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。MISSION法案在护理协调方面面临前所未有的挑战，因为更多地使用