Understanding the Effects of the MISSION Act on VA's Specialty Care Referral Networks

了解 MISSION 法案对 VA 专业护理转诊网络的影响

• 批准号: 10308254
• 负责人: Megan Adkins Adams
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-01 至 2025-10-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10308254
• 关键词: Address; Affect; Ambulatory Care; COVID-19 pandemic; Caring; Case Study; Characteristics; Cirrhosis; Communities; Complex; Enrollment; Event; Face; Future; Geography; Goals; Grant; Health; Health Services Accessibility; Health system; Healthcare Systems; Individual; Interview; Knowledge; Leadership; Measurable; Measures; Methodological Studies; Methodology; Methods; Modernization; Natural experiment; Nephrology; Outcome; Patients; Performance; Phase; Policies; Population; Process; Ramp; Recommendation; Recovery; Research; Resources; Sampling; Services; Site; Specialist; Structure; System; Telephone; Time; Variant; Veterans; base; care coordination; care delivery; comorbidity; coronavirus disease; economic impact; environmental change; experience; financial incentive; health care service organization; health management; improved; innovation; insight; medical specialties; post-COVID-19; response; time use; virtual healthcare

Background: Recently, VA underwent two unprecedented disruptive changes that fundamentally altered how care is delivered to Veterans. First, the VA MISSION Act was implemented in June 2019. Arguably the biggest policy change in VA care delivery since the "Kizer revolution,” MISSION’s purpose is to improve Veteran access to care, especially for services that have traditionally been resource-limited in VA due to geographic/ temporal barriers (e.g., specialty care). While VA healthcare systems were still in the early phases of adapting to MISSION, the COVID pandemic spread rapidly across the world, resulting in a sudden and prolonged ramp- down of elective outpatient care across the entire US healthcare system. VAMCs nationwide are independently adapting to these disruptive changes in ways that directly impact Veterans’ health and experience. Significance/Impact: Currently, we know little about MISSION’s early effects on where and how Veterans access specialty care (as moderated by COVID-related disruptions), or factors influencing community care referral. We also lack a clear understanding of how individual VAMCs are responding to these disruptive forces in realigning organizational strategy/structure to optimize performance. Addressing these knowledge gaps is critical to assessing the long-term impacts of MISSION and COVID on VA specialty care delivery and helping VAMCs to tailor adaptation approaches to their local setting to optimize the health and experience of Veterans. Innovation: Expansion of VA community care under the MISSION Act represents one of the largest natural experiments in delivery transformation in any U.S. healthcare system in modern times. Thus, VA community care expansion under MISSION offers an unparalleled opportunity to study the relationship between rapid environmental change, organizational adaptation, and long-term performance. The unanticipated system "reset" caused by COVID will only amplify and accelerate the adaptation process already underway. Specific Aims: Aim 1: Examine the relationship between VAMC organizational/environmental characteristics and longitudinal performance under MISSION/post-COVID, and the extent to which facility-level organizational adaptation measurably impacts performance. Aim 2: Characterize variation in organizational adaptation by high-performing tertiary VAMCs with different organizational/environmental characteristics. Aim 3: Explore how the experience of Veterans with specialty care needs differs at high-performing VAMCs with distinct organizational adaptation approaches. Methodology: In Aim 1a, using a longitudinal pre-/post- comparison analysis, we will examine the relationship between VAMC organizational/environmental characteristics and longitudinal performance under MISSION/post-COVID, including measures of access, care coordination, and community care referral. In Aim 1b, using a difference-in-differences approach, we will leverage differences in financial incentives between VAMCs to empirically assess the effect of VAMC organizational adaptation on longitudinal rates of VA community care referral and other outcomes. In Aim 2, we will interview leadership at 12 high-performing Level 1 VAMCs with varying organizational/environmental attributes to characterize variation in adaptation approaches under MISSION/post-COVID. In Aim 3, we will explore how VAMC organizational adaptation impacts Veterans’ specialty care experience through qualitative interviews of 48 Veterans at select Aim 2 sites. Implementation/Next Steps: This study will provide critical information about where and how Veterans access specialty care under MISSION/post-COVID, how high-performing tertiary VAMCs with different organizational/ environmental characteristics are adapting to enhance specialty care delivery under MISSION/post-COVID, and how variation in these adaptation approaches affects the Veteran experience of care. Grant products will provide vital information to VHA leaders about how tertiary VAMCs with unique facility-level characteristics can best adapt their organizational approaches to optimize performance and enhance the Veteran care experience.

