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.
Our research program will add to the evidence base for how to use education to create and sustain innovative, effective practice. Beyond the potential impact of improved outcomes in hypertension and smoking cessation for veterans, our approach will permit us to develop and test educational theory that can then guide VA's investment in educational strategies nationally. While the clinical focus of this proposal is on veterans with hypertension and smoking, the models, measures, interventions, and processes we develop should be generalizable to veterans with other common chronic diseases including diabetes, heart failure, ischemic heart disease, chronic pain, and depression. We seek to demonstrate proof of concept that education and work processes that enhance microsystem function can improve outcomes in veterans with chronic disease.