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

背景：患者报告的经验措施（PREM）是一个过程的措施，重点是 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保健服务的女退伍军人人数继续增加。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。使用VA医疗保健的女性退伍军人越来越多样化， 种族/民族和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，以及性创伤，包括军事性创伤（MST）的高发病率。这些 特点和经验，这往往是重叠的，塑造他们的经验，卫生保健在弗吉尼亚州， 这反过来又影响患者报告的护理结果和临床结果。 意义：拟议的研究将开发第一个患者报告的经验措施（PREM） 专门用于量化退伍军人妇女在退伍军人管理局医疗保健方面的经验（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，如妇女 通过与API和WHS的伙伴关系，在弗吉尼亚州实施《健康行动计划》和反骚扰倡议。它还将使 在各种患者人口统计学资料中检查VA护理的公平性，包括人种/种族和 性别/性取向。 创新与影响：该提案具有创新性，因为它关注患者体验， 参与的退伍军人在措施的发展过程中，并有意纳入不同的 妇女退伍军人的声音，特别是那些被边缘化的身份。与VA中使用的当前PREM不同， WV_PREM将包括对女性退伍军人特别重要的VA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 平等的退伍军人事务部生殖保健和宣传和加速质量改进工作。 具体目标： 1.确定结构突出的经验，妇女退伍军人使用退伍军人保健通过一系列 半结构化访谈不同的妇女退伍军人与不同的医疗保健需求。 2.根据目标1的结果和文献综述生成初步WV_PREM工具 现有措施。通过评审和反馈，就项目和内容有效性达成共识 从退伍军人和VA利益相关者;清晰度将通过认知访谈确定。 3.心理测量学评估WV_PREM在一个队列的600名女性退伍军人接受卫生保健在弗吉尼亚州， 细化测量，评估和确认因素结构，并测试结构有效性。 方法：本提案将采用顺序混合方法。目标1涉及一系列半- 与使用退伍军人管理局医疗保健的女性退伍军人进行了结构化访谈。目标2将包括发展一个 基于目标1调查结果的初步PREM，以及基于迭代审查和来自 退伍军人焦点小组，由VA利益相关者审查，和认知访谈。目标3将心理测量 通过评估和确认因素，在600名女性退伍军人的队列中验证目标2的最终PREM 结构和结构效度检验。 后续步骤/实施：在整个项目期间，我们将为我们的业务合作伙伴准备简报， 分享关键的初步和最终结果，并在弗吉尼亚州妇女健康研究网络的支持下， 给不同的退伍军人团体。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 我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的医疗质量监督

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.