Care Coordination and Outcomes for High Risk Patients: Building the Evidence for Implementation

高危患者的护理协调和结果：建立实施证据

• 批准号: 10315963
• 负责人: Denise M. Hynes
• 金额: --
• 依托单位: PORTLAND VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-10-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10315963
• 关键词: Address; Adoption; Assessment tool; COVID-19 pandemic; Caring; Case Management; Chronic Care; Clinical; Communities; Complex; Consult; Data; Data Sources; Development; Diffusion of Innovation; Electronic Health Record; Elements; Emergency medical service; Ensure; Evaluation; Evidence based practice; Exposure to; Future; Goals; Group Interviews; Health; Health Services Accessibility; Health system; Healthcare; Hybrids; Impact evaluation; Interview; Life; Medicare; Methodology; Methods; Modeling; Needs Assessment; Nursing Care Management; Nursing Services; Observational Study; Office Nursing; Outcome; Patient Care; Patients; Perception; Primary Health Care; Process; Process Assessment; Provider; Qualitative Methods; Reporting; Research; Research Design; Role; Services; Site; Social Work; Surveys; System; Time; Trust; Veterans; Vital Status; base; care coordination; care outcomes; care systems; comparison group; cost; data warehouse; design; evidence base; experience; formative assessment; health care availability; health care service; health service use; high risk; implementation facilitation; implementation strategy; improved; innovation; insight; migration; mortality; multiple data sources; programs; psychosocial; satisfaction; service coordination; telehealth; theories; tool; uptake

Abstract Background: Care coordination is essential to improve patients’ access to healthcare, clinical outcomes, enhancing patients experience, increasing provider satisfaction, and decreasing or maintaining costs, yet appears to be most successful for those with complex care needs. While the VA’s established primary care model, the Patient Aligned Care Team (PACT) has proven effective in increasing Veterans’ experience and trust while decreasing costs, many high need, high risk Veterans lack support for their complex clinical and psychosocial needs that impacts their health care use, outcomes and costs. Two major VA initiatives led by the Offices of Nursing Service (ONS) and Care Management and Social Work (SW), and the Office of Community Care (OCC) intend to address this gap with initiation of new care coordination needs assessment (CCNA) tools to match Veterans with the right level of care coordination and services in 2019. Yet, the CCNA tools and organizational processes have not been evaluated. Significance: Evaluation and implementation of effective care coordination practices are a high priority for the VA and is the focus of two major national initiatives to address MISSION Act access to care goals. Innovation/Impact: We will leverage ongoing initiatives, using routinely collected CCNA data, supplemented with health care use data, and Veteran and provider perspectives to systematically evaluate care coordination needs assessment tools, practices, and impacts on Veterans’ services received, outcomes and costs. Specific Aims: We will build evidence about the CCNA, processes, and outcomes for high need, high risk Veterans seeking VA covered healthcare at VA facilities and community sites. Our aims are to: 1. Characterize and compare the relationship between Veteran needs assessment, services received, health outcomes and costs for Veterans exposed to CCNA with a matched comparison group. 2. Survey and compare Veterans about their experience with care coordination services, integration with other healthcare services, and perceived health impacts. 3. Conduct formative evaluation to assess provider perceptions at early adoption VA sites about CCNA tools and processes related to determinants of innovation diffusion, care integration, and to inform and conduct a broader survey of providers. Methodology: We will use an organizational theoretical approach including care coordination and innovation diffusion frameworks to guide our research and employ an observational design using quantitative and qualitative methods. Veterans treated at early adopter sites beginning in 2019 and categorized as needing complex care based on the CCNA will be compared to matched Veterans using multiple data sources. Data sources will include Veteran CCNA from the CC/ICM and OCC sites; CDW, VA Community Care, Consult Toolbox, Medicare, vital status, and cost data. Survey data will be collected from Veterans and providers. Quantitative analyses will describe and compare Veterans’ health services use, mortality and costs. Qualitative analyses will focus on understanding how perceived attributes of the CCNA tools, as well the perceived organizational context and implementation, influence uptake and adoption. The results of these analyses will inform ongoing CCNA adaptation, build the evidence for the utility of the innovation attributes for real-life implementation, and ensure evaluation of CCNA tools captures the most important elements. Next Steps/Implementation/Sustainability: Building the evidence for care coordination processes will inform best practices and implementation. With the VA’s electronic health record migration, this study may inform how to adapt new CCNA electronic tools to facilitate and sustain implementation of evidenced-based practices.

