behavior; Healthcare; Hybrids; Interview; Literature; Mentors; Mentorship; Methods; Modeling; Motivation; Nurses; Obesity; Outcome; Overweight; Patients; Persons; Physical Function; Population; Primary Health Care; Procedures; Protocols documentation; Quality of life; Randomized Controlled Trials; Research Personnel; Risk; Schedule; Scientific Advances and Accomplishments; Speed; Substance Use Disorder; Testing; Text; Time; Training; Veterans; Visit; Weight; Weight Gain; Weight maintenance regimen; Woman; Women' s Health; Women' s Health Services; Work; Writing; administrative database; behavioral health; cost; design; disorder prevention; experience; health administration; health belief; implementation science; implementation strategy; improved; innovation; men; motivational enhancement therapy; named group; neglect; novel; patient oriented; physical conditioning; population health; preference; programs; recruit; satisfaction; self help; theories; tool; tool development; treatment arm; treatment program

This CDA will provide Jessica Y. Breland, PhD with the training and experience to become an independent VA health services researcher focused on implementing patient-centered strategies to engage Veterans in behavioral health services. To achieve this goal, she will work with her mentors and consultants to develop and evaluate a patient-centered, motivational, self-help tool to increase engagement in weight loss treatments through three steps: 1 ) Identify patient and organizational predictors of weight loss treatment engagement; 2) Develop a motivational, self-help tool to engage Veterans in weight loss treatments; and 3) Pilot-test the self-help tool. Almost 80% of Veterans (and ~70% of other Americans) are overweight/obese, increasing their risk of costly and debilitating chronic conditions. Given that weight loss treatments reduce diabetes and other conditions, increasing weight loss treatment engagement (any and sustained engagement) could prolong millions of lives. Unfortunately, VA has a weight loss treatment implementation gap: VA offers treatment to 94% of overweight/obese Veterans, but only 10% use them. Further, while motivational interviewing improves engagement, clinicians have limited time to use it. A motivational, self-help tool could increase weight loss treatment engagement without requiring clinicians' time. To develop the tool, Dr. Breland proposes a mixed-methods approach offering three significant innovations: a population health orientation, a self-help application of motivational interviewing, and a novel theoretical basis for evaluation that uses implementation science and theories of health beliefs and behaviors. In Aim 1.1, she will identify VA behavioral weight loss treatments, including, but not limited to MOVE! (VA's primary weight loss treatment), through interviews with clinicians and national leaders. Results will identify dependent variables for Aim 1.2 analyses and treatments to include in the self-help tool (Aim 2.3). In Aim 1.2, she will identify patient and organizational predictors of engagement in the weight loss treatments identified in Aim 1.1, stratifying analyses by gender and using the existing Women's Health Evaluation Initiative Master Database. Results will offer population-level data on weight loss treatment engagement, and some of the first data on engagement in VA treatments other than MOVE!. Results will also identify populations and organizational factors associated with poor engagement, to further understand through interviews with clinicians (Aim 2.1) and Veterans (2.2) to develop tool content and define implementation strategies. In Aim 2.3, she will use results of prior aims to adapt existing motivational interviewing protocols into an interactive, motivational, self-help tool that uses text and videos to enhance engagement in weight loss treatments. Finally, she will pilot-test the tool by recruiting VA Palo Alto primary care clinicians and patients (Aim 3). Results will assess the feasibility of methods to test the tool in a subsequent Hybrid Type 1 trial, including clinicians' and Veterans' satisfaction with the tool, barriers to its use, and necessary changes to procedures for collecting/analyzing outcomes: weight loss treatment engagement, weight loss, quality of life, and physical functioning. Training related to these aims draws on her mentors' and consultants' expertise in: 1) Administrative Database Analyses (Frayne, Maguen, Phibbs); 2) Implementation Science (Asch, Goldstein); 3) Behavioral Health (Timko, Maguen); 4) Operational Partnerships (all mentors); and Grant Writing (all mentors). The work was developed with operational partners, including the National Center for Health Promotion and Disease Prevention and Women's Health Services, to ensure that it advances the scientific literature, while aligning with their goals. The work alsoaligns with VA's Blueprint for Excellence, emphasizing “high quality, Veteran-centered care” and advancing “healthcare innovation for Veterans and the country.”

该CDA将为Jessica Y. Breland，博士提供培训和经验，成为一个 独立VA卫生服务研究人员致力于实施以患者为中心的策略来参与 行为卫生服务的退伍军人。为了实现这一目标，她将与导师和顾问合作 开发和评估以患者为中心的，动机，自助工具以增加体重的参与 通过三个步骤损失治疗：1 ） 确定体重减轻的患者和组织预测指标 治疗参与； 2）开发一种动机，自助工具，使退伍军人减肥 治疗； 3）试点测试自助工具。 几乎80％的退伍军人（约70％的其他美国人）超重/肥胖，增加了风险 昂贵和使人衰弱的慢性病。鉴于减肥治疗减少了糖尿病和其他 条件，增加减肥治疗的参与度（任何和持续的参与）可能会延长 数百万的生命。不幸的是，VA具有减肥治疗差距：VA提供治疗 超重/肥胖的退伍军人中有94％，但只有10％使用它们。此外，励志采访 改善参与度，临床医生使用它的时间有限。激励性的自助工具可以增加 减肥治疗的参与度无需临床医生的时间。 为了开发该工具，Breland博士提出了一种混合方法，提供了三个重要的 创新：人口健康取向，动机访谈的自助应用和小说 评估的理论基础，使用实施科学和健康信念理论和 行为。在AIM 1.1中，她将确定VA行为减肥治疗，包括但不限于 移动！ （VA的主要减肥疗法），通过对临床医生和国家领导人的访谈。 结果将确定AIM 1.2分析和治疗的因变量，其中包括在自助工具中 （AIM 2.3）。在AIM 1.2中，她将确定体重参与的患者和组织预测指标 在AIM 1.1中确定的损失治疗，通过性别对分析进行分层并使用现有妇女健康 评估计划主数据库。结果将提供有关减肥治疗的人群级别的数据 参与，以及有关Move！以外的VA治疗的一些第一个数据！结果将 还确定与参与不良相关的人群和组织因素，以进一步了解 通过与临床医生（AIM 2.1）和退伍军人（2.2）的访谈来开发工具内容并定义 实施策略。在AIM 2.3中，她将使用先前目标的结果来调整现有的励志 采访协议成一种互动，动机，自助工具，该工具使用文本和视频来增强 参与减肥治疗。最后，她将通过招募VA Palo Alto Primary进行试验该工具 护理临床医生和患者（AIM 3）。结果将评估方法在A中测试该工具的可行性 随后的Hybrid 1型试验，包括临床医生和退伍军人对该工具的满意 使用和对收集/分析结果的程序的必要更改：减肥治疗 参与，体重减轻，生活质量和身体功能。 与这些目标相关的培训借鉴了她的导师和顾问的专业知识：1）行政 数据库分析（Frayne，Maguen，Phibbs）； 2）实施科学（ASCH，Goldstein）； 3）行为 健康（Timko，Maguen）； 4）运营伙伴关系（所有导师）；和授予写作（所有导师）。这 与运营伙伴一起开发了工作，包括国家健康促进中心和 预防疾病和妇女卫生服务，以确保它可以提高科学文献，而 与他们的目标保持一致。这项作品也与VA的蓝图有关卓越的蓝图，强调“高质量， 以退伍军人为中心的护理”并推进了“退伍军人和国家的医疗创新”。