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《使命法》给护理协调带来了前所未有的挑战，因为更多地使用 社区护理（CC）。然而，VA缺乏患者协调经验的数据，这阻碍了改善 努力这项前瞻性调查研究的重点是VA初级保健患者与常见的慢性医疗 需要护理协调的疾病[糖尿病、充血性心力衰竭（CHF）和慢性阻塞性肺疾病] 肺疾病（COPD）。它将比较患者的经验，专科护理协调与VA与CC， 检查患者和临床医生的协调经验如何相关，并检查 患者对重要结局的协调体验。 意义该项目涉及HSR&D优先事项：使命法案，VA和非VA护理的协调。它 我将研究如何协调，作为经验丰富的退伍军人，涉及到双方的先决条件和结果，在VA 和CC。这些数据是新颖的，对VA的使命很重要，以确保VA和CC的高质量护理， 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科护理协调，即由三个主要的 专科护理协调中的利益相关者（“三元组”）：患者、PCP和专科医生。直接评估 协调（而不是满意度）提供了关于需要改进的具体、可操作的信息。 三位一体的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。它还使我们能够研究利益相关者的经验如何相互关联。 具体目标。 AIM 1.比较VA与CC中患者的整体协调体验。 H1a。VA组的整体协调性评分优于CC组。 H1b. VA组与CC组相比，高复杂性患者与低复杂性患者的协调性评分的差距较小。 AIM 2.检查患者的整体协调经验如何与PCP和专家的相关性。 H2a。在VA中，患者的总体经验评分与PCP的量表评分相关性最强 和专家就角色和责任的明确性和一致性进行了讨论。 H2b。在CC中，患者的总体体验评分与以下量表评分的相关性最强： 测量数据传输充分性的PCP和专家。 AIM 3.检查患者的整体协调经验与选定结果的相关性：测试 重复，药物问题，A1 C控制（糖尿病），自我效能和患者满意度。 H3a。VA组的各项结局均优于CC组。 H3b.患者体验到的更好的协调性与更少的重复测试有关， 药物问题，更好的A1 C控制（糖尿病），自我效能和患者满意度。 方法论因糖尿病、CHF或COPD转诊至VA或CC专科护理的VA初级护理患者 将包括在内。将纳入患者调查受访者的临床医生。调查将用于衡量 协调、用药问题、自我效能和满意度。重复测试和A1 C控制将来自 VA数据库。分层回归模型将控制设施复杂性内的患者嵌套 水平和系统水平的比较将考虑选择偏差与倾向评分加权。 执行/后续步骤。业务伙伴的半年期报告将包括可采取行动的证据- 基于临床或政策干预的建议，可以解决我们发现的任何缺点。我们 将申请项目资金，以检验拟议工作产生的假设。这些可以包括 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， 任何观察到的设施效应的原因，或关于协调和其他结果的前瞻性研究。