Regional Data Exchange to Improve Care for Veterans after Non-VA Hospitalization

区域数据交换可改善非 VA 住院后退伍军人的护理

• 批准号: 10179390
• 负责人: Kenneth S. Boockvar
• 金额: --
• 依托单位: JAMES J PETERS VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-02-01 至 2021-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10179390
• 关键词: Accident and Emergency department; Accountability; Acute; Address; Adverse event; Appointment; Caring; Clinic; Clinical; Counseling; Data; Decision Support Systems; Development; Direct Costs; Education; Effectiveness; Elderly; Emergency department visit; Event; Feasibility Studies; Future; Geographic Locations; Geriatrics; Health; Home environment; Hospitalization; Hospitals; Indiana; Inpatients; Intervention; Interview; Lead; Length of Stay; Measures; Medical center; Medicare; Medication Errors; Methods; Modeling; Notification; Outcome; Patient Care; Patient Monitoring; Patients; Pharmaceutical Preparations; Pilot Projects; Primary Health Care; Private Hospitals; Procedures; Protocols documentation; Provider; Quality of Care; Randomized; Randomized Controlled Trials; Reporting; Research; Research Personnel; Resources; Respondent; Safety; Sampling Studies; Schedule; Self Perception; Services; Site; Source; Structure; System; Technology; Telephone; Test Result; Testing; Time; Veterans; Visit; base; care coordination; care systems; cost; data exchange; evidence base; experience; follow-up; hospital readmission; hospital utilization; improved; improved outcome; information gathering; information organization; intervention effect; member; prevent; primary outcome; programs; response; secondary outcome; service coordination; service delivery; service utilization; telehealth; treatment as usual; uptake; virtual

 DESCRIPTION (provided by applicant): Background: Among older VA patients who have Medicare coverage, 43% use both VA and non-VA (Medicare-covered) services. VA and non-VA providers are often uninformed about encounters, treatments and test results provided in the other system. In particular, the absent or delayed notification of a non-VA hospital encounter is a missed opportunity for the VA to provide post-hospital transitional care services that have been shown to be effective in preventing adverse events and hospital readmission after hospital discharge. Objectives: The overall objective of this project is to examine the effectiveness, cost, and implementation acceptance of VA provider notification of non-VA hospitalization or emergency department (ED) visit using electronic health information exchange (HIE), with or without provision of evidence-based post-hospital transitional care services. Specific Aim 1 is to examine the impact of these approaches on preventing hospital admission or readmission as the primary outcome, and, as secondary outcomes, increasing provider follow-up, improving patient's condition self-knowledge, and preventing medication errors after discharge. Specific Aim 2 is to examine the effect of these approaches on VA and non-VA costs. Specific Aim 3 is to examine the acceptance of these approaches among VA and non-VA stakeholders. Methods: The study sample consists of veterans followed in geriatrics or primary care clinics at the Bronx and Indianapolis VAs who are older than 65. We will monitor patients for non-VA hospital admission or ED visit using technology provided by regional HIE organizations (i.e., the Bronx Regional Health Information Organization and the Indiana Health Information Exchange). Patients will be cluster-randomized 1:1 to notification-plus-coordination or notification-only groups by PACT team, stratified by facility. For both groups the PACT provider will receive real-time notification of a non-VA hospital admission or ED visit if it occurs. For the notification-plus-coordination group, a care transitions coordinator will deliver coordination activities during a home and/or VA facility visit and via follow-up phone calls over 1 month. Coordination activities will consist of: reconciliation of and counseling on the patient's VA and non-VA medications, education on signs of condition worsening, coordination of VA and non-VA follow-up appointments, and counseling on communicating with VA and non-VA providers, using structured protocols. All information-gathering by the transitions coordinator will include the HIE as an information source. The notification-only group will receive usual care after the notification. Multivariable regression models will be estimated to compare effects of notification-plus-coordination versus notification-only on primary and secondary outcomes and costs (Aims 1 and 2). We will conduct interviews with intervention team members, patients, VA and non-VA staff, and other stakeholders to ascertain the barriers and facilitators to implementation of these approaches (Aim 3).



项目成果

Improving Patient Activation among Older Veterans: Results from a Social Worker-Led Care Transitions Intervention.

• DOI: 10.1080/01634372.2021.1932003
• 发表时间: 2022-01
• 期刊: Journal of gerontological social work
• 影响因子: 3.2
• 作者: Koufacos NS;May J;Judon KM;Franzosa E;Dixon BE;Schubert CC;Schwartzkopf AL;Guerrero VM;Traylor M;Boockvar KS
• 通讯作者: Boockvar KS

The VA and Non-VA Experience of Tracking Good Care.

VA 和非 VA 跟踪良好护理的经验。

• DOI: 10.1089/pop.2019.0039
• 发表时间: 2020
• 期刊: Population health management
• 影响因子: 2.5
• 作者: Langhoff,Erik;Siu,Albert;Boockvar,Kenneth;Bund,Linda;Connell,Jim;Hung,William
• 通讯作者: Hung,William

Reasons Older Veterans Use the Veterans Health Administration and Non-VHA Care in an Urban Environment.

• DOI: 10.3122/jabfm.2021.02.200332
• 发表时间: 2021-03
• 期刊: JOURNAL OF THE AMERICAN BOARD OF FAMILY MEDICINE
• 影响因子: 2.9
• 作者: Augustine, Matthew R.;Mason, Tanieka;Baim-Lance, Abigail;Boockvar, Kenneth
• 通讯作者: Boockvar, Kenneth

Event Notification in Support of Population Health: The Promise and Challenges from a Randomized Controlled Trial.

支持人口健康的事件通知：随机对照试验的前景和挑战。

• 发表时间: 2017
• 期刊: Studies in health technology and informatics
• 作者: Dixon,BrianE;Boockvar,KennethS
• 通讯作者: Boockvar,KennethS

Characteristics of Veterans With Non-VA Encounters Enrolled in a Trial of Standards-Based, Interoperable Event Notification and Care Coordination.

• DOI: 10.3122/jabfm.2021.02.200251
• 发表时间: 2021-03
• 期刊: Journal of the American Board of Family Medicine : JABFM
• 作者: Kartje R;Dixon BE;Schwartzkopf AL;Guerrero V;Judon KM;Yi JC;Boockvar K
• 通讯作者: Boockvar K