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

通过参与和保留增强女性的身心健康 EMPOWER

• 批准号: 9075438
• 负责人: Bevanne Bean-Mayberry
• 金额: --
• 依托单位: VA GREATER LOS ANGELES HEALTHCARE SYSTEM
• 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/9075438
• 关键词: Address; Address; Administrator; Administrator; Adoption; Adoption; Anxiety; Anxiety; Cardiovascular system; Caring; Caring; Clinic; Clinic; Communication; Complex; Complex; Effectiveness; Effectiveness; Ensure; Ensure; Evaluation; Evaluation; Exposure to; Exposure to; Female; Female; Future; Future; Gender; Gender; Glean; Glean; Goals; Goals; Growth; Growth; Health; Health; Health Priorities; Health Priorities; Health Services; Health Services; Healthcare; Healthcare; Intervention; Intervention; Link; Link; Los Angeles; Los Angeles; Measures; Measures; Mental Depression; Mental Depression; Mental Health; Mental Health; Methodology; Methods; Methods; Minority; Minority; Modeling; Modeling; Organizational Change; Organizational Change; Outcome; Outcome; Patient-Centered Care; Patient-Centered Care; Patients; Patients; Persons; Persons; Phase; Phase; Policies; Policies; Population; Population; Prediabetes syndrome; Prediabetes syndrome; Primary Health Care; Primary Health Care; Process; Process; Productivity; Productivity; Provider; Provider; Psyche structure; Qi; Research; Research Personnel; Research Personnel; Research Project Grants; Research Project Grants; Resources; Resources; Risk Behaviors; Risk Behaviors; Risk Factors; Risk Factors; Risk Reduction; Risk Reduction; Services; Services; Site; Site; System; System; Veterans; Veterans; Woman; Woman; Women' s Health; Women' s Health; barrier to care; base; cardiovascular health; cardiovascular risk factor; cardiovascular risk factor; care fragmentation; cohesion; collaborative care; collaborative care; comorbidity; comorbidity; design; design; diabetes prevention program; diabetes prevention program; diabetes risk; diabetes risk; empowerment; empowerment; evidence base; evidence base; experience; experience; gender disparity; health administration; health administration; health care quality; health care quality; health practice; implementation research; implementation research; implementation science; implementation science; implementation strategy; improved; improved; innovation; innovation; insight; insight; male; male; multidisciplinary; multidisciplinary; multilevel analysis; operation; operation; patient oriented; patient oriented; patient-clinician communication; peer; peer; physical conditioning; physical conditioning; practice-based research network; preference; preference; programs; programs; research study; research study; screening; screening; shared decision making; shared decision making; success; success; synergism; tool; tool; uptake; uptake

 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.

 描述（由申请人提供）： 项目背景：退伍军人是退伍军人卫生管理局（VHA）使用者的发展最快的部分。这种戏剧性的增长给VHA带来了挑战。性别差异持续存在于心血管（CV）和糖尿病风险因素控制，抑郁，焦虑和心理健康合并症的率在女性退伍军人中的比例不成比例。此外，VA护理中的老年退伍军人流失率很高，以及组织的障碍，可以证实需要组织变更，以吸引和保留以证据为基于循证的，以患者为中心的证据的女性VHA使用者。项目目标：通过参与和保留（Empower）QuERI来提高妇女的身心健康，以解决VHA蓝图的卓越策略6，通过“推进“个性化，积极主动，以患者为中心的，以患者为中心”的“护理”模型和变革策略7.2.g。条件，即糖尿病前，心血管和心理健康，我们提出了一个具有以下目的的项目组合：（1）使用基于证据的实施策略，该策略强调了护理模型的局部量身定制VHA妇女健康中的个性化，积极主动，以患者为中心的创新，对提供者和患者都可以接受，可行，令人满意，相关和有效，从而鼓励妇女退伍军人的参与，创新的保留和可持续性； （3）为我们的合作伙伴生成“剧本”的实施，这些实施是可扩展的，并为将来实施一系列更广泛的循证妇女健康计划和政策提供指导。项目方法：三个项目将由经验丰富的多学科团队进行。 “针对妇女退伍军人的需求量身定制VA的糖尿病预防计划”是一个为期一年的QI项目，该项目将在弗吉尼亚州大洛杉矶妇女健康诊所进行。具有糖尿病前期的女性退伍军人将选择面对面的，同伴或在线性别的基于循证的糖尿病预防计划，以解决其风险行为和健康状况。 “促进心血管风险筛查和降低女性退伍军人的风险”将增加对女性退伍军人的简历风险的识别，增强患者/提供者的沟通和有关简历风险的共同决策，并提供支持性的，协调的健康教练干预，以支持女性退伍军人在适当卫生服务中的退伍军人参与。 “针对妇女退伍军人的量身定制协作护理的实施”将评估量身定制的基于证据的协作护理模型的实施，以提高提供者和系统级别的能力，以满足女性退伍军人的焦虑和抑郁症治疗需求，从而提高组织初级保健健康整合（PC-MHI）的有效性，以及女性退伍军人的参与度和PC-MHI。两项实施研究将使用修改后的楔形设计，并将应用基于证据的复制有效计划（REP）实施策略。混合方法实施评估将着重于研究采用，可接受性，可行性和覆盖范围的主要实施结果。多级利益相关者的参与将优先考虑。范围内的组织，提供者和患者水平的措施和工具将用于提高协同作用，生产力和影响。作为妇女健康实施研究和质量改进的连贯计划，拟议的Empower Queri将构成实现BPE策略并实现女性退伍军人参与的重要里程碑，并最终在我们的VHA系统中获得授权。