Assessing VHA patient and provider perceptions of Point of Care research (POCr)

描述（由申请人提供）： 最近，VHA已经开始了一项计划，通过建立护理点研究（POCr）试验来启动临床研究的创新重新设计。新的创新将需要采用新的基础设施和研究流程。本研究的目的是提供确保VA POCr项目成功的信息。该提案将产生可交付成果，为营销、教育、实施和信息学准则的设计提供信息。目标将是提供者、患者、管理人员和工作人员。具体目标1。确定采用POCr研究创新计划的障碍和促进因素。评估患者、提供者、工作人员和管理人员对隐私、患者-提供者关系、伦理问题的看法和态度，以及对护理等效性、工作流程和患者入组、实施和CPRS功能障碍的担忧。为VHA制定关于实施POCr的指南，重点是：1）有效的实施策略和工作流程修改; 2）克服已识别的采用障碍的定制建议; 3）对提供者的营销和教育内容的要求; 4）对患者的营销和教育要求; 5）机构政策要求，以及6）利用CPRS支持POCr患者识别、跟踪和决策支持的关键功能要求。研究方法：将在已经使用POCr的2个VA Vanguard研究中心对患者、提供者、工作人员和管理人员进行认知访谈，然后在另外3个研究中心进行访谈，以了解与POCr实施相关的基本问题、关注点、语言和工作流程模式。从这些采访中获得的信息将用于构建相关的小插曲和焦点小组脚本。试点后，将在根据规模和地理多样性选择的15个VA研究中心开展30个焦点小组（1个针对患者，另一个针对提供者/工作人员/管理人员）。将对焦点小组的录音带进行定性分析。分析的关键问题可能包括POCr对提供者-患者关系、工作流程、隐私、护理质量和其他问题的影响。目标2将利用与利益相关者的反馈和讨论来设计营销、教育和实施指导方针。

DESCRIPTION (provided by applicant): Recently, VHA has embarked on a program to launch an innovative re-design of clinical research by instituting point of care research (POCr) trials. The new innovation will require the adoption of new infrastructure and research processes. The goal of this study is to provide information that will ensure the success of the VA POCr program. This proposal will result in deliverables that will inform the design of marketing, education, implementation and informatics guidelines. The targets will be providers, patients, administrators and staff. Specific Aim 1. Identify the barriers and facilitators to adoption of a POCr research innovation program. Assess the perceptions and attitudes of patients, providers, staff and administrators regarding privacy, patient-provider relationships, ethical issues, and concerns regarding the equivalence of care, workflow, and barriers to patient enrollment, implementation, and CPRS functionality Specific Aim 2. Produce guidelines for VHA regarding implementation of POCr, focusing on: 1) effective implementation strategies and workflow modifications; 2) tailored recommendations for overcoming identified barriers to adoption; 3) requirements for marketing and education content for providers; 4) requirements for marketing and education for patients; 5) institutional policy requirements, and 6) key functional requirements for utilizing CPRS to support POCr patient identification, tracking and decision support. Methods: Cognitive interviewing of patients, providers, staff and administrators will be conducted at 2 VA Vanguard sites already using POCr followed by 3 additional sites to understand basic issues, concerns, language and workflow patterns relevant to implementation of POCr. Information from these interviews will be used to construct relevant vignettes and a focus group script. Following piloting, 30 focus groups (1 for patients and another for providers/staff/ administrators) will be conducted at 15 VA sites selected for diversity in size and geography. Qualitative analysis will be conducted on transcribed audio-tapes from the focus groups. Key issues for analysis will likely include the impact of POCr on provider-patient relationships, workflow, privacy, quality of care and other issues. Aim 2 will use feedback and discussion with stakeholders to design marketing, education, and implementation guidelines for dissemination.