Quality of Care and Patient Experience in GeriPACT: A Comparative Effectiveness Study

GeriPACT 的护理质量和患者体验：比较效果研究

• 批准号: 10208958
• 负责人: Susan Nicole Hastings
• 金额: --
• 依托单位: DURHAM VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-07-01 至 2021-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10208958
• 关键词: Accident and Emergency department; Address; Advance Care Planning; Advance Directives; American; Caring; Clinical; Cognitive; Complex; Computerized Medical Record; Computerized Patient Records; Cost Savings; Data; Data Analyses; Elderly; Electronic Health Record; Enrollment; Evaluation; Frail Elderly; Geriatrics; Health; Health Status; Health system; Home; Hospitals; Impaired cognition; Long-Term Care; Measures; Medical; Medical Records; Methods; Modeling; Older Population; Outcome; Patient Care; Patient Self-Report; Patient-Focused Outcomes; Patients; Performance; Personal Satisfaction; Persons; Pharmaceutical Preparations; Plague; Population; Primary Health Care; Process; Process Measure; Quality of Care; Quality of life; Reporting; Research; Resources; Sampling; Scoring Method; Services; Source; Special Population; Surveys; System; Veterans; advanced disease; aged; base; clinical care; clinical risk; community based service; comparative effectiveness study; cost; data warehouse; design; experience; functional disability; health care service; high risk; improved; insight; interest; medical specialties; model design; multiple chronic conditions; older patient; prospective; psychosocial; recruit; treatment as usual

Background: GeriPACT is a “Special Population PACT” designed to provide comprehensive primary care combined with specialty expertise for complex geriatric and high-risk Veterans. GeriPACT strives to optimize independence, quality of life, and quality of care for Veterans who are particularly vulnerable due to multiple interacting cognitive, functional, psychosocial, and medical challenges in the setting of advanced age. Preliminary findings from the evaluation of GeriPACT led by the Geriatrics and Extended Care Data Analysis Center (GEC DAC) has demonstrated that care for complex patients in GeriPACTs costs 40-60% less than caring for similar patients in traditional PACTs. Although this is an important and compelling finding, we lack essential information about how GeriPACT differs from traditional PACT care in terms of clinical processes and patient experience of care. This information is essential for understanding the overall net benefit of the model, and understanding how best to target this service to patients that stand to yield the greatest benefit from enrollment. Methods: The main objective of this study is to understand the impact of GeriPACT on patient experience and key quality of care measures that may be contributing to observed cost differences. This prospective matched comparative effectiveness study will address the following specific aims: (AIM 1) To examine quality of care clinical process measures among Veterans cared for in GeriPACT, compared to similar patients in traditional PACTs. We hypothesize that Veterans cared for in GeriPACT will have fewer potentially inappropriate medications (PIMs) at 6, 12, and 18 months; higher rates of completed advance directives at 18 months; and higher performance on frail elder quality measures at 12 months. (AIM 2) To examine patient experience of care among Veterans cared for in GeriPACT, compared to similar patients in traditional PACTs. We hypothesize that Veterans in GeriPACT will have more days alive and at home (defined as days not in the emergency department (ED) or hospital) at 18 months; greater perceived care integration at 6, 12, and 18 months; and higher self-reported health and well-being at 6, 12, and 18 months. Finally, clinicians and Geriatrics and Extended Care leaders have identified sub-populations expected to differentially benefit from GeriPACT care but these subpopulations have not been examined empirically. Thus, Aim 3 is to examine whether the relationship between GeriPACT exposure and outcomes differs based on cognitive status, functional disability, or multiple chronic conditions (MCC). We hypothesize that impaired cognitive status, functional disability, and MCC will moderate the effects of GeriPACT on quality of care measures (increased effects) and experience of care (increased effects). Using targeted recruiting strategies to increase homogeneity between GeriPACT and PACT patients, along with coarsened matching and minimum distance score methods to derive a balanced sample, we will examine between-person changes between GeriPACT and PACT patients, controlling for initial health status. By combining data from a patient-reported survey and VHA electronic health records, we will minimize sources of bias that commonly plague comparative effectiveness studies. Anticipated Impact: More than half of all Veterans receiving primary care in VHA are aged 65 or older and the proportion of older patients is growing rapidly; however more than 40% of VAMCs do not have GeriPACT. The results of this study will provide critically-needed information to guide decisions about optimal dissemination and scale of this model of care designed to serve a large and growing population of older and medically complex Veterans. The results will be of great relevance outside VHA as health systems and Accountable Care Organizations throughout the U.S. look for effective primary care models to improve quality and value for older Americans.

