Measuring and improving specialty care coordination in VA

衡量和改善 VA 的专业护理协调

基本信息

批准号：
10392860
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
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-12-01 至 2022-11-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10392860
关键词：
Accountability Address Affect Caring Clinical Complement Consolidated Framework for Implementation Research Coordinated Specialty Care Data Data Analyses Development Diagnostic Errors Effectiveness Ensure Face Foundations Frequencies Frustration Funding Future Goals Health Health Care Costs Health Services Healthcare Home Integrated Health Care Systems Intervention Intervention Trial Interview Lead Measurable Measurement Measures Medical Medical center Medication Errors Mentors Methods Modeling Outcome Participant Patient Care Patient-Centered Care Patients Physicians Positioning Attribute Primary Health Care Process Property Provider Psychometrics Qualitative Methods Quality of Care Research Research Personnel Research Training Resources Review Literature Risk Specialist Structure Survey Methodology Surveys System Testing Training Triad Acrylic Resin Veterans Visit Work adverse outcome care coordination care providers care systems career comparison intervention cost outcomes design experience health care delivery health care service high risk improved innovation instrument medical specialist medical specialties member method development multi-component intervention pilot test pilot trial post intervention prevent programs satisfaction skills success therapy development wasting

项目摘要

BACKGROUND Fragmented health care – the splitting of a patient's care across multiple providers – increases risks of patient and provider dissatisfaction, resource waste, and potentially devastating health outcomes. Coordinating care to prevent these outcomes is a VA priority, and an increasing challenge as Veterans receive more care from non- VA providers. Coordination is the organization of patient care between two or more participants to ensure appropriate delivery of healthcare services. For specialty care referrals, which number >25 million yearly in VA, the most direct participants are patient, specialist and PCP, the “specialty care triad”. To improve specialty care coordination, a measure and interventions are needed that account for the experience of each triad member. OBJECTIVES Aim 1. 1.1. Adapt a trio of surveys designed to a) measure the experience of specialty care coordination, and b) measure the frequency and effectiveness of specific coordination mechanisms among patients, medical specialists, and primary care providers 1.2. Determine the psychometric properties of the survey questions on coordination (from 1.1a) Aim 2. 2.1. Use qualitative methods to identify barriers and facilitators to effective use of 4 specialty care coordination mechanisms that are found in Aim 1 to be both widely used and variably successful Aim 3. 3.1. Use data from Aim 2 to develop and pilot-test an intervention to implement one or more mechanisms to improve specialty care coordination, and evaluate it on the basis of feasibility, acceptability, and changes in scores of survey questions about mechanisms (from 1.1b) 3.2. Examine concurrent validity of the survey questions about coordination (from 1.1a) by comparing changes in them pre- and post-intervention to changes in existing validated scales METHODS In Aim 1, existing instruments will be adapted into 3 surveys to measure the experience of specialty care coordination and the helpfulness of specific mechanisms to coordinate. Psychometric properties of the surveys will be assessed through a national VA pilot administration. In Aim 2, semi-structured interviews will be conducted with triad members at 8 VA medical centers, to understand the key factors to success of 4 selected mechanisms. Data analysis will use a mixed deductive-inductive approach and be guided by the Consolidated Framework for Implementation Research. Aim 3 will build on Aims 1 and 2 to develop and evaluate a multi- faceted intervention that uses one or more mechanisms to improve specialty care coordination for the triad. ANTICIPATED IMPACT This CDA will provide a metric of success that accounts for the experience of the most direct participants in specialty care coordination, including the patient. It will provide information about the barriers and facilitators to success of commonly used mechanisms to coordinate specialty care. It will also result in an intervention to improve specialty care coordination for the triad members. In future work, the survey measure 1) can be used to evaluate and compare interventions to improve coordination, both within and outside of VA; 2) can be used to identify which organizational features and mechanisms to coordinate care correlate with high and low success in specialty care coordination, for each triad member; and 3) will allow examination of which aspects of coordination, from which triad members' perspectives, are associated with which clinical and cost outcomes.

背景零散的医疗保健 - 在多个提供者中分裂患者护理 - 增加了患者的风险提供者的不满，资源浪费以及潜在的毁灭性健康结果。协调护理防止这些结果是VA的优先事项，并且由于退伍军人从非 - VA提供商。协调是两个或多个参与者之间的患者护理的组织适当提供医疗服务。对于专业护理推荐，每年在弗吉尼亚州> 2500万最直接的参与者是患者，专家和PCP，即“专业护理三合会”。改善专业护理需要协调，措施和干预措施，以说明每个三合会成员的经验。目标目标1。1.1。调整设计旨在a）衡量特殊护理协调的体验的调查， b）测量特定协调机制的频率和有效性患者，医疗专家和初级保健提供者 1.2。确定有关协调问题的心理测量特性（从1.1a）目标2。2.1。使用定性方法来识别障碍和促进者，以有效使用4个专业护理在AIM 1中发现的协调机制既广泛使用又可变目标3。3.1。使用AIM 2的数据来开发和进行测试，以实施一个或多个改善专业护理协调的机制，并根据可行性进行评估可接受性，以及有关机制的调查问题的变化（从1.1b起） 3.2。检查调查问题的并发有效性有关协调的问题（从1.1a）将干预前后的变化与现有验证量表的变化进行比较方法在AIM 1中，现有工具将被调整为3次调查，以衡量专业护理的体验协调和特定机制协调的帮助。调查的心理测量特性将通过国家弗吉尼亚州试点管理局进行评估。在AIM 2中，半结构化访谈将是在8 VA医疗中心与三合会成员一起进行，以了解4个选定的成功的关键因素机制。数据分析将使用混合的演绎感应方法，并以合并的指导实施研究框架。 AIM 3将基于目标1和2建立，以开发和评估多种多样采用一种或多种机制来改善三合会的专业护理协调。预期的影响该CDA将提供成功指标，以说明最直接参与者的经验专业护理协调，包括患者。它将提供有关障碍和促进者的信息常用机制的成功来协调专业护理。这也将导致干预改善三合会成员的专业护理协调。在以后的工作中，调查测量1）可以使用评估和比较VA内外的干预措施以改善协调； 2）可以使用确定哪些组织特征和机制可以协调与高和低相关的护理每个三合会成员的专业护理协调成功； 3）将允许检查哪些方面三合会成员的观点与临床和成本结果相关联的协调。