VA Video Connect to Improve Access to Multi-disciplinary Specialty Care

VA 视频连接可改善获得多学科专业护理的机会

• 批准号: 9721402
• 负责人: Thomas P Giordano
• 金额: --
• 依托单位: MICHAEL E DEBAKEY VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-01-01 至 2023-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9721402
• 关键词: Address; Adherence; Adoption; Affect; Ambulatory Care Facilities; Annual Reports; Appointment; Area; Biometry; Blood Pressure; Caring; Chronic; Chronic Disease; Clinic; Clinic Visits; Clinical; Clinical effectiveness; Communicable Diseases; Communities; Complex; Computer software; Computers; Data; Development; Devices; Diagnosis; Effectiveness; Enrollment; Evaluation; Fostering; Funding; Gold; HIV; HIV Infections; HIV diagnosis; Health; Health Services Accessibility; Healthcare; Hepatitis; Home environment; Hospitals; Hybrids; Improve Access; Intervention; Interview; Knowledge; Lead; Leadership; Location; Logistics; Measures; Medical; Medical center; Medicine; Mental Health; Methodology; Methods; Modeling; Modernization; Monitor; Outcome; Participant; Patients; Peripheral; Persons; Phase; Physiologic pulse; Primary Health Care; Privatization; Process; Provider; Randomized; Readiness; Research; Rural; Rural Health; Safety; Secure; Services; Social Work; Stethoscopes; Technology; Telemedicine; Testing; Time; Training Support; Travel; United States; Veterans; Videoconferencing; Viral; Virus Diseases; Visit; Weight; Work; antiretroviral therapy; base; behavioral health; care systems; effectiveness implementation study; effectiveness trial; encryption; evidence base; experience; falls; formative assessment; glucose monitor; handheld mobile device; health care delivery; health disparity; heart rate monitor; high risk; implementation strategy; improved; innovation; mHealth; medical specialties; multidisciplinary; primary outcome; programs; remote location; routine care; secondary outcome; social stigma; telehealth; transmission process; uptake

Background: Improving retention in human immunodeficiency virus (HIV) care and increasing the proportion of Veterans with persistent HIV suppression is one of the 4 national priorities outlined in the VHA HIV, Hepatitis and Related Conditions Program’s 2016 Annual Report. Treatment of complex conditions like HIV requires multidisciplinary care and monitoring at regular clinic visits with multiple providers. In VHA that care is located and delivered primarily in VA medical centers, posing logistic and stigma related barriers to Veterans’ access to multidisciplinary HIV care. VA Video Connect (VVC), a VA-supported mobile health video technology that allows Veterans and providers to complete clinical visits from any remote location including the home, has the potential to transform delivery of multidisciplinary care for HIV and other chronic conditions by increasing access to care. VA leadership wants 5% of Veterans to receive care via VVC in FY2018, but less than 0.1% of Veterans with HIV have used VVC. VVC could help fill these gaps in care. Specific Aims: The aims are: Aim 1-Clinical Effectiveness: To determine the effectiveness of VVC-delivered, multidisciplinary HIV care compared to routine care on retention in care. Aim 2-Implementation: To conduct a mixed-methods formative evaluation to refine and evaluate our implementation facilitation (IF) strategy to improve the reach of VVC-delivered HIV care, increase provider and Veteran adoption, and determine potential for sustainability. Exploratory Aim: To assess the implementation potential of VVC- delivered HIV care across 6 diverse VHA settings and identify contextually specific barriers and facilitators to adoption. Significance to Veterans’ Health: The VA is one of the largest providers of HIV care in the US, and improving retention in care and HIV suppression is associated with improved survival with HIV. Priority areas: Improving access to care, modernization of VA, healthcare equity and health disparities. Innovation: While VVC is gaining a foothold in mental health care, it has not been widely used in specialty medical care. We will determine if multidisciplinary care delivered by VVC can improve retention in care and clinical outcomes for vulnerable Veterans in need of specialty medical care. The research will provide models and evidence for a transformative solution to increase Veterans' access to multidisciplinary care. Methodology: Aim 1 will be achieved with a pragmatic, Hybrid Type II effectiveness-implementation study within the Michael E. DeBakey VA Medical Center infectious diseases clinic, which cares for nearly 1000 Veterans with HIV. We will deploy an IF strategy to facilitate uptake of VVC and randomize Veterans to either be offered or not offered VVC. The study will enroll 360 Veterans and is powered to detect a 12% absolute improvement in retention in care, the primary outcome. Secondary outcomes include adherence to antiretroviral therapy, HIV suppression, and safety measures. Guided by the RE-AIM QuEST framework, Aim 2 layers a mixed-method evaluation on top of the effectiveness trial, enrolling 40 Veteran participants and numerous staff in in-depth interviews at all phases of the trial. The Exploratory Aim will be conducted working with 6 diverse VA HIV clinics and includes assessing organizational readiness, deploying the IF strategy, conducting in-depth interviews, and assessing reach and adoption of VVC in these clinics. Expected Results: We hypothesize that VVC will improve engagement and clinical outcomes and be acceptable to patients and providers. We will generate extremely valuable data and experience on implementation of VVC outside mental health care, regardless of impact on HIV care, and identify IF strategies that could be used in later implementation of VVC. Next Steps: If successful, we will work with partners to disseminate and implement VVC for multi-disciplinary HIV care throughout VA. We will also foster work in other chronic medical conditions. Our results could lead to accelerated uptake of VVC, improved access to care, and improved health for many Veterans.

