权益分类	功能权益	普通用户	{{item.name}}会员
{{category.name}}	{{benefitItem.name}}

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.

背景分散的医疗保健-将患者的护理分散在多个提供者之间-增加了患者的风险以及提供者的不满、资源浪费和潜在的破坏性健康结果。协调护理，预防这些结果是VA的优先事项，随着退伍军人从非退伍军人那里获得更多的照顾， VA供应商。协调是两个或多个参与者之间的患者护理组织，以确保适当提供医疗保健服务。对于弗吉尼亚州每年超过2500万的专科护理转诊，最直接的参与者是病人、专科医生和初级保健医生，即“专科护理三合一”。改善专科护理协调、措施和干预措施需要考虑到每个三合会成员的经验。目标目标1. 1.1.调整三项调查，旨在a）衡量专科护理协调的经验，和B）衡量具体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.确定关于协调的调查问题的心理测量学特性（从1.1a开始）目标二。2.1.使用定性方法识别有效使用4种专科护理的障碍和促进因素目标1中的协调机制被广泛使用，并取得了巨大成功目标3. 3.1.使用目标2中的数据制定和试点测试干预措施，以实施一项或多项改善专科护理协调的机制，并根据可行性进行评估，可接受性，以及关于机制的调查问题得分的变化（从1.1b起） 3.2.通过以下方式检查关于协调的调查问题（从1.1a开始）的同时有效性：将干预前后的变化与现有经验证的量表的变化进行比较方法在目标1中，现有工具将被改编为3项调查，以衡量专科护理的经验协调和具体协调机制的帮助。调查的心理测量特性将通过国家VA试点管理进行评估。在目标2中，半结构化面试将在8个VA医疗中心与三合会成员进行，以了解4个选定的成功的关键因素机制等数据分析将采用混合演绎-归纳方法，并遵循实施研究框架。目标3将在目标1和目标2的基础上，制定和评价一项多方面的多方面的干预，使用一个或多个机制，以改善专科护理协调的三合会。预期影响该CDA将提供一个衡量成功的指标，该指标反映了最直接参与者的经验，专业护理协调，包括患者。它将提供关于障碍和促进因素的信息，协调专科护理的常用机制的成功。这也将导致干预，加强对三合会成员的专科护理协调。在今后的工作中，可以使用调查措施1）评估和比较干预措施，以改善VA内外的协调; 2）可以使用确定协调护理的组织特征和机制与高和低成功的专科护理协调，为每一个三合会成员;和3）将允许检查哪些方面协调，从黑社会成员的角度来看，与临床和成本结果。