Optimizing Outcomes in Home-Based Primary Care

优化家庭初级保健的结果

• 批准号: 10186521
• 负责人: Samuel T Edwards
• 金额: --
• 依托单位: PORTLAND VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-07-01 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10186521
• 关键词: Academic Detailing; Address; Ambulatory Care; Area; Caring; Chronic Disease; Clinical; Complex; Data; Data Analyses; Data Collection; Development; Effectiveness; Elements; Enrollment; Evaluation; Feedback; Focus Groups; Goals; Group Structure; Health Care Costs; Health Services; Health Services Administration; Health Services Research; Home; Hospitalization; Hospitals; Intervention; Interview; Intuition; Investigation; Knowledge; Learning; Length; Literature; Medical; Medication Management; Mentors; Mentorship; Methods; Modeling; Multicenter Trials; Nature; Outcome; Palliative Care; Patient Care; Patient Selection; Patients; Pattern; Perception; Performance; Phase; Physicians; Primary Health Care; Process; Provider; Quality of Care; Reading; Regression Analysis; Research; Research Methodology; Research Personnel; Selection Criteria; Services; Site; Subgroup; System; Telephone Interviews; Testing; Training; Training Programs; Variant; Veterans; Veterans Health Administration; Vulnerable Populations; Work; acceptability and feasibility; base; care coordination; care delivery; care providers; career; chronic care model; clinical predictors; cohort; cost; density; design; experience; formative assessment; health care service utilization; high risk; hospitalization rates; implementation intervention; implementation science; improved; insight; longitudinal analysis; multi-component intervention; multiple chronic conditions; patient subsets; prevent; primary care services; programs; secondary analysis; service delivery; skills; social; social health determinants; success; support tools; therapy development

Objective: This proposal is for a CDA-2 mentored training program that will transition Samuel Edwards, MD, MPH into an independent VA health services researcher who has special expertise in the design, function and evaluation of care models for medically and socially complex Veterans. The overarching objective of the research plan is explore what features of VA Home Based Primary Care (HBPC) drive its success in reducing hospitalizations for ambulatory care sensitive conditions, and use these insights to develop an intervention to promote best practices in HBPC. Research Plan: Dr. Edwards will conduct three studies using mixed methods. The research approach will draw upon the literature on patient complexity, core features of primary care, and the chronic care model. The Specific Aims of the proposed research are to: 1) Characterize patterns of enrollment and care delivery within HBPC, and determine clinical and systems correlates of preventable hospitalizations, 2) Assess HBPC providers perceptions of appropriate patient selection and care delivery patterns, core functions of HBPC, and barriers and facilitators to HBPC performance, and 3) Develop and test a pilot intervention to promote best practices in HBPC. Methods: Aims 1 and 2 will consist of an explanatory sequential mixed methods study exploring HBPC patient selection, care delivery patterns, core functions of HBPC. Aim 1, is a quantitative study consisting of four secondary analyses of national VHA data to (1) determine predictors of enrollment in HBPC, (2) define clinical subgroups of HBPC patients, (3) describe care delivery patterns within HBPC, and (4) determine association of patient subgroups and care delivery patterns with ambulatory care sensitive hospitalizations. Aim 2 is a two phase qualitative study. In the first phase, we will perform an in depth study of our local HBPC program using interviews, focus groups and structured observation. Second, we will perform interviews with program directors at other HBPC programs to gain a broader understanding of differences between sites. In both phases we will explore perceptions of the patient selection process, appropriate care delivery patterns, and the importance of core HBPC functions focusing on 5 proposed domains: 1) strong provider-patient relationships, 2) medication management 3) addressing social determinants of health, 4) integration of palliative care, and 5) coordination of care. We also plan to explore provider perspectives on barriers and facilitators on HBPC performance. Finally, Aim 3 will be the development of a pilot intervention to promote best practices in HBPC learned from Aims 1 and 2, which will be tested locally in a trial. We will perform a formative evaluation concurrently focused on acceptability and feasibility, with a preliminary look at efficacy. The expected outcome will be preliminary data to support a multicenter trial of a refined intervention to be tested at multiple HBPC sites. Career Plan: Dr. Edwards is a physician-investigator with training in health services research methods and expertise in primary care redesign, team based care, and HBPC. This proposal will deepen his theoretical understanding, content expertise, and research skills. Specific areas for training are: 1) Qualitative and advanced quantitative skills that can be applied to mixed methods approaches in health services research; 2) Content expertise in patient complexity and home based primary care; and 3) Implementation science and intervention development. The training plan will consist of coursework, seminars, and readings guided by the mentorship team. Ultimately, these efforts will assist in Dr. Edwards reaching his goal of becoming a national leader in conducting research and testing care models directed at medically and socially complex Veterans.

