Factors Associated with Institutional Use by Veterans in Home Based Primary Care

与退伍军人在家庭初级保健中使用机构相关的因素

• 批准号: 10176245
• 负责人: Suzanne Gillespie
• 金额: --
• 依托单位: SYRACUSE VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-07-01 至 2019-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10176245
• 关键词: Address; Administrator; Admission activity; Affect; Aged, 80 and over; Aging; Ambulatory Care Facilities; Bed Occupancy; Caring; Cessation of life; Characteristics; Chronic; Communication; Communities; Complex; Conflict (Psychology); Data; Databases; Day Care; Development; Dimensions; Disabled Persons; Disease; Effectiveness; Emergency Nursing; Emergency department visit; Enrollment; Ensure; Exposure to; Goals; Health Care Costs; Healthcare Systems; Home environment; Hospital Nursing; Hospitals; Inpatients; Leadership; Length of Stay; Letters; Location; Measures; Medical center; Modeling; Nursing Homes; Patients; Performance; Policies; Primary Health Care; Process Measure; Provider; Quality of Care; Questionnaires; Research; Research Personnel; Risk; Site; Structure; Surveys; System; Team Process; Technology; Testing; Time; Variant; Veterans; Visit; base; care costs; cohesion; cohort; cost; design; disabling disease; hospital readmission; hospital utilization; improved; organizational structure; patient home care; personalized approach; primary care services; programs; scale up; telehealth

DESCRIPTION (provided by applicant): VA Home Based Primary Care (HBPC) is an interdisciplinary team-based home care program that serves a rapidly aging cohort of oldest old Veterans (85+) and younger OIF/OEF Veterans with complex chronic disabling conditions. In 2011, approximately 15,000 Veterans were enrolled in 139 VA Medical Center HBPC programs and an associated 101 community-based outpatient clinic locations nationwide. Although HBPC program quality has been established along a number of institutional utilization dimensions (e.g., inpatient days) and cost, the use of institutional care varies substantially across HBPC programs nationally. Lower utilization of institutional care may suggest tailored approaches that optimize a veteran's care. Higher utilization of institutional care may be an indicator of potentially inappropriate or mismanaged care that places vulnerable HBPC Veterans at risk for complications. The proposed study seeks to identify the factors contributing to these variations by investigating associations between HBPC organizational structures, team functioning, and eight risk adjusted quality measures (QMs) of institutional use for hospitals, emergency departments (ED), and nursing homes (NHs). The starting place for redesigning the health care system is to understand the organizational structural attributes of the settings in which care occurs. To that end, a structura survey is conducted to develop a profile of the organizational structure characteristics of HBPC programs. Structure refers to HBPC program characteristics that affect the system's capacity to deliver primary care services to Veterans in their home and includes HBPC program standards, team structures, and telehealth technology. The study will then evaluate differences in HBPC interdisciplinary team functioning with regard to seven dimensions: culture, leadership, communication, coordination, conflict management, team cohesion, and team effectiveness through administration and analysis of the organizational assessment questionnaire (OAQ) survey. Next, associations between HBPC organizational structures and team functioning will be analyzed to identify organizational structures associated with more effective team functioning. Finally, the influence of HBPC organizational structures and team functions on the quality of HBPC care will be examined with respect to risk-adjusted QMs of institutional use: hospital and NH admissions and days, 30-day and 90-day rehospitalizations, ED visits, and Veteran's site of death. Primary data for this proposed study will be obtained through surveys and on-site observational visits. Secondary data will include two years of VA and CMS patient databases (2013-2014). Findings from this study will identify organizational structures and team functions associated with lower use of institutional care that can be integrated as best practices into policies and system redesign initiatives to bring lower performing HBPC programs up to the level of the highest performing programs. Ultimately, reducing avoidable and costly institutional care advances HBPC program goals, and as such, enables HBPC Veterans to be treated at home and to retain their maximal independence.

描述（由申请人提供）： VA 家庭初级护理 (HBPC) 是一项基于跨学科团队的家庭护理计划，为快速老龄化的老年退伍军人 (85 岁以上) 和患有复杂慢性残疾状况的年轻 OIF/OEF 退伍军人提供服务。 2011 年，约 15,000 名退伍军人参加了 139 个 VA 医疗中心 HBPC 项目以及全国 101 个相关的社区门诊诊所。尽管 HBPC 计划的质量是根据多个机构利用维度（例如住院天数）和成本来确定的，但全国范围内各个 HBPC 计划的机构护理使用情况差异很大。机构护理利用率较低可能建议采取量身定制的方法来优化退伍军人的护理。机构护理利用率较高可能表明护理可能存在不当或管理不当，从而使脆弱的 HBPC 退伍军人面临并发症的风险。拟议的研究旨在通过调查 HBPC 组织结构、团队运作以及医院、急诊科 (ED) 和疗养院 (NH) 机构使用的八项风险调整质量衡量标准 (QM) 之间的关联来确定导致这些差异的因素。重新设计医疗保健系统的起点是了解医疗保健发生环境的组织结构属性。为此，进行了结构调查，以了解 HBPC 项目的组织结构特征。结构是指影响系统向退伍军人在家中提供初级保健服务的能力的 HBPC 计划特征，包括 HBPC 计划标准、团队结构和远程医疗技术。然后，该研究将通过组织评估问卷（OAQ）调查的管理和分析，从七个维度评估 HBPC 跨学科团队运作的差异：文化、领导力、沟通、协调、冲突管理、团队凝聚力和团队有效性。接下来，将分析 HBPC 组织结构和团队运作之间的关联，以确定与更有效的团队运作相关的组织结构。最后，将根据机构使用的风险调整质量管理来检查 HBPC 组织结构和团队职能对 HBPC 护理质量的影响：医院和 NH 入院和天数、30 天和 90 天再住院、急诊就诊和退伍军人死亡地点。这项拟议研究的主要数据将通过调查和现场观察访问获得。二手数据将包括两年的 VA 和 CMS 患者数据库（2013-2014 年）。这项研究的结果将确定与机构护理使用率较低相关的组织结构和团队职能，这些组织结构和团队职能可以作为最佳实践纳入政策和系统重新设计举措中，以使绩效较低的 HBPC 计划达到绩效最高的计划的水平。最终，减少可避免且昂贵的机构护理可推进 HBPC 计划目标，因此使 HBPC 退伍军人能够在家接受治疗并保持最大程度的独立性。