Development and Validation of a Patient Reported Experience Measure for VA Women's Health Care

背景：患者报告的体验测量 (PREM) 是侧重于以下方面的过程测量： 护理的人际方面，并越来越多地用于衡量护理质量和解决不平等问题。的 使用退伍军人管理局医疗保健的女性退伍军人人数持续增加。 2015财年超过40万 女性退伍军人使用退伍军人管理局的医疗保健服务。使用 VA 医疗保健的女性退伍军人在以下方面日益多样化 种族/民族、性取向和性别认同方面，具有复杂的医疗和心理健康状况 护理需求以及性创伤的高发，包括军事性创伤 (MST)。这些 特征和经验通常是重叠的，塑造了他们在 VA 内的医疗保健经验， 这反过来又影响患者报告和临床护理结果。 意义：拟议的研究将开发第一个患者报告的体验测量（PREM） 专门设计用于量化女性退伍军人在 VA 医疗保健方面的体验 (WV_PREM)。 WV_PREM 可用于监测和告知正在进行的以患者为中心的质量改进工作，例如妇女 通过与 API 和 WHS 合作，在 VA 实施 Health PACT 和反骚扰倡议。它还将启用 检查各种患者人口统计数据（包括种族/族裔）中 VA 护理的公平性 性别/性取向。 创新和影响：该提案具有创新性，因为它注重患者体验和积极主动 退伍军人参与措施制定过程，并有意将不同的 女性退伍军人的声音，特别是那些具有边缘化身份的女性退伍军人的声音。与 VA 目前使用的 PREM 不同， WV_PREM 将包括 VA 中对女性退伍军人特别重要的患者体验领域 例如安全、尊重和歧视。 WV_PREM 将是一个独特的工具，用于监控质量和 退伍军人管理局生殖保健的公平性，并为质量改进工作提供信息和加速。 具体目标： 1. 通过一系列的项目，确定女性退伍军人使用 VA 医疗保健体验的显着结构 对具有不同医疗保健需求的不同女性退伍军人进行半结构化访谈。 2. 根据目标 1 的发现和文献综述生成初步的 WV_PREM 工具 现有措施。将通过审查和反馈就项目和内容有效性达成共识 来自退伍军人和退伍军人事务部利益相关者；清晰度将通过认知访谈来确定。 3. 对 600 名在 VA 接受医疗保健的女性退伍军人组成的队列进行心理测量评估 WV_PREM 细化衡量标准，评估和确认因素结构，并测试结构有效性。 方法：本提案将使用顺序混合方法。目标 1 涉及一系列半 对使用退伍军人管理局医疗保健的女性退伍军人进行结构化访谈。目标 2 将包括开发 基于目标 1 研究结果的初步 PREM，以及基于迭代审查和反馈的细化 退伍军人焦点小组、退伍军人管理局利益相关者的审查以及认知访谈。目标 3 将进行心理测量 通过评估和确认因素，在 600 名女性退伍军人队列中验证目标 2 的最终 PREM 结构和构建有效性测试。 后续步骤/实施：在整个项目中，我们将为我们的运营合作伙伴准备简报，以便 分享关键的初步和最终结果，并在 VA 妇女健康研究网络的支持下 结果给各个退伍军人团体。研究结果将提交给 VA 和非 VA 科学界 通过参加国家会议和在同行评审期刊上发表文章。从第四年开始，我们 将与我们的运营合作伙伴合作，将 WV_PREM 的最终验证版本作为常规工具实施 用于 VA 医疗保健质量监测。

Background: Patient-reported experience measures (PREMs) are process measures that focus on the interpersonal aspects of the care, and increasingly used to measure care quality and address inequities. The number of women Veterans using VA health care continues to increase. In fiscal year 2015 over 400,000 women Veterans used VA health care. Women Veterans using VA health care are increasingly diverse in terms of race/ethnicity and sexual orientation and gender identity, have complex medical and mental health care needs, and a high prevalence of sexual trauma, including military sexual trauma (MST). These characteristics and experiences, which are often overlapping, shape their experiences of health care within VA , which in turn influence patient-reported and clinical outcomes of care. Significance: The proposed study will develop the first patient-reported experiences measure (PREM) designed specifically to quantify women Veterans’ experiences with VA health care (WV_PREM). WV_PREM can be used to monitor and inform on-going patient-centered quality improvement efforts such as the Women’s Health PACT and anti-harrassment initiative in VA through partnerships with API and WHS. It will also enable examination of equity in VA care across a variety of patient demographics including race/ethnicity and gender/sexual orientation. Innovation & Impact: This proposal is innovative due to its focus on patient experience and active engagement of Veterans in the measure development process, and by intentionally incorporating diverse voices of women Veterans, particularly those with marginalized identities. Unlike current PREMs used in VA, WV_PREM will include domains of patient experience in VA that are uniquely important to women Veterans such as safety, respect, and discrimination. WV_PREM will be a unique tool for monitoring the quality and equity of VA reproductive health care and informing and accelerating quality improvement efforts. Specific Aims: 1. Identify constructs salient to the experience of women Veterans using VA health care through a series of semi-structured interviews with diverse women Veterans with different health care needs. 2. Generate a preliminary WV_PREM instrument based on findings from Aim 1 and literature review of existing measures. Consensus on items and content validity will be reached using review and feedback from Veterans and VA stakeholders; clarity will be determined via cognitive interviews. 3. Psychometrically evaluate WV_PREM in a cohort of 600 women Veterans receiving health care at VA to refine the measure, assess and confirm the factor structure, and test construct validity. Methodology: This proposal will use a sequential mixed methods approach. Aim 1 involves a series of semi- structured interviews with women Veterans who used VA health care. Aim 2 will in clude development of a preliminary PREM based on Aim 1 findings, and refinement based on iterative review and feedback from Veteran focus groups, review by VA stakeholders, and cognitive interviews. Aim 3 will psychometrically validate the final PREM from Aim 2 in a cohort of 600 women Veterans by assessing and confirming the factor structure and testing for construct validity. Next Steps/Implementation: Throughout the project, we will prepare briefings for our operational partners to share key preliminary and final results, and with support of the VA Women’s Health Research Network pres ent results to various Veteran’s groups. Findings will be presented to the VA and non -VA scientific community through participation in national meetings and publication in peer reviewed journals. Starting in year four, we will work with our operational partners to implement the final validated version of WV_PREM as a regular tool for VA health care quality surveillance.