目标：本提案是一个CDA-2指导培训计划，将过渡塞缪尔爱德华兹，医学博士， MPH成为一个独立的VA卫生服务研究员谁拥有特殊的专业知识，在设计，功能和 评估医疗和社会复杂退伍军人的护理模式。的首要目标 一项研究计划是探索VA家庭初级保健（HBPC）的哪些功能推动其成功减少 住院治疗门诊护理敏感条件，并使用这些见解来制定干预措施， 在HBPC中推广最佳做法。 研究计划：Edwards博士将使用混合方法进行三项研究。研究方法将 利用文献对病人的复杂性，初级保健的核心特点，慢性病护理模式。的 拟议研究的具体目标是：1）描述在 HBPC，并确定可预防住院的临床和系统相关性，2）评估HBPC 提供者对适当的患者选择和护理提供模式、HBPC核心功能的看法，以及 HBPC性能的障碍和促进因素，以及3）开发和测试试点干预措施，以促进最佳 在HBPC中的应用 方法：目的1和2将包括一项探索HBPC患者的解释性序贯混合方法研究 选择，护理提供模式，HBPC的核心功能。目的1是一项定量研究，包括四个方面 对国家VHA数据进行二次分析，以（1）确定入组HBPC的预测因素，（2）定义临床 HBPC患者的亚组，（3）描述HBPC内的护理模式，（4）确定 患者亚组和护理提供模式与门诊护理敏感住院。目标2是2 阶段定性研究。在第一阶段，我们将对我们当地的HBPC计划进行深入研究， 访谈、焦点小组和结构化观察。第二，我们将对节目导演进行采访 在其他HBPC计划中，以更广泛地了解不同地点之间的差异。在这两个阶段，我们将 探索患者选择过程的看法，适当的护理提供模式，以及 核心HBPC功能集中在5个拟议领域：1）强有力的提供者-患者关系，2）药物 3）解决健康的社会决定因素，4）整合姑息治疗，5）协调 护理。我们还计划探讨供应商对HBPC绩效的障碍和促进因素的看法。 最后，目标3将是制定一项试点干预措施，以推广从 目标1和2，将在当地进行试验。我们将同时进行一次形成性评估， 可接受性和可行性，并初步探讨其有效性。预期的结果将是初步的 数据，以支持在多个HBPC站点测试的精细干预的多中心试验。 职业规划：爱德华兹博士是一名接受过卫生服务研究方法培训的医生兼研究员， 在初级保健重新设计，团队为基础的护理和HBPC的专业知识。这一建议将深化他的理论 理解，内容专业知识和研究技能。培训的具体领域是：（1）质量和 先进的定量技能，可应用于卫生服务研究的混合方法; 2） 患者复杂性和基于家庭的初级护理的内容专业知识;以及3）实施科学和 干预发展。培训计划将包括课程作业、研讨会和阅读材料， 导师团队最终，这些努力将有助于爱德华兹博士实现他成为一名全国 领导者进行研究和测试护理模式针对医疗和社会复杂的退伍军人。