Patient Experience of Specialty Care Coordination under the MISSION Act

根据 MISSION 法案进行特殊护理协调的患者体验

• 批准号: 10311691
• 负责人: Varsha Vimalananda
• 金额: --
• 依托单位: EDITH NOURSE ROGERS MEMORIAL VETERANS HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-01 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10311691
• 关键词: Address; Affect; Agreement; Annual Reports; Caring; Case Management; Case Mixes; Chronic; Chronic Obstructive Pulmonary Disease; Client satisfaction; Clinical; Collaborations; Communities; Community Care Networks; Congestive Heart Failure; Contracts; Coordinated Specialty Care; Data; Databases; Diabetes Mellitus; Electronic Health Record; Ensure; Foundations; Funding; Future; Health; Health Care Costs; Healthcare; Information Specialists; Intervention; Knowledge; Lead; Measurement; Measures; Medical; Methodology; Methods; Mission; Modeling; Outcome; Patient Care; Patients; Pharmaceutical Preparations; Policies; Primary Health Care; Prospective Studies; Provider; Quality of Care; Resources; Respondent; Risk; Role; Science; Scientific Advances and Accomplishments; Selection Bias; Self Efficacy; Specialist; Statutes and Laws; Surveys; System; Testing; Triad Acrylic Resin; Veterans; Weight; Work; base; care coordination; care providers; care systems; community based care; data exchange; evidence based guidelines; experience; health care settings; improved; innovation; medical specialties; novel; patient subsets; prospective; provider networks; satisfaction; stakeholder perspectives; wasting

Background. The MISSION Act incurs unprecedented challenges to care coordination due to greater use of community care (CC). Yet VA lacks data on patients' experience of coordination, which hinders improvement efforts. This prospective survey study focuses on VA primary care patients with common chronic medical conditions that require care coordination [diabetes, congestive heart failure (CHF), and chronic obstructive pulmonary disease (COPD)]. It will compare patients' experience of specialty care coordination with VA vs. CC, examine how patients' and clinicians' experiences of coordination relate, and examine the association of patients' experience of coordination to important outcomes. Significance. This project addresses HSR&D priority: MISSION Act, coordination of VA and non-VA care. It will examine how coordination, as experienced by Veterans, relates to both antecedents and outcomes in VA and CC. These data are novel, important to VA's mission to ensure high quality care within VA and for CC, and will be actionable by operational partners while advancing the science of care coordination. Innovation. The surveys measure specialty care coordination directly, i.e. as experienced, by the three main stakeholders (“triad”) in specialty care coordination: patient, PCP and specialist. Direct assessment of coordination (rather than of satisfaction) provides specific, actionable information about what needs to improve. The triad approach permits comprehensive assessment by those who most directly experience the effects of efforts organize care. It also enables us to examine how stakeholder experiences inter-relate. Specific Aims. AIM 1. Compare patients' overall experience of coordination in VA vs. CC.  H1a. Scores for overall coordination will be better in VA vs CC.  H1b. The gap in coordination scores for high- vs. low-complexity patients will be less in VA vs. CC. AIM 2. Examine how patients' overall experience of coordination correlates with those of PCPs and specialists.  H2a. In VA, patients' scores for overall experience will correlate most strongly with scale scores for PCPs and specialists on clarity and agreement on roles and responsibilities.  H2b. In CC, patients' scores for overall experience will correlate most strongly with the scale scores for PCPs and specialists that measure adequacy of data transfer. AIM 3. Examine the association of patients' overall experience of coordination with selected outcomes: test duplication, medication problems, A1C control (in diabetes), self-efficacy, and patient satisfaction.  H3a. Each outcome is better in VA vs. CC.  H3b. Better coordination as experienced by patients is associated with fewer duplicated tests and medication problems, and better A1C control (in diabetes), self-efficacy, and patient satisfaction. Methodology. VA primary care patients with referrals to VA or CC specialty care for diabetes, CHF, or COPD will be included. Clinicians of patient survey respondents will be included. Surveys will be used to measure coordination, medication problems, self-efficacy, and satisfaction. Test duplication and A1C control will be from VA databases. Hierarchical regression models will control for the nesting of patients within facility complexity levels, and system-level comparisons will account for selection bias with propensity score weighting. Implementation/ Next Steps. Bi-annual reports for operational partners will include actionable and evidence- based recommendations about clinical or policy interventions that could address any shortcomings we find. We will apply for project funding to examine hypotheses generated by the proposed work. These may include studies to examine, for example, best practices to coordinate from the patient and/or clinician perspective, reasons for any observed facility effects, or prospective studies on coordination and other outcomes.

背景。 《任务法》由于更多地使用而构成了前所未有的挑战 社区护理（CC）。然而，弗吉尼亚州缺乏有关患者协调经验的数据，这阻碍了改善 努力。这项前瞻性调查研究重点是VA初级保健患者 需要护理协调的条件[糖尿病，充血性心力衰竭（CHF）和慢性阻塞性 肺疾病（COPD）]。它将与VA与CC进行特殊护理协调的特殊护理协调经验， 检查患者和临床医生如何协调关系的经历，并检查 患者对重要结果的协调经验。 意义。该项目涉及HSR＆D优先事项：Mission Act，VA协调和非VA护理。它 将研究退伍军人经历的协调如何与VA中的先例和结果有关 和CC。这些数据是新颖的，对VA的使命至关重要，以确保VA和CC内的高质量护理以及 在进行护理协调科学的同时，运营伙伴将是可行的。 创新。调查直接测量特殊护理协调，即经历了三个主要 专业护理协调的利益相关者（“三合会”）：患者，PCP和专家。直接评估 协调（比满意度更高）提供了有关改进需要的特定，可操作的信息。 三合会方法允许那些最直接体验的人进行全面评估 努力组织护理。它还使我们能够研究利益相关者如何相互关系。 具体目标。 AIM 1。比较患者在VA与CC中协调的总体经验。 H1A。在VA与CC中，总体协调的得分将更好。 H1B。在VA与CC中，高复杂患者的协调得分差距将较小。 AIM 2。检查患者的协调总体经验与PCP和专家的协调如何相关。 H2A。在VA中，整体经验的患者分数将与PCP的量表得分最密切相关 以及关于角色和责任的清晰度和同意的专家。 H2B。在CC中，患者的整体经验分数将与量表得分最密切相关 PCP和专家，衡量数据传输的充分性。 目标3。检查患者协调的总体经验与选定结果的关联：测试 重复，用药问题，A1C控制（糖尿病），自我效能感和患者满意度。 H3A。在VA与CC中，每个结果都更好。 H3B。患者所经历的更好的协调与重复的测试较少有关 用药问题，以及更好的A1C控制（糖尿病），自我效能感和患者满意度。 方法论。 VA初级保健患者转介给VA或CC专业护理糖尿病，CHF或COPD 将包括在内。将包括患者调查受访者的临床医生。调查将用于测量 协调，药物问题，自我效能和满意度。测试重复和A1C控制将来自 VA数据库。分层回归模型将控制设施复杂性中患者的筑巢 水平和系统级比较将带来选择偏差，并具有承诺得分加权。 实施/下一步。针对运营伙伴的两年一次报告将包括可操作和证据 - 基于有关临床或政策干预措施的建议，这些建议可以解决我们发现的任何缺点。我们 将申请项目资金来检查拟议工作产生的假设。这些可能包括 研究以检查从患者和/或临床角度进行协调的最佳实践， 任何观察到的设施影响的原因，或对协调和其他结果的前瞻性研究。