Enhancing Mental and Physical Health of Women through Engagement and Retention (EMPOWER): a protocol for a program of research

Abstract Background The Enhancing Mental and Physical health of Women through Engagement and Retention or EMPOWER program represents a partnership with the US Department of Veterans Health Administration (VA) Health Service Research and Development investigators and the VA Office of Women’s Health, National Center for Disease Prevention and Health Promotion, Primary Care-Mental Health Integration Program Office, Women’s Mental Health Services, and the Office of Patient Centered Care and Cultural Transformation. EMPOWER includes three projects designed to improve women Veterans’ engagement and retention in evidence-based care for high-priority health conditions, i.e., prediabetes, cardiovascular, and mental health. Methods/Design The three proposed projects will be conducted in VA primary care clinics that serve women Veterans including general primary care and women’s health clinics. The first project is a 1-year quality improvement project targeting diabetes prevention. Two multi-site research implementation studies will focus on cardiovascular risk prevention and collaborative care to address women Veterans’ mental health treatment needs respectively. All projects will use the evidence-based Replicating Effective Programs (REP) implementation strategy, enhanced with multi-stakeholder engagement and complexity theory. Mixed methods implementation evaluations will focus on investigating primary implementation outcomes of adoption, acceptability, feasibility, and reach. Program-wide organizational-, provider-, and patient-level measures and tools will be utilized to enhance synergy, productivity, and impact. Both implementation research studies will use a non-randomized stepped wedge design. Discussion EMPOWER represents a coherent program of women’s health implementation research and quality improvement that utilizes cross-project implementation strategies and evaluation methodology. The EMPOWER Quality Enhancement Research Initiative (QUERI) will constitute a major milestone for realizing women Veterans’ engagement and empowerment in the VA system. EMPOWER QUERI will be conducted in close partnership with key VA operations partners, such as the VA Office of Women’s Health, to disseminate and spread the programs nationally. Trial registration The two implementation research studies described in this protocol have been registered as required: Facilitating Cardiovascular Risk Screening and Risk Reduction in Women Veterans: Trial registration NCT02991534 , registered 9 December 2016. Implementation of Tailored Collaborative Care for Women Veterans: Trial registration NCT02950961 , registered 21 October 2016

Ontogeny of Neuroendocrine Centers in the Eyestalk of Homarus-Gammarus Embryos - an Anatomical and Hormonal Approach

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The Development of the Eahad Physiotherapists Committee

Introduction: September 2015 saw the agreement by the EAHAD executive committee to proceed with the establishment of a Physiotherapists Committee. The purpose of the group is to improve the quality of care to patients with haemophilia throughout Europe by enhancing physiotherapy and musculoskeletal services as a core component of the comprehensive care team. Methods: The founding 4 members of the committee met in July 2015 to discuss both the terms of reference, as well as a 3‐year strategy for the group. Discussions highlighted that membership of the committee should reflect and represent the geographical spread of the EAHAD community. Individuals were identified from all European regions and invited to participate. A physio specific EAHAD email address was used to collate clinician details as they made contact. The main objectives identified in the strategy document were to: 1. Determine the current position of physiotherapy services for people with haemophilia throughout Europe 2. Establish and maintain an EAHAD physiotherapy network 3. Increase physiotherapy involvement in EAHAD congresses 4. Produce an evidence‐informed set of recommended standards of practice for haemophilia physiotherapy care 5. Improve knowledge and training of physiotherapists in haemophilia care 6. Develop a forum for facilitating Pan‐European physiotherapy initiated multidisciplinary research Results: The committee now consists of 7 members. 37 physiotherapists from 15 regions of Europe have made contact and expressed interest in the project. A co‐ordinator has been assigned for each region, their role being critical in disseminating information and involving each geographical area in the work of the committee. The physiotherapists committee is collaborating closely with the nurses committee in shared educational activities. This has successfully resulted in a new ‘pre‐congress day’ at EAHAD 2017 specifically for both professions. Discussion/Conclusion: The positive response and interest from physiotherapists across Europe to the call for contact has been very encouraging. This, coupled with the support from EAHAD to the inclusion and development of a specific Physiotherapists committee, bodes well for the ongoing work of the group. This ultimately will help to make physiotherapy more visible, improve physiotherapy provision across Europe and create opportunities for research, to the benefit of patients and service users.Sin financiación2.768 JCR (2017) Q2, 32/71 Hematology1.277 SJR (2017) Q1, 30/134 HematologyNo data IDR 2017UE

Cluster randomized trial of a multilevel evidence-based quality improvement approach to tailoring VA Patient Aligned Care Teams to the needs of women Veterans

BACKGROUND: The Veterans Health Administration (VA) has undertaken a major initiative to transform care through implementation of Patient Aligned Care Teams (PACTs). Based on the patient-centered medical home (PCMH) concept, PACT aims to improve access, continuity, coordination, and comprehensiveness using team-based care that is patient-driven and patient-centered. However, how VA should adapt PACT to meet the needs of special populations, such as women Veterans (WVs), was not considered in initial implementation guidance. WVs’ numerical minority in VA healthcare settings (approximately 7–8 % of users) creates logistical challenges to delivering gender-sensitive comprehensive care. The main goal of this study is to test an evidence-based quality improvement approach (EBQI) to tailoring PACT to meet the needs of WVs, incorporating comprehensive primary care services and gender-specific care in gender-sensitive environments, thereby accelerating achievement of PACT tenets for women (Women’s Health (WH)-PACT). METHODS/DESIGN: EBQI is a systematic approach to developing a multilevel research-clinical partnership that engages senior organizational leaders and local quality improvement (QI) teams in adapting and implementing new care models in the context of prior evidence and local practice conditions, with researchers providing technical support, formative feedback, and practice facilitation. In a 12-site cluster randomized trial, we will evaluate WH-PACT model achievement using patient, provider, staff, and practice surveys, in addition to analyses of secondary administrative and chart-based data. We will explore impacts of receipt of WH-PACT care on quality of chronic disease care and prevention, health status, patient satisfaction and experience of care, provider experience, utilization, and costs. Using mixed methods, we will assess pre-post practice contexts; document EBQI activities undertaken in participating facilities and their relationship to provider/staff and team actions/attitudes; document WH-PACT implementation; and examine barriers/facilitators to EBQI-supported WH-PACT implementation through a combination of semi-structured interviews and monthly formative progress narratives and administrative data. DISCUSSION: Lack of gender-sensitive comprehensive care has demonstrated consequences for the technical quality and ratings of care among WVs and may contribute to decisions to continue use or seek care elsewhere under the US Affordable Care Act. We hypothesize that tailoring PACT implementation through EBQI may improve the experience and quality of care at many levels. TRIAL REGISTRATION: ClinicalTrials.gov, NCT0203985