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

退伍军人事务部妇女医疗保健患者报告经验衡量标准的制定和验证

• 批准号: 10426011
• 负责人: Jodie Katon
• 金额: --
• 依托单位: VA PUGET SOUND HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-01 至 2026-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10426011
• 关键词: Address; Area; Black race; Caring; Characteristics; Client satisfaction; Clinic; Clinical; Communities; Complex; Consensus; Development; Dimensions; Discrimination; Ensure; Ethnic Origin; Face; Feedback; Focus Groups; Future; Gender; Gender Identity; Health Care Surveys; Health Personnel; Healthcare; Healthcare Systems; High Prevalence; Individual; Institution; Interview; Journals; Judgment; Learning; Measures; Medical; Mental Health; Mental Health Services; Methodology; Methods; Military Personnel; Monitor; Outcome; Patient Care; Patient Monitoring; Patient-Centered Care; Patients; Peer Review; Performance; Policies; Population; Primary Health Care; Privacy; Process; Process Measure; Provider; Psychometrics; Publications; Quality of Care; Race; Recording of previous events; Reporting; Reproductive Health; Research; Research Personnel; Review Literature; Role; Safety; Sampling; Series; Sex Orientation; Shapes; Site; Structure; Terminology; Testing; Time; Trust; Validation; Variant; Veterans; Voice; Woman; Women' s Health; Work; base; biological sex; care coordination; care outcomes; cognitive interview; cohort; demographics; design; effectiveness testing; experience; gender minority; health care quality; health disparity; implementation trial; improved; innovation; instrument; medical specialties; meetings; patient expectation; patient oriented; patient-clinician communication; perceived discrimination; preference; programs; racial discrimination; sex; sexual minority; sexual trauma; social; therapy design; tool

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.

背景：患者报告的体验测量(PREM)是一种过程测量，侧重于 护理的人际方面，越来越多地被用来衡量护理质量和解决不平等问题。这个 使用退伍军人保健的女性退伍军人人数继续增加。2015财年超过40万 女退伍军人使用退伍军人医疗保健。使用退伍军人医疗保健的女性退伍军人在 在种族/族裔、性取向和性别认同方面，有复杂的医疗和心理健康 护理需求高，性创伤，包括军事性创伤(MST)发生率高。这些 特点和经验往往是重叠的，形成了他们在退伍军人管理局内的保健经验， 这反过来又会影响患者报告的护理结果和临床结果。 意义：这项拟议的研究将开发首个患者报告体验测量(PREM) 专门为量化退伍军人在退伍军人保健方面的经历而设计的(WV_PREM)。WV_PREM 可用于监控和告知正在进行的以患者为中心的质量改进努力，如妇女的 通过与API和WHS的伙伴关系，在退伍军人管理局制定健康公约和反骚扰倡议。它还将启用 在包括种族/民族和性别在内的各种患者人口统计数据中检查退伍军人管理局护理的公平性 性别/性取向。 创新与影响：这项建议是创新的，因为它注重患者体验和主动性 让退伍军人参与衡量标准的制定过程，并有意将不同的 妇女退伍军人的声音，特别是那些身份被边缘化的人。与目前退伍军人管理局使用的PREM不同， WV_PREM将包括退伍军人中对女性特别重要的患者经验领域 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 促进退伍军人生殖保健的公平性，并告知和加快质量改进工作。 具体目标： 1.通过一系列确定退伍军人使用退伍军人保健的经验的显著结构 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的调查结果和文献回顾，生成初步的WV_PREM工具 现有措施。将使用审查和反馈就项目和内容的有效性达成共识 来自退伍军人和退伍军人利益相关者；清晰度将通过认知访谈来确定。 3.对在退伍军人管理局接受医疗保健的600名女性退伍军人进行心理测量学评估 对测量进行细化，对因素结构进行评估和确认，并检验结构效度。 方法：本提案将使用顺序混合方法方法。目标1涉及一系列半- 对使用退伍军人医疗保健的女性退伍军人进行结构化采访。目标2将包括开发一种 基于目标1调查结果的初步PREM，以及基于迭代审查和反馈的改进 资深焦点小组、退伍军人事务部利益相关者的审查和认知访谈。《目标3》将在心理测量学上 通过评估和确认因素，在600名女性退伍军人队列中验证来自Aim 2的最终PREM 结构和结构效度检验。 下一步/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 在退伍军人事务部妇女健康研究网络的支持下，分享关键的初步和最终结果 结果传给了不同的老兵团体。研究结果将提交给退伍军人管理局和非退伍军人管理局科学界 通过参加国家会议和在同行评议的期刊上发表文章。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 用于退伍军人管理局医疗质量监测。