Hamilton Alison B, Olmos-Ochoa Tanya T, Canelo Ismelda, Rose Danielle, Hoggatt Katherine J, Than Claire, Yano Elizabeth M
VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073 USA.
Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095 USA.
Implement Sci Commun. 2020 Jun 30;1:59. doi: 10.1186/s43058-020-00038-0. eCollection 2020.
Women's Health Services (WHS) in the Veterans Health Administration (VA) has long partnered with VA researchers to evaluate how VA care is organized for women veterans. This partnership has yielded substantial evidence of (1) variations in women veterans' access to comprehensive healthcare services that contribute to disparities in quality and patient experience and (2) the positive impacts of gender-specific care models for women veterans' quality and satisfaction. In an effort to provide support specifically to sites that were low-performing in women's health, WHS and the VA Quality Enhancement Research Initiative co-funded an effort to roll out and evaluate evidence-based quality improvement (EBQI), an implementation strategy with demonstrated effectiveness in a prior cluster randomized trial in women's health clinics.
We will identify 21 low-performing VA facilities through a combination of practice data, VA quality metrics (by gender), and other indicators. In partnership with WHS, an EBQI contractor will deliver the EBQI "package"-local consensus development and priority setting using stakeholder panels, multilevel stakeholder engagement, practice facilitation, local EBQI team training, and formative feedback-to participating sites. We propose a dynamic wait-listed design to evaluate the WHS plans for seven EBQI launches per year over 3 years. The goal is to evaluate (1) barriers and facilitators to achieving delivery of comprehensive women's health care in low-performing VA facilities; (2) effectiveness of EBQI in supporting low-performing VA facilities to achieve improved practice features (e.g., level of comprehensive services available, care coordination arrangements, Patient Aligned Care Team (PACT) features implemented, environment of care improvements), provider/staff attitudes (e.g., improved gender awareness, women's health knowledge and practice), quality of care, and patient experience; and (3) contextual factors, local implementation processes, and organizational changes over time.
Access to comprehensive women's health care reduces fragmentation of care, improves patient satisfaction, and results in better patient outcomes. We hypothesize that EBQI implementation will result in changes in leadership awareness and buy-in, multilevel engagement in problem-solving, an enhanced culture of quality improvement, structural changes in care, improved provider/staff attitudes, and better quality and patient experience.
ClinicalTrials.gov, NCT03238417. Registered 3 August 2017. Retrospectively registered, https://clinicaltrials.gov/ct2/show/study/NCT03238417.
长期以来，退伍军人健康管理局（VA）的妇女健康服务（WHS）部门一直与VA研究人员合作，评估为女性退伍军人提供VA护理的组织方式。这种合作产生了大量证据，证明（1）女性退伍军人获得全面医疗服务的机会存在差异，这导致了质量和患者体验方面的差距；（2）针对女性退伍军人的特定性别护理模式对其质量和满意度产生了积极影响。为了专门支持在妇女健康方面表现不佳的机构，WHS和VA质量提升研究计划共同资助了一项推广和评估循证质量改进（EBQI）的工作，这是一种在先前针对妇女健康诊所的整群随机试验中已证明有效的实施策略。
我们将通过实践数据、VA质量指标（按性别）和其他指标相结合的方式，确定21个表现不佳的VA机构。与WHS合作，一个EBQI承包商将向参与机构提供EBQI“套餐”——利用利益相关者小组进行本地共识发展和优先级设定、多层次利益相关者参与、实践促进、本地EBQI团队培训以及形成性反馈。我们提出一种动态等待列表设计，以评估WHS在3年内每年进行7次EBQI推广的计划。目标是评估（1）在表现不佳的VA机构中实现全面妇女健康护理的障碍和促进因素；（2）EBQI在支持表现不佳的VA机构实现改善实践特征（例如，可用的综合服务水平、护理协调安排、实施的患者对齐护理团队（PACT）特征、护理环境改善）、提供者/工作人员态度（例如，提高性别意识、妇女健康知识和实践）、护理质量和患者体验方面的有效性；以及（3）背景因素、本地实施过程和随时间变化的组织变革。
获得全面的妇女健康护理可减少护理的碎片化，提高患者满意度，并带来更好的患者结局。我们假设实施EBQI将导致领导意识和支持度的变化、解决问题的多层次参与、质量改进文化的增强、护理结构的变化、提供者/工作人员态度的改善以及更好的质量和患者体验。
ClinicalTrials.gov，NCT03238417。2017年8月3日注册。追溯注册，https://clinicaltrials.gov/ct2/show/study/NCT03238417。
