Virtual Medical Modality Implementation Strategies for Patient-Aligned Care Teams to Promote Veteran-Centered Care: Protocol for a Mixed-Methods Study.
Virtual Medical Modality Implementation Strategies for Patient-Aligned Care Teams to Promote Veteran-Centered Care: Protocol for a Mixed-Methods Study.
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DOI：
10.2196/11262
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发表时间：
2018-08-15
影响因子：
1.7
通讯作者：
Nazi K
中科院分区：
文献类型：
--
作者：
Haun J;Chavez M;Hathaway W;Antinori N;Melillo C;Cotner BA;McMahon-Grenz J;Zilka B;Patel-Teague S;Messina W;Nazi K
退伍军人健康管理局（VHA）正在全系统范围内努力增加健康信息技术（HIT）的综合使用，包括My HealtheVet（MHV），退伍军人事务部（VA）电子患者门户网站，Vet Link亭，远程医疗和移动的应用程序。HIT的综合使用可以提高个人和系统效率，最大限度地利用资源，并提高患者的治疗效果。先前的研究表明，提供者的认可和强化是患者采用HIT的关键决定因素。HIT实施策略需要反映供应商的观点，以促进采用和认可这些工具，但是，供应商往往缺乏意识或没有动机将HIT纳入临床护理与他们的病人。当患者使用这些模式时，这种方法往往是分散的，而不是在护理环境内和跨护理环境进行整合。需要进行研究，以确定有效的实施策略，提高患者导向护理团队（PACT）成员（即VHA的以患者为中心的医疗之家）的意识和动机，以主动和综合的方式与患者使用HIT。本文介绍了PACT协议的基本原理，设计和方法，以促进积极主动的综合使用HIT。在目标1中，焦点小组（n=21）与PACT成员（n=65）一起进行了沿着问卷调查和后续个人访谈（n=16）。在目标2中，该团队与VA临床医生，电子健康研究人员和运营合作伙伴合作，进行个人专家访谈（n=13），并进行环境扫描，以收集当前和新兴的以提供商为重点的实施工具和资源。根据目标1的调查结果，进行了差距分析，以确定需要调整或开发哪些实施策略和内容。在改编或开发资源之后，召集了一个PACT专家小组，以评价所产生的内容。在目标3中，当地实施的PACT为重点的战略，以促进HIT的综合使用进行了评估，使用前和后问卷调查，简短的结构化访谈，和二级数据分析与PACT成员（n=63）。目标1的研究入组已完成。目标1和2的数据收集和分析正在进行中。目标3活动定于第3年进行。这项工作突出了实际的，技术的，参与性的因素，促进实施研究，旨在从事PACT临床成员积极主动的综合使用HIT。这些努力旨在支持综合和主动使用VA HIT，以直接符合PACT成员偏好的方式支持临床护理协调。本研究采用混合方法和多个数据源评价了VA HIT的综合使用。可交付成果包括以PACT为重点的战略，以支持在门诊护理环境中综合使用HIT，这也将为其他护理系统的战略制定提供信息，并支持区域和国家层面的后续实施工作。RR1-10.2196/11262
The Veterans Health Administration (VHA) is making system-wide efforts to increase integrated use of health information technology (HIT), including My HealtheVet (MHV), the Veterans Affairs (VA) electronic patient portal, Vet Link kiosks, telehealth, and mobile apps. Integrated use of HIT can increase individual and system efficiency, maximize resources, and enhance patient outcomes. Prior research indicates that provider endorsement and reinforcement are key determinants of patient adoption of HIT. HIT implementation strategies need to reflect providers’ perspectives to promote adoption and endorsement of these tools; however, providers often lack awareness or are unmotivated to incorporate HIT into clinical care with their patients. When these modalities are used by patients, the approach is often fragmented rather than integrated within and across care settings. Research is needed to identify effective implementation strategies for increasing patient-aligned care team (PACT) member (ie, the VHA’s Patient Centered Medical Home) awareness and motivation to use HIT in a proactive and integrated approach with patients. This paper describes the rationale, design, and methods of the PACT protocol to promote proactive integrated use of HIT. In Aim 1, focus groups (n=21) were conducted with PACT members (n=65) along with questionnaires and follow-up individual interviews (n=16). In Aim 2, the team collaborated with VA clinicians, electronic health researchers and operational partners to conduct individual expert interviews (n=13), and an environmental scan to collect current and emerging provider-focused implementation tools and resources. Based on Aim 1 findings, a gap analysis was conducted to determine what implementation strategies and content needed to be adapted or developed. Following the adaptation or development of resources, a PACT expert panel was convened to evaluate the resultant content. In Aim 3, a local implementation of PACT-focused strategies to promote integrated use of HIT was evaluated using pre- and postquestionnaire surveys, brief structured interviews, and secondary data analysis with PACT members (n=63). Study enrollment for Aim 1 has been completed. Aims 1 and 2 data collection and analysis are underway. Aim 3 activities are scheduled for year 3. This work highlights the practical, technological, and participatory factors involved in facilitating implementation research designed to engage PACT clinical members in the proactive integrated use of HIT. These efforts are designed to support the integrated and proactive use of VA HIT to support clinical care coordination in ways that are directly aligned with PACT member preferences. This study evaluated integrated VA HIT use employing mixed-methods and multiple data sources. Deliverables included PACT-focused strategies to support integrated use of HIT in the ambulatory care setting that will also inform strategy development in other systems of care and support subsequent implementation efforts at regional and national levels. RR1-10.2196/11262