Patient Experience of Specialty Care Coordination under the MISSION Act

根据 MISSION 法案进行特殊护理协调的患者体验

• 批准号: 10595498
• 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: 2022
• 资助国家: 美国
• 起止时间: 2022-06-01 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10595498
• 关键词: Address; Affect; Agreement; Annual Reports; Caring; Case Management; Case Mixes; Chronic; Chronic Obstructive Pulmonary Disease; Cladribine; Client satisfaction; Clinical; Collaborations; Communities; Community Care Networks; Community Healthcare; Congestive Heart Failure; Contracts; Coordinated Specialty Care; Data; Databases; Diabetes Mellitus; Electronic Health Record; Ensure; Foundations; Funding; Future; Health; Healthcare; Homogeneously Staining Region; Intervention; Knowledge; Measurement; Measures; Medical; Methodology; Methods; Mission; Modeling; Outcome; Patients; Pharmaceutical Preparations; Policies; Prospective Studies; Provider; Quality of Care; Resources; Respondent; Risk; Role; Science; Scientific Advances and Accomplishments; Selection Bias; Self Efficacy; Specialist; Statutes and Laws; Surveys; System; Testing; Veterans; Work; Writing; care coordination; care systems; community based care; cost; data exchange; evidence based guidelines; experience; health care settings; improved; innovation; medical specialties; novel; patient subsets; primary care patient; primary care provider; prospective; provider networks; satisfaction; stakeholder perspectives; wasting

Background. The MISSION Act incurs unprecedented challenges to care coordination due to greater use of community care (CC). Yet VA lacks data on patients' experience of coordination, which hinders improvement efforts. This prospective survey study focuses on VA primary care patients with common chronic medical conditions that require care coordination [diabetes, congestive heart failure (CHF), and chronic obstructive pulmonary disease (COPD)]. It will compare patients' experience of specialty care coordination with VA vs. CC, examine how patients' and clinicians' experiences of coordination relate, and examine the association of patients' experience of coordination to important outcomes. Significance. This project addresses HSR&D priority: MISSION Act, coordination of VA and non-VA care. It will examine how coordination, as experienced by Veterans, relates to both antecedents and outcomes in VA and CC. These data are novel, important to VA's mission to ensure high quality care within VA and for CC, and will be actionable by operational partners while advancing the science of care coordination. Innovation. The surveys measure specialty care coordination directly, i.e. as experienced, by the three main stakeholders (“triad”) in specialty care coordination: patient, PCP and specialist. Direct assessment of coordination (rather than of satisfaction) provides specific, actionable information about what needs to improve. The triad approach permits comprehensive assessment by those who most directly experience the effects of efforts organize care. It also enables us to examine how stakeholder experiences inter-relate. Specific Aims. AIM 1. Compare patients' overall experience of coordination in VA vs. CC.  H1a. Scores for overall coordination will be better in VA vs CC.  H1b. The gap in coordination scores for high- vs. low-complexity patients will be less in VA vs. CC. AIM 2. Examine how patients' overall experience of coordination correlates with those of PCPs and specialists.  H2a. In VA, patients' scores for overall experience will correlate most strongly with scale scores for PCPs and specialists on clarity and agreement on roles and responsibilities.  H2b. In CC, patients' scores for overall experience will correlate most strongly with the scale scores for PCPs and specialists that measure adequacy of data transfer. AIM 3. Examine the association of patients' overall experience of coordination with selected outcomes: test duplication, medication problems, A1C control (in diabetes), self-efficacy, and patient satisfaction.  H3a. Each outcome is better in VA vs. CC.  H3b. Better coordination as experienced by patients is associated with fewer duplicated tests and medication problems, and better A1C control (in diabetes), self-efficacy, and patient satisfaction. Methodology. VA primary care patients with referrals to VA or CC specialty care for diabetes, CHF, or COPD will be included. Clinicians of patient survey respondents will be included. Surveys will be used to measure coordination, medication problems, self-efficacy, and satisfaction. Test duplication and A1C control will be from VA databases. Hierarchical regression models will control for the nesting of patients within facility complexity levels, and system-level comparisons will account for selection bias with propensity score weighting. Implementation/ Next Steps. Bi-annual reports for operational partners will include actionable and evidence- based recommendations about clinical or policy interventions that could address any shortcomings we find. We will apply for project funding to examine hypotheses generated by the proposed work. These may include studies to examine, for example, best practices to coordinate from the patient and/or clinician perspective, reasons for any observed facility effects, or prospective studies on coordination and other outcomes.

