Primary Care Quality and Homeless Service Tailoring

初级护理质量和无家可归者服务定制

• 批准号: 9086772
• 负责人: STEFAN G KERTESZ
• 金额: --
• 依托单位: BIRMINGHAM VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-07-01 至 2021-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9086772
• 关键词: Acute; Acute; Address; Address; Affect; Affect; Area; Area; Assessment tool; Assessment tool; Caregivers; Caregivers; Caring; Caring; Clinic; Clinic; Clinical Services; Clinical Services; Communication; Communication; Continuity of Patient Care; Country; Country; Databases; Databases; Distal; Distal; Federally Qualified Health Center; Federally Qualified Health Center; Feeling; Feeling; Fostering; Fostering; Funding; Funding; Future; Future; Goals; Goals; Health; Health; Health Services Research; Health Services Research; Healthcare; Healthcare; Healthcare Systems; Healthcare Systems; Home environment; Home environment; Homelessness; Homelessness; Hospitals; Hospitals; Housing; Housing; Improve Access; Improve Access; Individual; Individual; Inpatients; Inpatients; Left; Literature; Literature; Mainstreaming; Mainstreaming; Maps; Maps; Medical; Medical; Medical center; Medical center; Mission; Modeling; Modeling; Natural experiment; Natural experiment; Observational Study; Observational Study; Outcome; Outcome; Pain; Pain; Patient Care Team; Patients; Patients; Policies; Policies; Population; Population; Primary Health Care; Primary Health Care; Provider; Provider; Psychometrics; Quality of Care; Records; Records; Reporting; Reporting; Research; Research; Research Personnel; Research Personnel; Sampling; Sampling; Services; Services; Stigmatization; Surveys; Surveys; Time; Time; Training; Training; Veterans; Veterans; Vulnerable Populations; Vulnerable Populations; addiction; addiction; base; base; care delivery; care delivery; comparative; comparative; cost; design; design; expectation; expectation; experience; experience; health care service utilization; health care service utilization; improved; improved; meetings; operation; operation; outreach; outreach; patient oriented; patient oriented; primary care services; programs; programs; response; response; satisfaction; satisfaction; social vulnerability

 DESCRIPTION (provided by applicant): The Department of Veterans Affairs has embraced the patient-centered medical home, termed the Patient-Aligned Care Team (PACT) in VA, an approach that promises care that is comprehensive, patient- centered, team-based, focused on coordination and communication, and able to sustain a relationship that continues over time. For patients who are homeless or exiting homelessness, these ideals are often not met. Despite significant efforts to develop patient-centered medical homes for people who are homeless, little is known about the particular aspects service design delivery that create valuable, enduring primary care experiences for patients. Since 2012, VA has ambitiously piloted homeless-tailored primary care service design through Homeless PACTs (HPACTs, n=60). This has created a natural experiment that invites two questions important not just to VA but to non-VA agencies seeking to promote viable medical homes for socially-vulnerable populations. First, do VA's homeless-tailored primary care programs offer a substantively superior patient experience? Second, what particular organizational features actually matter? This proposal prioritizes homeless patients' experience of primary care as the proximal indicator of successful engagement in primary care. Patient experience surveys seek an experiential report of how well aspects of care delivery (access, coordination, etc.) map to what patients and experts consider ideal. In prior VA-funded research, we asked patients and providers about their aspirations for primary care of the homeless. From this we developed a psychometrically valid patient experience survey (Primary Care Quality-Homeless, PCQ-H), which has been used in homeless health care programs across the country. This study will combine patient surveys from homeless-experienced (currently and previously homeless) veterans (n=6,181) and organizational assessment among a sample of HPACTs to advance two aims: Aim 1: Compare the primary care experience (i.e. PCQ-H scores) for homeless-experienced patients obtaining primary care in HPACTs to patients receiving primary care in mainstream PACT clinics operated by the same VA Medical Center. Aim 2: Characterize those features of HPACT service design that are most strongly associated with a superior patient experience (i.e. better PCQ-H scores). This Aim will be advanced sequentially through (a) adaptation of an organizational assessment tool specific to homeless-tailored primary care for use in this project; (b) conducting that assessment through surveys of HPACT directors to identify the presence or absence of potentially relevant HPACT service features; (c) analysis to compare PCQ-H scores for HPACTs that have versus those that lack each potentially relevant HPACT service feature. Evidence from this study will help to guide the future of primary care delivery for homeless and formerly homeless patients within VA, and in non-VA Federally Qualified Health Centers. Additionally, it may help to foster a primary care culture that holds itself accountable, first and foremost, to the unique contextual needs of patients as they leave homelessness behind.

 描述（由申请人提供）： 退伍军人事务部已经接受了以患者为中心的医疗之家，称为患者对齐护理团队（PACT）在弗吉尼亚州，一种方法，承诺护理是全面的，以患者为中心，以团队为基础，专注于协调和沟通，并能够维持随着时间的推移而持续的关系。对于无家可归或正在离开无家可归状态的病人来说，这些理想往往得不到满足。尽管为无家可归者开发以患者为中心的医疗之家做出了重大努力，但人们对为患者创造有价值的，持久的初级保健体验的服务设计交付的特定方面知之甚少。 自2012年以来，VA雄心勃勃地通过无家可归者PACTs（HPACTs，n=60）试点无家可归者定制的初级保健服务设计。这创造了一个自然的实验，邀请两个重要的问题，不仅VA，但非VA机构寻求促进可行的医疗之家，为社会弱势群体。首先，退伍军人事务部为无家可归者量身定制的初级保健项目是否提供了实质上上级的患者体验？第二，什么样的组织特征才是真正重要的？ 这项建议优先考虑无家可归的病人的经验，初级保健的成功参与初级保健的近端指标。患者体验调查寻求关于护理提供方面（获取、协调等）映射到患者和专家认为理想的情况。在之前VA资助的研究中，我们询问了患者和提供者对无家可归者初级保健的愿望。由此，我们开发了一个心理测量有效的患者体验调查（初级保健质量无家可归者，PCQ-H），已被用于全国各地的无家可归者的医疗保健计划。 本研究将结合联合收割机对无家可归（目前和以前无家可归）退伍军人（n= 6，181）的患者调查和对HPACT样本的组织评估，以推进两个目标：目标1：比较在HPACT中获得初级保健的无家可归患者与在同一VA医疗中心运营的主流PACT诊所接受初级保健的患者的初级保健经验（即PCQ-H评分）。目标二：描述与上级患者体验（即更好的PCQ-H评分）最密切相关的HPACT服务设计特征。这一目标将通过以下方式依次推进：（a）调整专门针对无家可归者的初级保健的组织评估工具，以供本项目使用;（B）通过对HPACT主任进行调查进行评估，以确定是否存在潜在相关的HPACT服务功能;（c）进行分析，比较具有与缺乏每种潜在相关HPACT服务功能的HPACT的PCQ-H评分。 这项研究的证据将有助于指导未来的初级保健提供无家可归和以前无家可归的病人在弗吉尼亚州，并在非弗吉尼亚州联邦合格的卫生中心。此外，它可能有助于培养一种初级保健文化，这种文化首先要对病人的独特背景需求负责，因为他们离开了无家可归者。