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) 目前正在扩大虚拟医疗模式 [VMM（即 My HealtheVet、Vet 链接信息亭、远程医疗、移动应用程序）]以增加消费者使用并优化功能。 VMM的集成使用可以提高个体和系统的效率，最大化资源和 提高患者治疗效果。该提案是对 HSR&D 健康征集的回应 关于提供商行为的服务研究 (HX-16-009)，其目标是提高 VMM 的集成使用 由患者联合护理团队 (PACT) 使用新颖的以 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 团队实施策略，以 增加VMM的集成使用。从长远来看，这项研究将为地区和国家提供信息 促进 VMM 在门诊护理环境中综合使用的实施工作。的 研究目的是： (1) 确定影响 VMM 使用的 PACT 团队成员的特征 早期采用者和后期采用者； (2) 制定实施策略以促进PACT团队的发展 采用VMM； (3) 评估 PACT 重点战略的当地实施情况，以促进 VMM 采用。 方法：使用并行混合方法的基于社区的参与性研究方法 将用于进行这项为期三年的实施研究。本研究设计克服了 HSR&D 卫生服务定向招标中发现的先前研究的局限性 对提供者行为的研究。在第一阶段（目标 1）中，焦点小组（n=60）通过问卷调查和 后续个人访谈 (n=20) 将与 PACT 团队成员进行。在第二阶段 （目标 2）该团队将与 VA eHealth 研究人员和运营合作伙伴合作，开展 环境扫描并收集当前和新兴提供商重点实施工具 和资源。然后，团队将根据目标 1 的发现进行差距分析，以确定 需要调整或制定哪些实施策略和内容，以及调整/制定 必要的内容，并召集 PACT 专家小组来评估最终内容。在第三阶段 （目标 3）在当地实施以 PACT 为重点的战略，以促进 VMM 的综合使用 通过问卷调查前和调查后、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，以提高 综合使用 VMM 来增强主动的患者驱动护理的提供。这个提议是 及时与 VA 内 VMM 当前的重组和重新设计工作保持一致。 这项研究将产生第一个协议来客观评估集成 VA VMM 的使用 二手数据源。可交付成果将包括 PACT 驱动的战略，以支持综合使用 VMM 在门诊护理环境中的应用。这些方式的综合运用将促进 为退伍军人提供个性化、主动、以患者为主导的护理。数据源将被三角测量 使用 VMM 增加 PACT 团队经验的知识库并推进实施 科学。这项研究将评估本地提供的策略，以支持后续 区域和国家层面的实施工作。

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.