Applying Relational Coordination to Implement a Pulmonary E-consult Intervention

简介：这是退伍军人事务部HSR&D CDA向Seppo Rinne医学博士提交的第二份提案。Dr。 Rinne是一名执业的退伍军人肺病专家、临床信息学家，也是HSR&D中心的核心研究员 医疗保健组织和实施研究(合唱团)。这项建议包含了广泛的 修改以解决之前的审查者评论，这导致了精细化的研究重点和严谨的职业生涯 发展规划。自从第一份CDA提交以来，Rinne博士转到了一个新的退伍军人管理局研究环境 这与他的职业目标密切相关，更新了他的指导和建议团队，以支持这些新的 目标，并与主要业务伙伴建立了牢固的工作关系。当前的提案建立了 关于Rinne博士以前的培训经验和改善多学科协调的初步研究 通过开发和实施以理论为基础的信息学干预，改善肺部护理。 背景：获得特殊护理的机会往往不足以满足需求。提高时效性和 为了提高专科护理的效率，退伍军人管理局实施了电子会诊(e-Consults)，允许异步 通过电子健康记录进行提供者-提供者之间的协调。然而，有限的研究已经考虑到 电子会诊对患者和提供者的关系及其质量的潜在意外后果 沟通。关系协调(RC)理论提供了能够解决这些差距的见解 为电子咨询干预措施的设计和实施提供知识和信息。 目的：将RC理论与已建立的实施模式相结合，以指导以下目标： 目标1：探讨患者、初级保健医生和肺科医生对电子会诊和关系的看法。 目标2：就肺部电子会诊交流的基本组成部分达成共识。 目的3：设计并实现一种肺部电子会诊优先干预方案。 方法：目标1将使用半结构化访谈来探索电子咨询如何影响的观点 人际关系以及患者和提供者在以下背景下如何发展高质量的关系 经常使用电子咨询。Aim 2将使用Delphi小组和资深焦点小组的多步骤流程来 就肺部电子会诊交流的基本组成部分达成共识。目标3将：(A)适用 新的实施策略，使用社会网络分析来识别可以充当 变革推动者；(B)与这些个人和其他当地利益攸关方合作，调整来自AIMS 1的信息 和2开发电子咨询干预措施；以及(C)评估干预措施和实施的效果 战略通过进行访谈来评估实施成果，中断时间序列分析以 检查等待时间，以及患者和提供者对满意度和协调质量的调查。 预期结果：拟议的研究将确定建立和维持患者的循证做法 以及支持电子咨询的供应商关系的使用和建立新的通信规范。这些发现 将指导基于RC理论的成功的电子咨询干预的设计和实施 将具有高度的可转移性和适应当地环境的能力。 结论：考虑关系和沟通的人文因素的信息学干预 将带来更好的医疗保健服务。肺部电子咨询研究将成为提高质量的典范 以及跨专业护理的效率。因此，本提案中概述的研究与退伍军人管理局高度相关 优先事项是提高护理的及时性，使系统现代化，并更有效地集中资源。Dr。 Rinne得到了强大的指导团队、强大的运营合作伙伴和出色的研究的支持 环境。CDA提案中描述的研究和培训目标将为他提供 成为一名成功和独立的退伍军人管理局调查员所需的知识和技能 通过新颖的、以信息学为基础的干预措施改善多学科协调。

Introduction: This is the second submission of a VA HSR&D CDA proposal for Seppo Rinne, MD PhD. Dr. Rinne is a practicing VA Pulmonologist, Clinical Informaticist, and a Core Investigator in the HSR&D Center for Healthcare Organization and Implementation Research (CHOIR). This proposal incorporates extensive revisions to address prior reviewer comments, which has led to a refined research focus and a rigorous career development plan. Since the first CDA submission, Dr. Rinne transferred to a new VA research environment that is closely aligned with his career goals, updated his mentoring and advising team to support these new goals, and established strong working relationships with key operational partners. The current proposal builds on Dr. Rinne’s previous training experiences and preliminary research to improve multidisciplinary coordination of pulmonary care by developing and implementing a theoretically-based informatics intervention. Background: Access to specialty care is often insufficient to meet demand. To improve timeliness and efficiency of specialty care, VA implemented electronic consultations (e-consults), which allow asynchronous provider-provider coordination through the electronic health record. However, limited research has considered potential unintended consequences of e-consults on patients’ and providers’ relationships and their quality of communication. Relational Coordination (RC) Theory provides insight that can address these gaps in knowledge and inform the design and implementation of e-consult interventions. Objective: To combine RC Theory with an established implementation model to guide the following Aims: Aim 1: Explore patient, PCP, and pulmonologist perspectives of e-consults and relationships. Aim 2: Develop consensus on essential components of pulmonary e-consult communication. Aim 3: Design and implement a pulmonary E-consult-First intervention. Methods: Aim 1 will use semi-structured interviews to explore perspectives on how e-consults impact interpersonal relationships and how patients and providers develop high quality relationships in the context of frequent e-consult use. Aim 2 will use a multi-step process with Delphi panels and Veteran focus groups to develop consensus on essential components of pulmonary e-consult communication. Aim 3 will: (A) apply a novel implementation strategy using social network analysis to identify influential individuals who can act as change agents; (B) work with these individuals and other local stakeholders to adapt information from Aims 1 and 2 to develop an e-consult intervention; and (C) evaluate the effect of the intervention and implementation strategy by conducting interviews to assess implementation outcomes, interrupted time-series analysis to examine wait times, and patient and provider surveys on satisfaction and the quality of coordination. Expected results: The proposed research will identify evidence-based practices to build and maintain patient and provider relationships that support e-consult use and establish new communication norms. These findings will inform the design and implementation of a successful e-consult intervention grounded in RC Theory that will be highly transferrable and adaptable to local contexts. Conclusions: Informatics interventions that consider humanistic elements of relationships and communication will lead to better healthcare delivery. Research on pulmonary e-consults will act as a model to improve quality and efficiency across specialty care. Therefore, the research outlined in this proposal is highly relevant to VA priorities of improving the timeliness of care, modernizing systems, and focusing resources more efficiently. Dr. Rinne is supported by a robust mentoring team, strong operational partners, and an outstanding research environment. The research and training objective described in this CDA proposal will provide him with the necessary knowledge and skills to become a successful and independent VA investigator focused on improving multidisciplinary coordination through novel, informatics-based interventions.