Recommendations for the Evaluation of Cross-System Care Coordination from the VA State-of-the-art Working Group on VA/Non-VA Care
Recommendations for the Evaluation of Cross-System Care Coordination from the VA State-of-the-art Working Group on VA/Non-VA Care
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DOI：
10.1007/s11606-019-04972-1
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发表时间：
2019-05-01
影响因子：
5.7
通讯作者：
Bastian, Lori A.
中科院分区：
文献类型：
--
作者：
Mattocks, Kristin M.;Cunningham, Kristin;Bastian, Lori A.
为了回应对退伍军人获得退伍军人管理局护理的广泛关注，国会颁布了 2014 年退伍军人准入、选择和责任法案，要求退伍军人管理局建立退伍军人选择计划 (VCP)。自 VCP 启动以来，已有超过 200 万退伍军人接受了社区提供者的护理，约占参加 VA 护理的退伍军人的 25%。然而，非退伍军人事务部护理服务范围的扩大给退伍军人事务部和社区卫生系统之间的护理协调带来了挑战。 2018 年 3 月，退伍军人事务部卫生服务研究与开发服务处主办了一次重点关注护理协调的退伍军人事务部最新技术会议 (SOTA)。 SOTA 召集了 VA 研究人员、项目主管、临床医生和政策制定者，以确定 VA 内部以及 VA 与社区护理系统之间护理协调方面的知识差距。本文对相关文献进行了总结和综合，并提供了 SOTA 生成的有关如何评估跨系统护理协调的建议。通常使用健康结果（包括再入院和死亡）来评估护理协调；然而，在护理协调的跨系统评估中，需要纳入诸如获取、成本、退伍军人/患者和提供者满意度（包括跨系统沟通）、可比较的质量指标、背景（城市与农村）和患者复杂性（医疗和心理健康状况）等指标，以充分评估护理协调的有效性。未来的研究应该研究协调 VA 和非 VA 护理的多个个体的作用，以及这些协调员如何共同努力以优化协调。
In response to widespread concerns regarding Veterans' access to VA care, Congress enacted the Veterans Access, Choice and Accountability Act of 2014, which required VA to establish the Veterans Choice Program (VCP). Since the inception of VCP, more than two million Veterans have received care from community providers, representing approximately 25% of Veterans enrolled in VA care. However, expanded access to non-VA care has created challenges in care coordination between VA and community health systems. In March 2018, the VA Health Services Research & Development Service hosted a VA State of the Art conference (SOTA) focused on care coordination. The SOTA convened VA researchers, program directors, clinicians, and policy makers to identify knowledge gaps regarding care coordination within the VA and between VA and community systems of care. This article provides a summary and synthesis of relevant literature and provides recommendations generated from the SOTA about how to evaluate cross-system care coordination. Care coordination is typically evaluated using health outcomes including hospital readmissions and death; however, in cross-system evaluations of care coordination, measures such as access, cost, Veteran/patient and provider satisfaction (including with cross-system communication), comparable quality metrics, context (urban vs. rural), and patient complexity (medical and mental health conditions) need to be included to fully evaluate care coordination effectiveness. Future research should examine the role of multiple individuals coordinating VA and non-VA care, and how these coordinators work together to optimize coordination.