抽象的 背景：护理协调对于改善患者获得医疗保健的机会、临床结果、 增强患者体验，提高提供者满意度，并降低或维持成本，但 对于那些有复杂护理需求的人来说似乎是最成功的。虽然 VA 建立了初级保健 模型中，患者协调护理团队 (PACT) 已被证明可以有效增加退伍军人的经验和 在降低成本的同时建立信任，许多高需求、高风险的退伍军人缺乏对其复杂临床的支持 影响他们的医疗保健使用、结果和成本的社会心理需求。两大VA 由护理服务办公室 (ONS) 和护理管理和社会工作办公室 (SW) 领导的举措以及 社区护理办公室 (OCC) 打算通过启动新的护理协调需求来解决这一差距 评估 (CCNA) 工具，以便在 2019 年为退伍军人提供适当水平的护理协调和服务。然而， CCNA 工具和组织流程尚未经过评估。 意义：评估和实施有效的护理协调实践是医疗机构的高度优先事项 VA 是两项主要国家举措的重点，旨在实现 MISSION Act 获得护理的目标。 创新/影响：我们将利用正在进行的举措，使用定期收集的 CCNA 数据，并补充 利用医疗保健使用数据以及退伍军人和提供者的观点来系统地评估护理协调 需求评估工具、实践以及对退伍军人所获得的服务、结果和成本的影响。 具体目标：我们将针对高需求、高风险建立有关 CCNA、流程和结果的证据 寻求退伍军人事务部的退伍军人在退伍军人事务部设施和社区场所承保医疗保健。我们的目标是： 1. 描述并比较退伍军人需求评估、接受的服务、健康状况之间的关系 接触 CCNA 的退伍军人与匹配对照组的结果和成本。 2. 调查并比较退伍军人在护理协调服务、与其他服务整合方面的经验 医疗保健服务和感知的健康影响。 3. 进行形成性评估，以评估早期采用 VA 站点的提供商对 CCNA 工具的看法 与创新扩散、护理整合的决定因素相关的流程，并告知和开展 对提供者进行更广泛的调查。 方法：我们将使用组织理论方法，包括护理协调和创新 扩散框架来指导我们的研究并采用使用定量和分析的观察设计 定性方法。从 2019 年开始，退伍军人在早期采用者站点接受治疗，并被归类为需要 基于 CCNA 的复杂护理将与使用多个数据源的匹配退伍军人进行比较。数据 来源将包括来自 CC/ICM 和 OCC 站点的资深 CCNA； CDW、VA 社区关怀、咨询 工具箱、医疗保险、生命状态和成本数据。调查数据将从退伍军人和提供者处收集。 定量分析将描述和比较退伍军人的医疗服务使用情况、死亡率和成本。定性 分析将侧重于了解 CCNA 工具的感知属性以及感知 组织背景和实施，影响吸收和采用。这些分析的结果将 为正在进行的 CCNA 调整提供信息，为创新属性在现实生活中的实用性建立证据 实施，并确保 CCNA 工具的评估捕获最重要的要素。 后续步骤/实施/可持续性：建立护理协调流程的证据将提供信息 最佳实践和实施。随着退伍军人事务部的电子健康记录迁移，这项研究可能会告诉您如何 采用新的 CCNA 电子工具来促进和维持循证实践的实施。