PrOVE: PeRsonalizing Options through Veteran Engagement

ProOVE：通过退伍军人参与实现个性化选择

• 批准号: 9075231
• 负责人: ANGELA FAGERLIN
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-10-01 至 2020-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9075231
• 关键词: Accounting; Address; Address; Age; Age; Ambulatory Care Facilities; Ambulatory Care Facilities; Benefits and Risks; Benefits and Risks; Businesses; Businesses; Caring; Caring; Chronic; Chronic; Client satisfaction; Client satisfaction; Clinical; Clinical; Clinical Management; Clinical Management; Clinical Trials; Clinical Trials; Collaborations; Collaborations; Communities; Communities; Data; Data; Data Analyses; Decision Support Systems; Decision Support Systems; Development; Development; Diabetes Mellitus; Diabetes Mellitus; Disease; Disease; Effectiveness; Effectiveness; Elements; Elements; Engineering; Engineering; Evaluation; Evaluation; Funding; Funding; Goals; Goals; Guidelines; Guidelines; Health; Health Promotion; Health Promotion; Health Status; Health Status; Healthcare; Healthcare; Homogeneously Staining Region; Individual; Individual; Intelligence; Intelligence; Intervention; Measures; Measures; Medical center; Medical center; Patient Preferences; Patient Preferences; Patient risk; Patient risk; Patients; Patients; Performance; Performance; Personal Satisfaction; Personal Satisfaction; Population Study; Population Study; Prevention; Prevention; Prevention strategy; Prevention strategy; Primary Health Care; Primary Health Care; Provider; Provider; Qi; Quality of Care; Quality of Care; Research; Research; Resources; Resources; Risk; Risk; Risk Factors; Risk Factors; Running; Running; Self Management; Self Management; Services; Services; Site; Site; System; System; Techniques; Techniques; Testing; Testing; Variant; Variant; Veterans; Veterans; Vision; Vision; Weight maintenance regimen; Weight maintenance regimen; Work; Work; base; base; clinical center; disorder prevention; disorder prevention; evidence base; evidence base; experience; experience; health care delivery; health care delivery; implementation research; implementation research; implementation science; implementation science; implementation strategy; improved; improved; individual patient; individualized prevention; individualized prevention; intervention program; lung cancer screening; lung cancer screening; patient engagement; patient oriented; patient oriented; personalized care; personalized care; personalized decision; personalized health care; preference; preference; prevent; prevent; programs; programs; public health relevance; public health relevance; screening; screening program; self-management program; shared decision making; shared decision making; success; success; tool; tool; treatment risk

 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.

 描述（由申请人提供）： 医疗保健中的“一种尺寸并不适合所有尺寸”。没有两名退伍军人相同，也没有两个VA医疗中心或基于社区的门诊诊所（CBOC）。医疗保健提供的决策通常基于“平均”效果。当前的指南和绩效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处方相同的治疗方法，而无需考虑患者之间的重要差异。这 拟议中的Queri建立在VA临床管理研究中心（CCMR，VA HSR＆D Coin）和糖尿病QuERI的广泛工作基础上，以提高提供给退伍军人的护理的有效性。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个性化的医疗保健决策来改善慢性病的预防和管理，以考虑到个人患者的风险和偏好。通过这个目标，我们旨在提高护理的适当性（减少过度使用和不足），增加在医疗保健中的退伍军人参与，并增强退伍军人经验。这个目标直接与卓越策略的蓝图直接相吻合：个性化，积极主动和患者驱动的预先医疗保健，并互动并鼓励退伍军人达到其最高水平的健康和福祉水平。我们的QUERI计划的具体目的包括以下内容：1。实施以患者为中心的绩效管理系统，以增强护理的适当性并纳入共同的决策。 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计划将包括以下从第1年开始的项目：项目＃1：该项目将包括 与VA国家健康促进与疾病预防中心（NCP）和初级保健办公室合作，对肺癌筛查的共享决策制作工具的实施和评估。基于证据的工具已经在Ann Arbor VAMC开发并进行了试点测试，并将被传播到目前作为NCP国家肺癌筛查项目的试点站点参与的八个VAMC。项目＃2：在此项目中，我们将与NCP和VA的分析与商业智能办公室（OABI）合作，以改善新举动的传播！指南，目的是降低移动有效性的局部差异！并最大程度地利用小组环境中患者的个性化体重管理支持。本地QI倡议：该项目将实施并评估一种绩效管理工具，用于改善Ann Arbor VAMC中他汀类药物的使用，该工具是个性化的患者风险因素。实施核心：该核心将着重于使用合并的实施研究框架（CFIR）在整个研究的上下文上收集和分析数据，包括本QuERI以及与至少五个其他Queri计划（如果是资助的话）来确定上下文和实施成功之间的关联。我们针对所有项目的实施策略将结合系统重新设计技术（与VA的应用系统工程中心合作），使用裁缝工具（“屏障混蛋”工具），这些工具将帮助本地团队根据本地环境的功能选择适当的实施策略。