Optimizing the Implementation of Whole Health Coaching for Veterans with COPD

优化患有慢性阻塞性肺病的退伍军人的整体健康指导的实施

• 批准号: 10634783
• 负责人: Ekaterina Anderson
• 金额: --
• 依托单位: EDITH NOURSE ROGERS MEMORIAL VETERANS HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2028-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10634783
• 关键词: Adoption; Caring; Chronic; Chronic Disease; Chronic Obstructive Pulmonary Disease; Clinical; Complementary Health; Complex; Data; Distress; Enabling Factors; Enrollment; Ensure; Evaluation; Face; Foundations; Goals; Health; Health Services; Healthcare; Healthcare Systems; Hospitalization; Hybrids; Integrative Medicine; Intervention; Interview; K-Series Research Career Programs; Knowledge; Leadership; Longitudinal trends; Medical; Mentored Clinical Scientist Development Program; Mentors; Mentorship; Methodology; Methods; Modeling; Modernization; Morphologic artifacts; National Heart, Lung, and Blood Institute; Outcome; Patient Outcomes Assessments; Patient-Centered Care; Patients; Personal Satisfaction; Persons; Play; Population; Positioning Attribute; Promoting Action on Research Implementation in Health Services framework; Publishing; Qualitative Research; Quality of Care; Quality of life; Rehabilitation therapy; Research; Research Methodology; Research Personnel; Role; Self Care; Services; Site; Strategic Planning; Surveys; System; Testing; Tobacco; Training; Training Programs; Veterans; Veterans Health Administration; Vision; Work; aspirate; care seeking; care systems; career; clinical care; cohort; complex chronic conditions; design; effectiveness/implementation trial; empowerment; experience; health care service utilization; implementation efforts; implementation science; improved; innovation; insight; military veteran; patient oriented; patient population; programs; psychologic; psychosocial; pulmonary rehabilitation; skills; smoking cessation; success; supportive environment; theories; treatment services; trial design; whole health

Background: VHA has committed to building the Whole Health system of care in which Veterans are empowered and equipped to pursue their best possible vision of health and well-being through self-care, conventional clinical care, and complementary and integrative health services. A key component of this system is Whole Health Coaching (WH-Coaching), a service that pairs Veterans with trained professionals who deliver extended, one-on-one support for setting and achieving personally meaningful health and well-being goals. WH Coaches are being increasingly integrated into Veteran care, yet very little guidance exists on the best practices for using this inherently “whole person” approach when coaching Veterans with complex clinical needs. With my background in qualitative research methods and implementation science, I am well-positioned to fill this gap in our knowledge. However, I still require additional training in theory-driven evaluation and complex systems approaches, quantitative research methods, co-design, and implementation/hybrid trials to succeed in the proposed study and my broader career goals. After pursuing mentored research and training as a CDA awardee, I will be well underway toward my career goal of becoming a nationally recognized VA researcher with expertise in implementing patient-centered care to improve the well-being and experiences with care for Veterans with complex chronic conditions. Significance/Impact: Implementing the Whole Health system of care is a major priority for VHA and VA, as reflected in VA’s FY2018-2024 and FY2022-2028 Strategic Plans, the 2019 VHA Modernization Plan, and the 2020 VHA Vision Plan. The proposed CDA will provide OPCC&CT and VHA with insights that will inform the ongoing rollout of WH-Coaching for years to come. By focusing on optimizing the implementation of WH- Coaching for Veterans with COPD, the study is also poised to improve the quality of care, experiences with care, and the quality of life for this large, important patient population. My partnership with the Office of Patient- centered Care & Cultural Transformation (OPCC&CT) is an additional testament to the study’s significance. Innovation: To our knowledge, there is no published or unpublished research on the existing approaches to implementing WH-Coaching for Veterans with COPD and/or best practices for improving its implementation. Moreover, the use of realist evaluation and co-design approaches in Aims 2 and 3 is methodologically innovative. Specific Aims: (1) Assess the impact of WH-Coaching on healthcare utilization and smoking cessation outcomes for Veterans with COPD. (2) Identify barriers and facilitators of effective WH-Coaching for Veterans with COPD. (3) Co-design a toolkit with best practices for effective partnership between WH Coaches and Veterans with COPD. Methods: In Aim 1, I will analyze CDW data to identify longitudinal trends in healthcare utilization and smoking cessation outcomes for a national cohort of Veterans with COPD who used WH-Coaching in the prior 2 fiscal years. In Aim 2, guided by an innovative realist evaluation framework, I will use a combination of observations, interviews with the key stakeholders (Veterans, WH Coaches, clinicians), and artifact analysis to understand which factors enable or, conversely, hamper Veterans’ ability to derive benefits from participation at 6 purposively selected VA sites. In Aim 3, I will involve a group of Veterans with COPD, WH Coaches, and clinicians in co-designing a toolkit with best practices for Veterans with COPD and WH Coaches who work with them to ensure more effective implementation of WH-Coaching for this population. Next Steps: The CDA will inform at least three IIRs: (1) a national survey of patient-reported outcomes of WH- Coaching; (2) an expert panel study expanding the toolkit developed in Aim 3 to other complex chronic conditions with expert panel input; and (3) a hybrid implementation-effectiveness trial of the toolkit.

