PROVE: Program for Research on Outcomes of VA Education

PROVE：退伍军人事务部教育成果研究计划

• 批准号: 8182873
• 负责人: Mark D Schwartz
• 金额: --
• 依托单位: VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-07-01 至 2013-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8182873
• 关键词: Adherence; Area; Attitude; Behavior; Blood Pressure; Caring; Chronic; Chronic Disease; Clinic; Clinical; Complex; Continuing Education; Data; Development; Diabetes Mellitus; Disease Management; Education; Educational Intervention; Effectiveness; Environment; Evidence based practice; Exposure to; Goals; Health; Health Personnel; Health Professional; Health Services; Health Services Research; Health system; Healthcare; Healthcare Systems; Heart failure; Hour; Hypertension; Individual; Informatics; Institute of Medicine (U.S.); Interdisciplinary Study; Intervention; Investments; Job Satisfaction; Knowledge; Learning; Link; Measurement; Measures; Medical Education; Mental Depression; Methods; Mission; Modeling; Myocardial Ischemia; New York; Nurses; Outcome; Outcomes Research; Patient-Centered Care; Patients; Performance; Pharmacists; Phase; Physicians; Primary Health Care; Process; Professional Education; Provider; Randomized Controlled Trials; Research; Research Infrastructure; Research Personnel; Research Support; Resources; Role; Self Efficacy; Shapes; Smoking; Testing; Time; Training; Training and Education; Translations; Universities; Variant; Veterans; Work; arm; base; behavior change; chronic pain; clinical care; cost; data management; efficacy testing; evidence base; experience; hypertension prevention; improved; infancy; innovation; medical schools; meetings; member; microsystems; programs; skills; smoking cessation; theories

ABSTRACT Project Background: Education is a core mission of VA, which spends >$1 billion annually to educate over 100,000 health professionals. Despite this ongoing commitment, little is known about the effectiveness of VA's education investment in improving health outcomes of veterans. In this proposal, VA New York Harbor Healthcare System (VA NYHHS) partners with New York University School of Medicine (NYUSOM) to establish an innovative, multidisciplinary research program aiming to "delineate the causal chain" from educational innovations and interventions through changed health professional behavior within clinical microsystems to improved health outcomes of veterans. Project Objectives: The specific aims for this study are: (1) To identify health professional educational and clinical microsystem determinants of outcomes for hypertension and smoking cessation in veterans, (2) to assess the impact of the implementation of panel management on primary patient outcomes in hypertension and smoking cessation (blood pressure and quit rates), and (3) to assess the impact of the implementation of panel management on secondary, intermediary, patient (patient activation, adherence, behavior change), provider (knowledge and attitudes, self-efficacy, job satisfaction) and microsystem outcomes (collective efficacy, teamwork, use of data, redesign of patient processes and provider roles/responsibilities, use of panel management strategies). Project Methods: This project will consist of two phases. In Phase I (one year), we will develop the necessary measurement and data infrastructure to assess health professional education, microsystem function, and clinical outcomes. We will examine variations in education exposure (to clinical microsystems and panel management) and explore their association with processes of care and clinical outcomes. In Phase II (two years), we will conduct a demonstration project, comparing two interventions in a randomized controlled trial. Primary care (PC) microsystem teams at VA NYHHS will be randomly allocated to one of three arms: ¿ Panel Management Data (PM-Data): these microsystem teams will get panel performance data but no support and no education; ¿ Panel Management Data and Support (PM-Support): these microsystem teams will get panel performance data as above plus have one hour per week for the physician to meet with a research supported panel manager assistant (PMA) to facilitate panel management. Once per month this meeting will include the entire team (physician, nurse, clerk, and pharmacist); ¿ Panel Management Data, Support, and Education (PM-Education): these microsystem teams will get panel performance data, panel support and time for regular meetings as above, plus an educational intervention that aims to enhance microsystem team performance in using panel management skills to improve outcomes in hypertension and smoking.

抽象的 项目背景： 教育是 VA 的核心使命，每年花费超过 10 亿美元为超过 100,000 人提供健康教育 尽管有这一持续的承诺，但人们对 VA 教育的有效性知之甚少。 在这项提案中，VA 纽约港医疗保健公司投资改善退伍军人的健康状况。 System (VA NYHHS) 与纽约大学医学院 (NYUSOM) 合作建立 创新的多学科研究计划，旨在从教育中“描绘因果链” 通过改变临床微系统内的卫生专业行为进行创新和干预 改善退伍军人的健康状况。 项目目标： 本研究的具体目的是：（1）确定卫生专业教育和临床微系统 退伍军人高血压和戒烟结果的决定因素，(2) 评估 对高血压和戒烟的主要患者结局实施小组管理 （血压和戒烟率），以及（3）评估实施小组管理对 次要、中介、患者（患者激活、依从性、行为改变）、提供者（知识和 态度、自我效能、工作满意度）和微系统结果（集体效能、团队合作、数据的使用、 重新设计患者流程和提供者角色/职责，使用小组管理策略）。 项目方法： 该项目将分为两个阶段，在第一阶段（一年），我们将制定必要的测量和方法。 用于评估卫生专业教育、微系统功能和临床结果的数据基础设施。 将检查教育经历的变化（临床微系统和小组管理）并探索 它们与护理过程和临床结果的关系在第二阶段（两年），我们将进行一项研究。 示范项目，比较初级保健（PC）中的两种干预措施。 VA NYHHS 的微系统团队将被随机分配到三个部门之一： ¿面板管理数据（PM-Data）：这些微系统团队将获得面板性能数据，但没有 支持但没有教育； ¿面板管理数据和支持（PM-Support）：这些微系统团队将获得面板性能 数据如上，加上每周一小时让医生与研究支持的小组会面 经理助理 (PMA) 每月一次，以促进小组管理。 整个团队（医生、护士、文员和药剂师）； ¿小组管理数据、支持和教育（PM-教育）：这些微系统团队将获得小组 如上所述的绩效数据、小组支持和定期会议时间，以及教育干预 旨在提高微系统团队在使用面板管理技能来改进方面的绩效 高血压和吸烟的结果。