背景：GeriPACT是一个“特殊人群PACT”，旨在提供全面的初级保健 结合复杂的老年和高风险退伍军人的专业知识。GeriPACT致力于优化 独立性，生活质量和护理质量对于退伍军人来说，由于多种原因， 在高龄背景下，认知、功能、心理社会和医学方面的挑战相互作用。 由老年医学和扩展护理数据分析领导的GeriPACT评估的初步结果 中心（GEC DAC）已经证明，在老年ACT中，复杂患者的护理费用比老年ACT低40-60%。 在传统的PACTs中照顾类似的病人。虽然这是一个重要而令人信服的发现，但我们缺乏 关于GeriPACT与传统PACT护理在临床流程方面的差异的基本信息， 病人的护理经验。这些信息对于理解模型的总体净效益至关重要， 并了解如何最好地将这项服务针对那些能够从 招生 方法：本研究的主要目的是了解GeriPACT对患者体验的影响， 可能导致观察到的成本差异的关键护理质量指标。这一前瞻性匹配 比较有效性研究将针对以下具体目标：（目的1）检查护理质量 在GeriPACT中护理的退伍军人中的临床过程措施，与传统的类似患者相比， PACT。我们假设，在GeriPACT中照顾的退伍军人将有更少的潜在不适当的 6、12和18个月时的药物（PIM）; 18个月时完成预先指令的比率较高;以及 12个月时体弱老人质量指标表现更好。(AIM 2）检查患者的经验 与传统PACTs中的类似患者相比，GeriPACT中的退伍军人护理。我们 假设GeriPACT中的退伍军人将有更多的日子活着和在家（定义为不在 18个月时急诊科（艾德）或医院）; 6、12和18个月时感知的护理整合更大 在6个月、12个月和18个月时，自我报告的健康和幸福感更高。最后，临床医生和 老年医学和延伸护理领导人已经确定了预期从以下方面受益的亚人群： 但是这些亚群还没有经过经验检验。因此，目标3是检查 GeriPACT暴露与结果之间的关系是否因认知状态而异， 功能性残疾或多种慢性疾病（MCC）。我们假设受损的认知状态， 功能性残疾，MCC将缓和GeriPACT对护理质量措施的影响（增加 效果）和护理经验（效果增加）。使用有针对性的招聘策略， GeriPACT和PACT患者之间的同质性，沿着粗匹配和最小距离 评分方法，以获得一个平衡的样本，我们将研究人与人之间的变化GeriPACT 和PACT患者，控制初始健康状况。通过结合患者报告的调查数据， VHA电子健康记录，我们将尽量减少偏见的来源，通常困扰比较 有效性研究。 预期影响：在VHA接受初级保健的所有退伍军人中，有一半以上年龄在65岁或以上， 老年患者的比例正在迅速增长;然而，超过40%的VAMC没有GeriPACT。的 这项研究的结果将提供急需的信息，以指导有关最佳传播的决策 这种护理模式旨在为大量和不断增长的老年人和医疗保健人员提供服务， 复杂的退伍军人这些结果将对VHA以外的卫生系统和问责机构具有重要意义。 美国各地的护理组织都在寻找有效的初级保健模式，以提高质量和价值， 美国老人

项目成果

Evaluation of a geriatrics primary care model using prospective matching to guide enrollment.

• DOI: 10.1186/s12874-021-01360-4
• 发表时间: 2021-08-16
• 期刊: BMC medical research methodology
• 影响因子: 4
• 作者: Smith VA;Van Houtven CH;Lindquist JH;Hastings SN
• 通讯作者: Hastings SN