背景资料。《使命法案》在护理协调方面遇到了前所未有的挑战，因为更多地使用 社区护理(CC)。然而，退伍军人管理局缺乏关于患者协调体验的数据，这阻碍了改善 努力。这项前瞻性调查研究的重点是退伍军人初级保健患者的常见慢性病 需要护理协调的情况[糖尿病、充血性心力衰竭(CHF)和慢性梗阻 肺部疾病(COPD)]。它将比较患者与VA和CC在专科护理协调方面的体验， 检查患者和临床医生的协调经验是如何联系的，并检查 患者对重要结果的协调经验。 意义重大。该项目涉及高铁和研发的优先事项：使命法案，退伍军人和非退伍军人护理的协调。它 我将研究退伍军人所经历的协调与退伍军人退伍军人病的前因后果之间的关系 和CC.这些数据是新颖的，对退伍军人管理局确保退伍军人事务部和CC的高质量护理的使命很重要，以及 将可由业务伙伴采取行动，同时推进护理协调科学。 创新。调查直接衡量专科护理的协调性，即根据三个主要方面的经验 专科护理协调中的利益相关者(“三合会”)：患者、初级保健医生和专科医生。直接评估 协调(而不是满意)提供了关于需要改进的具体的、可操作的信息。 三合会的做法使那些最直接体验到 努力组织关怀。它还使我们能够检查利益相关者的体验是如何相互关联的。 明确的目标。 目的1.比较VA组和CC组患者的整体协调体验。 H1a。在整体协调方面，退伍军人会比CC的得分更高。 H1B。复杂性高的患者与低复杂性的患者在协调分数上的差距在VA组与CC组之间将较小。 目的2.检查患者的总体协调体验如何与儿科医生和专家的协调体验相关。 H_2A。在退伍军人管理局，患者的总体体验得分与PCP的量表得分相关性最强 以及明确和商定角色和责任的专家。 H2B。在CC中，患者的总体体验得分将与以下量表得分关联最强 衡量数据传输充分性的PCP和专家。 目的3.检查患者的总体协调体验与选定结果的关系：测试 重复、用药问题、糖化血红蛋白控制(在糖尿病中)、自我效能和患者满意度。 H3a。与CC相比，VA组的每一种结果都更好。 H3B。患者体验到的更好的协调性与较少的重复测试和 药物问题，更好的A1C控制(在糖尿病中)，自我效能和患者满意度。 方法论。转诊至VA或CC糖尿病、CHF或COPD专科护理的VA初级护理患者 将被包括在内。患者调查受访者的临床医生将被包括在内。将使用调查来衡量 协调性、用药问题、自我效能和满足感。测试复制和A1C控制将来自 退伍军人事务部数据库。分级回归模型将控制设施复杂性内的患者嵌套 水平和系统级别的比较将考虑到倾向分数加权的选择偏差。 实施/后续步骤。针对运营合作伙伴的半年度报告将包括可采取行动的证据- 基于对临床或政策干预的建议，这些建议可以解决我们发现的任何缺陷。我们 将申请项目资金，以审查拟议工作产生的假设。这些可能包括 研究检查，例如，从患者和/或临床医生的角度协调的最佳实践， 任何观察到的设施影响的原因，或关于协调和其他结果的前瞻性研究。