2010 — Implementation of Patient Self-Management Programs among Veterans in VA

Damush T (Stroke-QUERI, HSRD COE Implementing Evidence Based Practices), Anderson J (Houston VAMC), Bosworth H (HSRD Center for Health Services Research in Primary Care)

Objectives:
Over the past two decades, patient self-management programs have been designed for patients diagnosed with specific chronic conditions and evaluated for effectiveness in randomized controlled trials. There is a paucity of knowledge on how to implement and sustain the delivery of such self-management programs within primary and specialty care in VA across medical conditions. The objectives of this workshop are to: 1) describe common barriers to implementation of traditional models of patient self-management programs among veterans; 2) discuss how to move along the QUERI Pipeline from effectiveness trials to regional and national implementation; 3) identify facilitators for implementation of self-management programs among veterans; 4) understand how to embed self-management patient programs within the VA structure of services; and 5) discuss the next steps for patient self-management implementation programs and evaluation in VA across QUERI.

Activities:
The workshop will be comprised of a structured panel discussion with significant chances for dialogue throughout. Hayden Bosworth, PhD, will discuss transitioning from effectiveness trials to real world interventions through a regional rollout in VA, developing partnerships with administration and operations to implement changes in care outside of research, and the struggle between the intervention fidelity and local adaptation. Jane Anderson, PhDc, RN, FNP-BC, and Teresa Damush, PhD, will discuss lessons learned during the implementation of two patient self-management programs for veterans with stroke: the Self-management TO Prevent (STOP) Stroke Clinic at the MEDVAMC and the Stroke Self-Management Program. The STOP Stroke Clinic is a hybrid specialty clinic staffed by nurse practitioner faculty and nurse practitioner students. The focus of the clinic is on the provision of secondary prevention interventions for veterans with stroke or transient ischemic attack (TIA). The STOP Stroke clinic provides a system through which evidence-based interventions are implemented using an integrative process that combines three essential care delivery areas: clinical management, patient education, and patient self-management. Clinical management of stroke risk factors is guided by a computerized template-based tool within CPRS that prompts the provider on current evidence-based practices. Patient education is incorporated into the process of care. The Stroke Self-Management Program, developed in Indianapolis, targets hospitalized veterans with ischemic stroke and provides follow up sessions after discharge at the hospital and by telephone while patients follow up with neurology services, primary care, and rehabilitation. Dialogue will focus on lessons learned and identifying the next steps for the implementation of patient self-management across chronic conditions.

Target Audience:
Clinical providers/QUERI investigators interested in delivering patient self-management programs in VA.

Assumed Audience Familiarity with Topic:
No previous knowledge needed.