Damush HSR&D Research Career Scientist Award Application

达穆什高铁

• 批准号: 10392953
• 负责人: TERESA M. DAMUSH
• 金额: --
• 依托单位: RLR VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-01 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10392953
• 关键词: Acute; Address; Adjuvant; Area; Award; Back Pain; Behavior; Behavior Therapy; Cardiac rehabilitation; Caring; Chronic Disease; Client satisfaction; Clinical; County; Data; Data Analyses; Data Collection; Department of Defense; Development; Dose; Effectiveness; Emergency Medicine; Engineering; Enrollment; Evaluation; Event; Evidence based practice; Feedback; Goals; Health; Health Services; Healthcare; Healthcare Systems; Hospital safety; Hospitals; Individual; Internal Medicine; Intervention; Investments; Italy; Joints; Journals; Lead; Link; Low Back Pain; Measures; Medical Care Team; Mentors; Methods; Midwestern United States; Modeling; Monitor; Musculoskeletal Pain; Neurologic Deficit; Neurologist; Neurology; Nursing Staff; Outcome; Pain; Patient-Focused Outcomes; Patients; Performance; Persons; Policies; Population; Process; Provider; Psychologist; Public Health; Publications; Publishing; Quality of Care; Recovery; Recovery of Function; Reporting; Research; Research Personnel; Rural; Rural Health; Sampling; Scientist; Self Management; Services; Standardization; Stroke; Symptoms; System; Telerobotics; Testing; Training; Transient Ischemic Attack; Translations; Ultrasonography; Veterans; Veterans Health Administration; Work; acute stroke; appropriate dose; base; behavioral outcome; care outcomes; care providers; care systems; career; cerebrovascular; clinical practice; contextual factors; design; electronic data; evidence base; formative assessment; health care delivery; health care service organization; health related quality of life; implementation evaluation; implementation measures; implementation outcomes; implementation questions; implementation research; implementation science; implementation strategy; improved; intervention mapping; medical specialties; multidisciplinary; operation; patient oriented; peer support; programs; provider behavior; response; satisfaction; self-management program; stroke recovery; telehealth; telestroke; therapy development; tool; usability; virtual

Background: New policies and healthcare processes are constantly rolling out to the front lines of clinical staff and providers across clinical conditions and multiple settings within VHA. Less is known about the investment needed into evidence based implementation strategies by VHA healthcare organizations to achieve systematic implementation. Moreover, implementation science has only recently begun to identify a set of implementation strategies. Research is needed to elucidate upon the appropriate dose of the intervention strategy tailored to the local context to modify provider behaviors' and patients' behaviors and systems of care with sustainable implementation. Through the Precision Monitoring (PRIS-M QUERI Center) to Transform Care program we are conducting the following implementation evaluations: 1) Conduct scalable clinical quality improvement projects that link electronic data to provider actions and reporting; 2) Investigate the effects of providing actionable data on care team behaviors and processes and Veteran behaviors and satisfaction; 3) Identify the implementation strategies including the investment needed in and contextual factors that activate VHA providers, leaders, and Veterans to use data to transform and improve care and patient outcomes; and 4) activate Veteran patients to engage in the healthcare system to manage their health. Methods: With the ongoing input of our core VHA Operational partners, we are accomplishing these aims via core research and quality improvement projects that cover multiple conditions and care settings. Our projects focus on: 1) national implementation of TeleStroke in rural VHA, 2) testing telehealth modules and electronic quality measures for improving rapid transient ischemic attack (TIA) care, 3) decision support to deimplement inappropriate carotid ultrasound image ordering, and 4) regional implementation of TeleRobotics in rural VHA. These projects are supported by an Implementation and Data Core that I lead which works across all projects to facilitate efficient use of data; usability testing of new tools; and standardized use of implementation measures, methods, and analytic approaches. Our overarching implementation strategy focuses on activating individuals and groups to use data to transform care, and we use the CFIR framework to plan data collection and analyses across projects to identify core implementation strategies and contextual factors that impact how people use data to transform care. Key partners include the Office of Specialty Care, the Office of Rural Health, the Office of Telehealth, the Roudebush VAMC, and the VA Center for Applied Systems Engineering. We have developed a professional video modeling a multidisciplinary VA healthcare team which uses data to activate provider changes across services in a data driven way to improve the quality of care, and provider/patient satisfaction. Using Planning, Goal Setting, and Reflection and Evaluation, we are promoting provider behavior modification and team activation. Moreover, we employ the strategy of external facilitation to guide clinical teams in the VHA field. In addition, my research on patient self-management programs attempts to reach Veterans where they are to engage in the healthcare system to promote their optimal health and functioning. I am piloting the adaptation of cardiac rehabilitation to delivery adjuvant recovery programs for Veterans with cerebrovascular events and other conditions. Anticipated impacts: Our project evaluations are addressing the important implementation questions about how best to activate providers, healthcare teams, and Veterans to improve healthcare delivery and outcomes across clinical conditions and settings. We anticipate demonstrating the effectiveness of our implementation strategies as well elucidating upon the tailoring to the local contexts and the adequate dose of the strategies to achieve sustainable implementation within the VHA system with applications to other healthcare systems. Moreover, my Veteran centered patient programs may help Veterans to engage with providers of their care and thus improving Veteran satisfaction and outcomes of care.

