Virtual Medical Modality Implementation Strategies for Patient Aligned Care Teams to Promote Veteran Centered Care

项目背景：MyVA和退伍军人事务部(VA)卓越蓝图 阐明利用信息技术提供以退伍军人为中心的护理的愿景， 分析，以及医疗保健提供的新模式。退伍军人健康管理局(VHA)是 目前正在扩大虚拟医疗模式的整合工作[VMM(即，My HealtheVet、Vet Link Kiosk、远程医疗、移动应用程序)]，以提高消费者使用率并优化功能。 综合使用VMM可以提高个人和系统效率、最大化资源和 提高患者的治疗效果。这项建议是对高铁和研发健康征集的回应 以提高VMM综合使用率为目标的服务提供者行为研究(HX-16-009 由患者对齐的护理团队(PACT)使用新的以PACT为重点的实施战略。 目标：我们的短期目标是制定创新的PACT团队实施战略，以 提高VMM的综合利用。从长远来看，这项研究将为地区和国家提供信息 实施努力，促进VMM在门诊护理环境中的综合使用。这个 研究目的是：(1)确定影响VMM使用的PACT团队成员的特征 在较早和较晚采用者中；(2)制定实施策略以促进PACT团队 采用VMM；和(3)评估以PACT为重点的战略在当地的执行情况，以促进 VMM领养。 方法：基于社区的参与式研究方法，采用并行混合方法 将用于进行这项为期三年的执行研究。这项研究设计克服了 HSR&D卫生服务定向征集中确定的先前研究的局限性 关于提供者行为的研究。在第一阶段(Aim1)，焦点小组(n=60)通过问卷调查和 后续个别面谈(n=20)将与PACT小组成员进行。在第二阶段 (目标2)该团队将与退伍军人管理局电子健康研究人员和运营合作伙伴合作，进行 环境扫描和收集当前和新兴提供商重点实施工具 和资源。然后，该团队将根据Aim 1的发现进行差距分析，以确定 需要调整或开发哪些实施战略和内容，以及需要调整/开发哪些实施策略和内容 必要的内容，并召集《公约》专家小组对产生的内容进行评估。在第三阶段 (目标3)在当地实施以《公约》为重点的战略，以促进综合使用VMM将 通过问卷调查前后的调查、简短的结构化访谈以及 与PACT小组成员(n=63)进行二次数据分析。 影响：该研究支持MyVA愿景和VA卓越蓝图，以增加 综合使用VMM，以增强以患者为导向的主动式护理的交付。这项建议是 及时与退伍军人事务部内VMM的当前重组和重新设计工作保持一致。 这项研究将产生第一个客观评估综合VA VMM使用情况的方案 辅助数据源。交付成果将包括协定驱动的战略，以支持综合使用 在门诊护理环境中的VMM。综合使用这些模式将促进 为退伍军人提供个性化、主动的、以患者为导向的护理。将对数据源进行三角测量以 使用VMM和先期实施增加PACT团队经验的知识库 科学。这项研究将评估当地交付的战略，以支持后续 区域和国家两级的执行工作。

Project Background: MyVA and the Department of Veteran's Affairs (VA) Blueprint for Excellence articulate a vision for delivering Veteran-centered care leveraging information technologies, analytics, and new models of health care delivery. The Veterans Health Administration (VHA) is currently expanding integration efforts of virtual medical modalities [VMM (i.e., My HealtheVet, Vet Link kiosks, telehealth, mobile applications)] to increase consumer use and optimize function. Integrated use of VMM can increase individual and system efficiency, maximize resources and enhance patient outcomes. This proposal is responsive to the HSR&D solicitation for health services research on provider behavior (HX-16-009) in its goal to increase integrated use of VMM by patient aligned care teams (PACT), using novel PACT-focused implementation strategies. Objectives: Our short-term goal is to develop innovative PACT team implementation strategies to increase integrated use of VMM. Long-term, this research will inform regional and national implementation efforts to promote integrated use of VMM in the ambulatory care setting. The research aims are to: (1) Identify characteristics of PACT team members that impact VMM use among early- and late- adopters; (2) Develop implementation strategies to promote PACT team adoption of VMM; and (3) Evaluate local implementation of PACT focused strategies to promote VMM adoption. Methods: A community-based participatory research approach using concurrent mixed-methods will be used to conduct this three-year implementation study. This study design overcomes limitations of previous research identified in the HSR&D targeted solicitation for health services research on provider behavior. In Phase 1 (Aim1) focus groups (n=60) with questionnaires and follow-up individual interviews (n=20) will be conducted with PACT team members. In Phase 2 (Aim 2) the team will collaborate with VA eHealth researchers and operational partners to conduct an environmental scan and collect current and emerging provider focused implementation tools and resources. The team will then conduct a gap analysis based on Aim 1 findings to determine what implementation strategies and content need to be adapted or developed, and adapt/develop necessary content and convene a PACT expert panel to evaluate resultant content. In Phase 3 (Aim 3) a local implementation of PACT-focused strategies to promote integrated use of VMM will be evaluated using pre- and post- questionnaire surveys, brief structured interviews, and secondary data analysis with PACT team members (n=63). Impact: This research supports the MyVA vision and the VA Blueprint for Excellence to increase the integrated use of VMM to enhance delivery of proactive patient-driven care. This proposal is timely in its alignment with the current re-organization and redesign efforts of VMM within the VA. This study will produce the first protocol to objectively evaluate integrated VA VMM use employing secondary data sources. Deliverables will include PACT-driven strategies to support integrated use of VMM in the ambulatory care setting. Integrated use of these modalities will promote personalized, pro-active patient-driven care for Veterans. Data sources will be triangulated to increase the knowledge base of PACT team experiences using VMM and advance implementation science. This research will evaluate locally delivered strategies to support subsequent implementation efforts at regional and national levels.