背景：最近，VA 经历了两次前所未有的颠覆性变化，从根本上改变了 向退伍军人提供护理。首先，《VA MISSION Act》于 2019 年 6 月实施。可以说是最大的 自“凯泽革命”以来 VA 护理服务的政策发生变化，MISSION 的目的是改善退伍军人 获得护理的机会，特别是对于传统上由于地理/原因而在弗吉尼亚州资源有限的服务 时间障碍（例如，专业护理）。虽然 VA 医疗保健系统仍处于适应的早期阶段 就 MISSION 而言，新冠肺炎疫情在全球范围内迅速蔓延，导致疫情突然且长期蔓延—— 整个美国医疗保健系统的选择性门诊护理数量下降。全国范围内的 VAMC 都是独立的 以直接影响退伍军人健康和体验的方式适应这些颠覆性变化。 意义/影响：目前，我们对 MISSION 对退伍军人的早期影响知之甚少。 获得专业护理（受新冠肺炎相关干扰影响），或影响社区护理的因素 转介。我们还不清楚各个 VAMC 如何应对这些破坏性力量 重新调整组织战略/结构以优化绩效。解决这些知识差距的关键是 对于评估 MISSION 和 COVID 对 VA 专业护理服务和帮助的长期影响至关重要 VAMC 根据当地情况制定适应方法，以优化退伍军人的健康和体验。 创新：根据《使命法案》扩大 VA 社区护理是最大的自然护理项目之一 现代美国医疗保健系统中的交付转型实验。因此，VA 社区 MISSION 下的护理扩展提供了无与伦比的机会来研究快速护理之间的关系 环境变化、组织适应和长期绩效。意想不到的系统 新冠疫情造成的“重置”只会放大并加速已经在进行的适应过程。 具体目标： 目标 1：检查 VAMC 组织/环境特征之间的关系 任务/新冠疫情后的纵向绩效，以及设施级组织的程度 适应会显着影响绩效。目标 2：通过以下方式表征组织适应的变化： 具有不同组织/环境特征的高性能三级 VAMC。目标 3：探索如何 具有特殊护理需求的退伍军人在表现出色的 VAMC 中的经验有所不同，具有独特的 组织适应方法。 方法：在目标 1a 中，我们将使用纵向前/后比较分析来检查关系 VAMC 组织/环境特征与纵向绩效之间的关系 使命/新冠疫情后，包括准入、护理协调和社区护理转介的措施。瞄准 1b，使用双重差分法，我们将利用不同经济体之间财务激励的差异 VAMC 实证评估 VAMC 组织适应对 VA 纵向比率的影响 社区护理转介和其他结果。在目标 2 中，我们将采访 12 个高绩效级别的领导层 1 VAMC 具有不同的组织/环境属性来表征适应变化 使命/新冠疫情后的方法。在目标 3 中，我们将探讨 VAMC 组织如何适应 通过在选定的 Aim 2 地点对 48 名退伍军人进行定性访谈，影响退伍军人的专业护理体验。 实施/后续步骤：这项研究将提供有关退伍军人在何处以及如何访问的重要信息 使命/新冠疫情后的专业护理，具有不同组织/的高绩效三级 VAMC 如何 环境特征正在适应，以加强使命/后新冠疫情下的专业护理服务， 以及这些适应方法的变化如何影响退伍军人的护理体验。格兰特产品将 向 VHA 领导者提供重要信息，了解具有独特设施级特征的三级 VAMC 如何能够 最好地调整他们的组织方法，以优化绩效并增强退伍军人护理体验。