背景：新的政策和医疗保健过程不断推出临床人员的前线 以及跨临床条件和VHA中多个环境的提供商。对投资知之甚少 VHA医疗保健组织需要纳入基于证据的实施策略 执行。此外，实施科学直到最近才开始确定一套实施 策略。需要进行研究以阐明适合量身定制的干预策略 改变提供者行为和患者的行为以及可持续性的护理系统的当地背景 执行。通过精确监控（Pris-M Queri中心）来改变护理程序，我们是 进行以下实施评估：1）进行可扩展的临床质量改进项目 将电子数据与提供者的行动和报告联系起来； 2）研究提供可行数据的效果 在护理团队的行为和过程中，退伍军人行为和满意度； 3）确定实现 包括激活VHA提供者，领导者和上下文因素的投资以及上下文因素的策略 退伍军人使用数据来改造和改善护理和患者的结果； 4）激活退伍军人患者 参与医疗保健系统以管理其健康。方法：随着我们核心VHA的持续输入 运营合作伙伴，我们正在通过核心研究和质量改进项目实现这些目标 涵盖了多种条件和护理设置。我们的项目重点是：1）国家实施 在农村VHA中的遥控器，2）测试远程医疗模块和电子质量措施，以改善快速 瞬态缺血性发作（TIA）护理，3）降低不适当颈动脉超声的决策支持 图像订购和4）乡村VHA中远程植物学的区域实施。这些项目得到 我领导的实施和数据核心在所有项目中都起作用，以促进有效地使用数据； 新工具的可用性测试；并标准化实施措施，方法和分析 方法。我们的总体实施策略着重于激活个人和群体使用数据 改变护理，我们使用CFIR框架来计划跨项目的数据收集和分析 确定核心实施策略和上下文因素，这些因素影响人们使用数据转换的方式 关心。主要合作伙伴包括专业护理办公室，农村健康办公室，远程医疗办公室， Roudebush VAMC和VA应用系统工程中心。我们已经发展了一个专业人士 视频建模多学科VA医疗团队，该团队使用数据激活提供商的变化 以数据驱动的方式提供服务，以提高护理质量以及提供者/患者满意度。使用计划， 目标设定，反思和评估，我们正在促进提供者的行为修改和团队 激活。此外，我们采用外部促进策略来指导VHA领域的临床团队。在 此外，我对患者自我管理计划的研究试图接触他们所在的退伍军人 参与医疗保健系统以促进其最佳健康和运作。我正在驾驶改编 对脑血管事件的退伍军人的辅助恢复计划的心脏康复 其他条件。预期的影响：我们的项目评估正在解决重要的实施 有关如何最好地激活提供者，医疗团队和退伍军人以改善医疗保健服务的问题 以及跨临床条件和环境的结果。我们预计会证明我们的有效性 实施策略以及对当地环境的裁缝以及适当剂量的裁缝 在VHA系统内实现可持续实施的策略，并应用于其他 医疗保健系统。此外，我以资深人士为中心的患者计划可以帮助退伍军人参与 他们的护理提供者，从而提高了退伍军人满意度和护理结果。