Measuring and improving specialty care coordination in VA

衡量和改善 VA 的专业护理协调

• 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
• 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

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-将患者的护理分散到多个提供者-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后果。协调护理以 预防这些结果是退伍军人管理局的优先事项，也是一个日益严峻的挑战，因为退伍军人从非退伍军人那里获得了更多的护理 退伍军人管理局供应商。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。对于每年在退伍军人事务部有2500万英镑的特殊护理转诊， 最直接的参与者是患者、专科医生和PCP，也就是“专科护理三合会”。改善专科护理 协调、措施和干预需要考虑到每个三合会成员的经验。 目标 目标1.1.1。采用三项调查，旨在a)衡量专科护理协调的体验， 和b)衡量具体协调机制的频率和效力 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2.2.1。使用定性方法确定有效使用4种专科护理的障碍和促进者 目标1中发现的协调机制既得到广泛使用，又取得了不同程度的成功 目标3.3.1。使用AIM 2中的数据开发和试行实施一项或多项干预措施 改进专科护理协调的机制，并在可行性的基础上进行评估， 可接受性，以及关于机制的调查问题的分数变化(从1.1b开始) 3.2.检查关于协调的调查问题(从1.1a开始)的同时效度 将干预前后的变化与现有验证量表的变化进行比较 方法 在目标1中，现有的工具将被改编为3项调查，以衡量特殊护理的经验 协调和具体协调机制的帮助。调查的心理测量学特性 将通过国家退伍军人管理局进行评估。在目标2中，半结构化面试将是 在8个退伍军人医疗中心与三合会成员进行调查，以了解选定的4个中心成功的关键因素 机制。数据分析将使用演绎-归纳混合方法，并由综合 实施研究框架。目标3将在目标1和目标2的基础上开发和评估多个 使用一个或多个机制来改善三合会的专科护理协调的多方面干预。 预期影响 这项CDA将提供一个衡量成功的指标，以说明最直接的参与者在 专科护理协调，包括患者。它将提供有关障碍和促进者的信息 成功建立协调专科护理的常用机制。它还将导致对 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) 评估和比较在退伍军人管理局内部和外部改善协调的干预措施；2)可以使用 确定哪些组织特征和机制与护理的高低相关 成功地为每个三合会成员进行专科护理协调；以及3)将允许检查哪些方面 从三合会成员的角度来看，协调程度与临床和成本结果有关。