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。由于更多地使用医疗设备，《使命法案》给护理协调带来了前所未有的挑战 社区关怀（CC）。然而，VA 缺乏患者协调体验的数据，这阻碍了改进 努力。这项前瞻性调查研究的重点是患有常见慢性病的 VA 初级保健患者 需要护理协调的病症[糖尿病、充血性心力衰竭 (CHF) 和慢性阻塞性肺疾病 肺部疾病（慢性阻塞性肺病）]。它将比较患者在 VA 与 CC 的专业护理协调方面的体验， 检查患者和临床医生的协调体验如何相关，并检查两者之间的关联 患者对重要结果的协调体验。 意义。该项目解决了 HSR&D 的优先事项：使命法案、退伍军人事务部和非退伍军人事务部护理的协调。它 将研究退伍军人所经历的协调如何与 VA 的前因和结果相关 和CC。这些数据是新颖的，对于 VA 的使命非常重要，即确保 VA 内部和 CC 的高质量护理，并且 将由业务合作伙伴采取行动，同时推进护理协调科学。 创新。这些调查直接衡量专业护理协调情况，即按照经验，由三个主要 专科护理协调中的利益相关者（“三方”）：患者、PCP 和专家。直接评估 协调（而不是满意度）提供了有关需要改进的具体的、可操作的信息。 三元组方法允许那些最直接经历影响的人进行全面评估 努力组织护理。它还使我们能够检查利益相关者的体验如何相互关联。 具体目标。 目的 1. 比较患者在 VA 与 CC 中的整体协调体验。 H1a。 VA 的整体协调性得分会比 CC 更好。 H1b。 VA 与 CC 中高复杂度患者与低复杂度患者的协调得分差距会更小。 目标 2. 检查患者的整体协调体验与 PCP 和专科医生的整体体验有何关联。 H2a。在 VA，患者的整体体验评分与 PCP 的量表评分相关性最强 以及专家就角色和责任进行明确和一致。  H2b。在 CC 中，患者的整体体验得分与以下方面的量表得分相关性最强： 衡量数据传输充分性的 PCP 和专家。 目标 3. 检查患者整体协调体验与选定结果的关联：测试 重复、药物问题、A1C 控制（糖尿病）、自我效能和患者满意度。 H3a。 VA 的每个结果都比 CC 更好。  H3b。患者体验到的更好的协调与更少的重复测试和 药物问题、更好的 A1C 控制（糖尿病）、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 专业护理的 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。调查将用于衡量 协调性、药物问题、自我效能和满意度。测试重复和 A1C 控制将来自 弗吉尼亚州数据库。分层回归模型将控制患者在设施复杂性中的嵌套 水平和系统级比较将通过倾向得分加权来解释选择偏差。 实施/后续步骤。运营合作伙伴的半年度报告将包括可操作的和证据- 基于有关临床或政策干预的建议，可以解决我们发现的任何缺陷。我们 将申请项目资金来检验拟议工作产生的假设。这些可能包括 例如，研究从患者和/或临床医生的角度进行协调的最佳实践， 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。