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， 分析和医疗保健提供的新模式。退伍军人健康管理局（VHA） 目前正在扩展虚拟医疗模式[VMM（即，My HealtheVet，兽医 链接信息亭、远程医疗、移动的应用）]，以增加消费者使用并优化功能。 VMM的集成使用可以提高个人和系统效率，最大限度地利用资源， 提高了患者效果。本提案是对HSR&D健康招标的回应 关于提供者行为的服务研究（HX-16-009），其目标是增加VMM的集成使用 由患者对齐的护理团队（PACT），使用新的PACT为重点的实施策略。 目标：我们的短期目标是制定创新的PACT团队实施战略， 增加VMM集成使用。从长远来看，这项研究将为区域和国家 实施工作，以促进综合使用VMM在门诊护理设置。的 研究的目的是：（1）确定影响VMM使用的PACT团队成员的特征 在早期和晚期采用者中;（2）制定实施战略，以促进PACT团队 （3）评估地方执行以PACT为重点的战略，以促进 VMM采用。 方法：采用同时混合方法的社区参与式研究方法 将用于进行这项为期三年的实施研究。该研究设计克服了 在HSR&D有针对性的健康服务征集中发现的先前研究的局限性 研究供应商行为。在1期（Aim 1）焦点组（n=60）中， 将与PACT小组成员进行后续个人访谈（n=20）。在阶段2中 (Aim 2）该团队将与VA eHealth研究人员和运营合作伙伴合作， 环境扫描和收集当前和新兴的以提供商为重点的实施工具 和资源然后，该小组将根据目标1的调查结果进行差距分析，以确定 需要调整或制定哪些实施战略和内容，并调整/制定 委员会还将审查必要的内容，并召集PACT专家小组，以评估最终内容。在阶段3中 (Aim 3）在当地实施以《行动计划》为重点的战略，以促进综合利用核监测机制， 通过调查前和调查后的问卷调查、简短的结构化访谈进行评估， 与PACT团队成员（n=63）进行二次数据分析。 影响：这项研究支持MyVA愿景和VA卓越蓝图， VMM的综合使用，以加强主动提供患者驱动的护理。这项建议是 这是及时的，以配合虚拟管理局内核查和监测机制目前的重组和重新设计工作。 本研究将产生第一个协议，以客观地评估集成VA VMM的使用， 二级数据源。可供选择的项目将包括《行动计划》驱动的战略，以支持综合利用 VMM在门诊护理环境中的应用。综合利用这些模式将促进 为退伍军人提供个性化、积极主动的患者驱动型护理。将对数据源进行三角测量， 增加PACT团队使用VMM和推进实施经验的知识基础 科学这项研究将评估当地提供的战略，以支持随后的 区域和国家各级的执行工作。

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.