Applying Relational Coordination to Implement a Pulmonary E-consult Intervention

引言：这是Seppo Rinne，MD PhD第二次提交VA HSR&D CDA提案。博士 Rinne是一名执业VA肺病学家，临床信息学家，也是HSR&D中心的核心研究者， 医疗保健组织和实施研究（CHOIR）。该提案包含了广泛的 修订，以解决先前的审查意见，这导致了一个完善的研究重点和严格的职业生涯 发展规划自从第一次提交CDA以来，Rinne博士转到了一个新的VA研究环境 这与他的职业目标密切相关，更新了他的指导和咨询团队，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。目前的建议是建立 Rinne博士以前的培训经验和初步研究，以提高多学科协调 通过开发和实施以理论为基础的信息学干预， 背景：获得专科护理往往不足以满足需求。为了提高及时性， 专业护理的效率，VA实施了电子咨询（电子咨询），允许异步 通过电子健康记录进行提供者-提供者协调。然而，有限的研究认为， 电子咨询对患者和提供者关系及其质量的潜在意外后果 通信关系协调（RC）理论提供了可以解决这些差距的见解， 知识，并为电子咨询干预措施的设计和实施提供信息。 目标：将联合收割机RC理论与已建立的实施模型相结合，以指导以下目标： 目的1：探索患者，PCP，和电子咨询和关系的肺病学家的观点。 目标2：就肺部电子会诊通信的基本组成部分达成共识。 目标3：设计和实施肺部电子咨询-第一干预。 方法：目标1将使用半结构化访谈来探讨电子咨询如何影响的观点 人际关系以及患者和提供者如何在以下背景下发展高质量的关系 经常使用电子咨询。目标2将使用一个多步骤的过程与德尔菲小组和退伍军人焦点小组， 就肺部电子会诊通信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，以确定有影响力的个人谁可以作为 变革推动者;（B）与这些个人和其他当地利益攸关方合作，调整目标1中的信息 2.制定电子咨询干预措施;（C）评估干预措施的效果和实施情况 通过访谈评估执行成果，中断时间序列分析， 检查等待时间，并对病人和提供者的满意度和协调质量进行调查。 预期结果：拟议的研究将确定以证据为基础的做法，以建立和维持病人 以及支持电子咨询使用并建立新的通信规范的提供商关系。这些发现 将告知基于RC理论的成功电子咨询干预的设计和实施， 将具有高度的可移植性和适应性。 结论：考虑人际关系和沟通的人文因素的信息学干预 将带来更好的医疗服务。对肺部电子咨询的研究将成为提高质量的典范 和专业护理的效率。因此，本提案中概述的研究与VA高度相关 提高护理的及时性、系统现代化和更有效地集中资源等优先事项。博士 Rinne拥有强大的指导团队，强大的运营合作伙伴和出色的研究团队。 环境本CDA建议书中描述的研究和培训目标将为他提供 必要的知识和技能，成为一个成功的和独立的VA调查员，专注于 通过新的、以信息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.