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Primary Care Quality and Homeless Service Tailoring

初级护理质量和无家可归者服务定制

基本信息

批准号：
10209945
负责人：
STEFAN G KERTESZ
金额：
--
依托单位：
BIRMINGHAM VA MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-07-01 至 2022-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10209945
关键词：
Acute Address Affect Area Assessment tool Caregivers Caring Clinic Clinical Services Communication Continuity of Patient Care Country Databases Distal Federally Qualified Health Center Feeling Fostering Funding Future Goals Health Health Services Research Healthcare Healthcare Systems Home Homelessness Hospitals Housing Improve Access Individual Inpatients Literature Mainstreaming Maps Medical Medical center Mission Modeling Natural experiment Observational Study Outcome Pain Patients Policies Population Primary Health Care Provider Psychometrics Quality of Care Records Reporting Research Research Personnel Sampling Services Stigmatization Surveys Time Training United States Department of Veterans Affairs Veterans Vulnerable Populations addiction base care delivery comparative cost design expectation experience health care service utilization improved operation outreach patient oriented primary care services programs response satisfaction social vulnerability

项目摘要

DESCRIPTION (provided by applicant): The Department of Veterans Affairs has embraced the patient-centered medical home, termed the Patient-Aligned Care Team (PACT) in VA, an approach that promises care that is comprehensive, patient- centered, team-based, focused on coordination and communication, and able to sustain a relationship that continues over time. For patients who are homeless or exiting homelessness, these ideals are often not met. Despite significant efforts to develop patient-centered medical homes for people who are homeless, little is known about the particular aspects service design delivery that create valuable, enduring primary care experiences for patients. Since 2012, VA has ambitiously piloted homeless-tailored primary care service design through Homeless PACTs (HPACTs, n=60). This has created a natural experiment that invites two questions important not just to VA but to non-VA agencies seeking to promote viable medical homes for socially-vulnerable populations. First, do VA's homeless-tailored primary care programs offer a substantively superior patient experience? Second, what particular organizational features actually matter? This proposal prioritizes homeless patients' experience of primary care as the proximal indicator of successful engagement in primary care. Patient experience surveys seek an experiential report of how well aspects of care delivery (access, coordination, etc.) map to what patients and experts consider ideal. In prior VA-funded research, we asked patients and providers about their aspirations for primary care of the homeless. From this we developed a psychometrically valid patient experience survey (Primary Care Quality-Homeless, PCQ-H), which has been used in homeless health care programs across the country. This study will combine patient surveys from homeless-experienced (currently and previously homeless) veterans (n=6,181) and organizational assessment among a sample of HPACTs to advance two aims: Aim 1: Compare the primary care experience (i.e. PCQ-H scores) for homeless-experienced patients obtaining primary care in HPACTs to patients receiving primary care in mainstream PACT clinics operated by the same VA Medical Center. Aim 2: Characterize those features of HPACT service design that are most strongly associated with a superior patient experience (i.e. better PCQ-H scores). This Aim will be advanced sequentially through (a) adaptation of an organizational assessment tool specific to homeless-tailored primary care for use in this project; (b) conducting that assessment through surveys of HPACT directors to identify the presence or absence of potentially relevant HPACT service features; (c) analysis to compare PCQ-H scores for HPACTs that have versus those that lack each potentially relevant HPACT service feature. Evidence from this study will help to guide the future of primary care delivery for homeless and formerly homeless patients within VA, and in non-VA Federally Qualified Health Centers. Additionally, it may help to foster a primary care culture that holds itself accountable, first and foremost, to the unique contextual needs of patients as they leave homelessness behind.

描述(由申请人提供)：退伍军人事务部已经接受了以患者为中心的医疗之家，在退伍军人事务部被称为以患者为中心的护理团队(PACT)，这种方法承诺提供全面、以患者为中心、以团队为基础、专注于协调和沟通的护理，并能够维持长期持续的关系。对于无家可归或无家可归的患者来说，这些理想往往得不到满足。尽管为无家可归者开发以患者为中心的医疗之家做出了重大努力，但人们对为患者创造宝贵、持久的初级保健体验的服务设计交付的具体方面知之甚少。自2012年以来，退伍军人管理局雄心勃勃地通过无家可归者契约(HPACT，n=60)试行为无家可归者量身定做的初级保健服务设计。这创造了一个自然的实验，引发了两个重要的问题，不仅对退伍军人管理局，而且对寻求为社会弱势群体推广可行的医疗之家的非退伍军人管理局。首先，退伍军人管理局为无家可归者量身定做的初级保健计划是否提供了实质上优越的患者体验？其次，哪些特定的组织特征实际上很重要？这项建议将无家可归患者的初级保健经验作为成功参与初级保健的最近指标。患者体验调查寻求提供医疗服务各方面(准入、协调等)的体验式报告映射到患者和专家认为理想的情况。在先前由退伍军人事务部资助的研究中，我们询问了患者和提供者他们对无家可归者的初级护理的渴望。在此基础上，我们开发了一份心理测量学有效的患者体验调查(初级护理质量-无家可归者，PCQ-H)，已在全国各地的无家可归者医疗保健计划中使用。这项研究将结合对有无家可归经历(目前和以前无家可归)的退伍军人(n=6,181)的患者调查和对HPACT样本的组织评估来推进两个目标：目标1：比较有无家可归经历的患者在HPACT获得初级保健的患者与在同一退伍军人医疗中心运营的主流PACT诊所接受初级保健的患者的初级保健经历(即PCQ-H评分)。目标2：描述HPACT服务设计中与卓越的患者体验(即更好的PCQ-H评分)最相关的特征。将通过以下方式顺序推进这一目标：(A)调整针对无家可归者量身定做的初级护理的组织评估工具，以供本项目使用；(B)通过对医疗保险工作队主任的调查进行评估，以确定是否存在潜在相关的医疗保险援助服务特点；(C)进行分析，比较具有和不具有每一种潜在相关的医疗保险援助援助服务特点的卫生政策援助工作队的PCQ-H分数。这项研究的证据将有助于指导未来在退伍军人事务部和非退伍军人联合会合格的卫生中心为无家可归和以前无家可归的患者提供初级保健的未来。此外，它可能有助于培养一种初级保健文化，这种文化首先要对患者的独特背景需求负责，因为他们离开了无家可归的家园。