背景：VHA 致力于建立退伍军人所在的整体医疗保健系统 有权并有能力通过自我保健来追求健康和福祉的最佳愿景， 传统临床护理以及补充和综合卫生服务是该系统的关键组成部分。 是整体健康辅导（WH-Coaching），这项服务将退伍军人与训练有素的专业人员配对，提供 为制定和实现个人有意义的健康和福祉目标提供长期的一对一支持。 WH 教练越来越多地融入退伍军人护理中，但关于最佳教练的指导却很少 在指导退伍军人进行复杂的临床治疗时，使用这种固有的“全人”方法的实践 凭借我在定性研究方法和实施科学方面的背景，我处于有利地位。 为了填补我们的知识空白，我仍然需要在理论驱动的评估和方面进行额外的培训。 复杂系统方法、定量研究方法、协同设计和实施/混合试验 在进行指导性研究和培训后，我将在拟议的研究和更广泛的职业目标中取得成功。 作为 CDA 获奖者，我将顺利实现成为国家认可的 VA 的职业目标 具有实施以患者为中心的护理以改善福祉和体验的专业知识的研究人员 照顾患有复杂慢性病的退伍军人。 意义/影响：实施整个医疗保健系统是 VHA 和 VA 的首要任务，因为 反映在 VA 2018-2024 财年和 2022-2028 财年战略计划、2019 年 VHA 现代化计划以及 2020 VHA 愿景计划。拟议的 CDA 将为 OPCC&CT 和 VHA 提供见解，为 未来几年持续推出 WH-Coach 重点关注优化 WH- 的实施。 该研究还为患有慢性阻塞性肺病的退伍军人提供指导，旨在提高护理质量和体验 我与患者办公室的合作伙伴关系。 以中心为中心的护理与文化转型 (OPCC&CT) 是该研究意义的另一个遗产。 创新：据我们所知，目前还没有关于现有方法的已发表或未发表的研究 为患有慢性阻塞性肺病 (COPD) 的退伍军人实施 WH 辅导和/或改进其实施的最佳实践。 此外，在目标 2 和 3 中使用现实主义评估和协同设计方法在方法论上是可行的。 创新的。 具体目标：(1) 评估 WH-Coaching 对医疗保健利用和戒烟的影响 (2) 确定退伍军人有效 WH 辅导的障碍和促进因素。 (3) 共同设计一个包含最佳实践的工具包，以促进 WH 教练与 COPD 之间的有效合作。 患有慢性阻塞性肺病的退伍军人。 方法：在目标 1 中，我将分析 CDW 数据，以确定医疗保健利用和吸烟的纵向趋势 在前 2 个财政年度使用 WH-Coaching 的全国患有慢性阻塞性肺病 (COPD) 退伍军人队列的戒烟结果 在目标 2 中，在创新的现实主义评估框架的指导下，我将结合观察、 与主要利益相关者（退伍军人、WH 教练、反叛者）的访谈以及工件分析以了解 哪些因素能够或相反地阻碍退伍军人从参与中获益的能力 6 在目标 3 中，我将有目的地选择 VA 站点，其中包括一组患有慢性阻塞性肺病 (COPD) 的退伍军人、WH 教练和人员。 勇士队为患有慢性阻塞性肺病的退伍军人和与他们合作的 WH 教练共同设计了一个包含最佳实践的工具包 以确保针对该人群更有效地实施 WH-Coaching。 后续步骤：CDA 将通知至少三个 IIR：(1) 对患者报告的 WH-结果进行全国调查 辅导；(2) 专家小组研究将目标 3 中开发的工具包扩展到其他复杂的慢性病 专家小组意见的条件；(3) 工具包的混合实施-有效性试验。