背景：提高人类免疫缺陷病毒 (HIV) 护理的保留率并提高比例 持续抑制艾滋病毒的退伍军人是 VHA 艾滋病毒、肝炎中概述的 4 个国家优先事项之一 及相关条件计划的 2016 年年度报告。治疗艾滋病毒等复杂疾病需要 与多个提供者定期就诊进行多学科护理和监测。在 VHA 中，护理位于 主要在退伍军人管理局医疗中心提供，对退伍军人的准入造成后勤和耻辱相关的障碍 多学科艾滋病毒护理。 VA Video Connect (VVC)，一种 VA 支持的移动健康视频技术， 允许退伍军人和提供者从任何远程位置（包括家中）完成临床访问， 通过增加对艾滋病毒和其他慢性病的多学科护理的提供方式的潜力 获得护理。 VA 领导层希望 5% 的退伍军人在 2018 财年通过 VVC 接受护理，但只有不到 0.1% 感染艾滋病毒的退伍军人曾使用过 VVC。 VVC 可以帮助填补护理方面的这些空白。 具体目标：目标是： 目标 1-临床有效性：确定 VVC 交付的有效性， 多学科艾滋病毒护理与常规护理在保留护理方面的比较。目标 2-实施：开展 混合方法形成性评估，以完善和评估我们的实施促进（IF）策略 扩大 VVC 提供的艾滋病毒护理的覆盖范围，增加提供者和退伍军人的采用，并确定潜在的 为了可持续性。探索性目标：评估 VVC 提供的艾滋病毒护理在 6 个国家的实施潜力 不同的 VHA 设置，并确定具体情况下采用的障碍和促进因素。 对退伍军人健康的重要性：退伍军人管理局是美国最大的艾滋病毒护理提供者之一，并且正在改善 保留护理和抑制艾滋病毒与艾滋病毒生存率的提高有关。 优先领域：改善医疗服务的可及性、退伍军人管理局的现代化、医疗保健公平性和健康差异。 创新：虽然 VVC 在精神卫生保健领域站稳脚跟，但尚未在专业领域广泛应用 医疗保健。我们将确定 VVC 提供的多学科护理是否可以提高护理保留率以及 需要专业医疗护理的弱势退伍军人的临床结果。研究将提供模型 以及增加退伍军人获得多学科护理机会的变革性解决方案的证据。 方法论：目标 1 将通过务实的混合型 II 型有效性实施研究来实现 Michael E. DeBakey VA 医疗中心传染病诊所内，该诊所照顾近 1000 名患者 患有艾滋病毒的退伍军人。我们将部署一项 IF 策略，以促进 VVC 的采用，并将退伍军人随机分配到 提供或不提供 VVC。该研究将招募 360 名退伍军人，并有能力检测 12% 的绝对比例 改善护理保留率，这是主要结果。次要结果包括遵守 抗逆转录病毒治疗、艾滋病毒抑制和安全措施。以 RE-AIM QuEST 框架为指导，目标 2 在有效性试验的基础上进行混合方法评估，招募了 40 名退伍军人参与者， 在审判的各个阶段对众多工作人员进行了深入访谈。探索性目标将在工作中进行 与 6 个不同的 VA HIV 诊所合作，包括评估组织准备情况、部署 IF 策略、 进行深入访谈，并评估 VVC 在这些诊所的覆盖范围和采用情况。 预期结果：我们假设 VVC 将提高参与度和临床结果，并成为 患者和提供者可以接受。我们将产生极其有价值的数据和经验 在精神卫生保健之外实施 VVC，无论对 HIV 护理的影响如何，并确定 IF 策略 可以在以后的 VVC 实现中使用。 后续步骤：如果成功，我们将与合作伙伴合作，传播和实施跨学科的 VVC 整个弗吉尼亚州的艾滋病毒护理。我们还将促进其他慢性疾病的工作。我们的结果可能会导致 加速 VVC 的吸收，改善获得护理的机会，并改善许多退伍军人的健康状况。