Virtual Specialty Care QUERI Program: Implementing and Evaluating Technology Facilitated Clinical Interventions to Improve Access to High Quality Specialty Care for Rural Veterans

虚拟专科护理 QUERI 计划：实施和评估技术促进的临床干预措施，以改善农村退伍军人获得高质量专科护理的机会

• 批准号: 9076947
• 负责人: JOHN C. FORTNEY
• 金额: --
• 依托单位: VA PUGET SOUND HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-10-01 至 2020-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9076947
• 关键词: Adoption; Adoption; Ambulatory Care Facilities; Ambulatory Care Facilities; Budgets; Caring; Caring; Clinic; Clinic; Clinical; Clinical; Clinical effectiveness; Clinical effectiveness; Communication; Communication; Communities; Communities; Consult; Consult; Data Collection; Data Collection; Discipline; Discipline; Effectiveness; Effectiveness; Electronic Mail; Electronics; Evaluation; Evaluation; Evidence based intervention; Evidence based intervention; Evidence based practice; Evidence based practice; Funding; Funding; Geography; Geography; Goals; Goals; Health; Health; Health Personnel; Health Resources; Health Resources; Health Services Accessibility; Health Services Accessibility; Health Services Research; Health Services Research; Healthcare; Healthcare; Home environment; Home environment; Improve Access; Improve Access; Internet; Internet; Intervention; Intervention; Intervention Trial; Length; Length; Life; Location; Logistics; Logistics; Marketing; Measures; Measures; Medical; Medical; Medical center; Medical center; Methods; Methods; Modality; Modality; Modification; Modification; Nature; Nature; Outcome; Outcome; Partnership Practice; Pathway interactions; Pathway interactions; Patient Care; Patient Care; Patient-Centered Care; Patient-Centered Care; Patients; Patients; Performance; Performance; Personal Satisfaction; Personal Satisfaction; Play; Play; Policies; Policies; Population; Population; Primary Health Care; Protocols documentation; Protocols documentation; Provider; Provider; Quality of Care; Quality of Care; Randomized Controlled Trials; Randomized Controlled Trials; Research; Research; Resources; Resources; Role; Role; Rural; Rural; Rural Health; Rural Health; Secure; Secure; Services; Services; Site; Site; Solutions; System; System; Technology; Technology; Text Messaging; Time; Time; Transportation; Transportation; Variant; Variant; Veterans; Veterans; Videoconferences; Videoconferencing; Videoconferencing; Work; base; base; budget impact; care systems; clinical practice; clinical practice; compare effectiveness; compare effectiveness; cost; cost; design; design; eHealth; eHealth; ethnographic method; ethnographic method; evidence base; evidence base; health administration; health administration; implementation strategy; improved; improved; improved outcome; innovation; innovation; mHealth; mHealth; medical specialties; medical specialties; meetings; mobile application; mobile application; new technology; new technology; patient portal; primary care services; programs; programs; recruit; remote communities; remote location; routine care; routine care; routine practice; routine practice; rural area; rural area; rural setting; telehealth; telehealth; therapy design; therapy design; virtual; virtual

 DESCRIPTION (provided by applicant): Anticipate Impacts on Veterans' Healthcare: The Veterans Health Administration (VHA) provides care to 3.3 million Veterans living in rural areas, comprising 36% of all VHA enrollees. In 1995, VHA began expanding its system of Community Based Outpatient Clinics (CBOCs) in order to improve access for the geographically dispersed Veteran population. There are now approximately 900 CBOCs delivering a range of services to approximately 64% of VHA enrollees. While these CBOCs have dramatically improved access to first class primary care services, it has been more challenging to deliver specialty care to rural Veterans. Evidence based specialty care practices developed for large VA Medical Centers are often not feasible to deploy in small CBOCs and thus not accessible to rural Veterans. The proposed QUERI Program will implement and evaluate technology-facilitated clinical interventions designed to improve outcomes for rural Veterans. Project Background: The Office of Rural Health's (ORH) Resource Centers are funded to examine the unique health care needs of rural Veterans and develop a pipeline of "promising practices" to better meet these needs. In order to improve access, these promising practices often utilize virtual care technologies (e.g., telehealth, eHealth, mHealth) developed by Telehealth Services (TS) and the Connected Health Office (CHO). Due to the remote locations of rural Veterans and the rapidly evolving technologies used in interventions designed to better serve them, it is extremely challenging to conduct traditional randomized controlled trials (RCTs). Consequently, there are relatively few RCTs establishing the evidence based for interventions designed to improve outcomes for rural Veterans. Even when the logistics of recruitment and data collection in rural remote settings can be overcome, the length of time it takes to conduct a RCT usually renders the technology used in the intervention obsolete. Consequently, ORH, TS and CHO need rigorous methods to evaluate promising practices as they are being initially deployed into the field and as they evolve over time. Project Objectives: The goal of the proposed QUERI Program is to implement and evaluate promising clinical practices incorporating virtual care technologies in order to improve access to high quality care for rural Veterans. To achieve this goal the proposed Virtual Specialty Care QUERI has three specific aims. The first aim is to develop, evaluate, and refine implementation strategies for the ORH, TS and CHO to roll out promising clinical practices that incorporate teleheath, ehealth, and mhealth virtual care technologies. The second aim is to evaluate and refine promising clinical practices that incorporate telehealth, ehealth, and mhealth virtual care technologies that have been developed at VHA Rural Resource Centers and elsewhere designed to improve access to high quality care for rural Veterans. The third aim is to measure implementation costs and assess the budget impact of rollout for operational partners. Project Methods: The projects proposed as part of the Virtual Specialty Care QUERI will compare enhanced implementation strategies to standard implementation strategies used by the ORH, TS and CHO. Enhanced implementation will include a variety of strategies including ethnographic methods to assess the existing clinical workflow at implementation sites, and modification of both the existing clinical workflow and the new clinical intervention to maximize fit. Evaluation of the implementation strategies will be assessed using qualitative and quantitative methods to measure provider adoption and sustainability. Population level effectiveness of the clinic intervention will be assessed using qualitative and quantitative methods to measure reach and outcomes. Given the dynamic nature of technology and the high degree of variability in context across clinics, we will employ methods that enable the new clinical intervention to be adapted from setting to setting and to be refined over time rather than focusing on fidelity to a manualized protocol.

 描述(由申请人提供)： 预计对退伍军人医疗保健的影响：退伍军人健康管理局(VHA)为居住在农村地区的330万退伍军人提供护理，占VHA登记人数的36%。1995年，VHA开始扩大其基于社区的门诊系统(CBOC)，以改善地理上分散的退伍军人人口的机会。目前约有900家CBOC为约%的VHA参与者提供一系列服务。虽然这些社区组织极大地改善了获得一流初级保健服务的机会，但向农村退伍军人提供特殊护理更具挑战性。为大型退伍军人医疗中心开发的循证特殊护理做法往往不可行，无法在小型CBOC中部署，因此农村退伍军人无法获得。拟议的QUERI计划将实施和评估旨在改善农村退伍军人结局的技术促进的临床干预措施。项目背景：农村卫生办公室(ORH)资源中心得到资助，以检查农村退伍军人的独特卫生保健需求，并开发一系列“有希望的做法”，以更好地满足这些需求。为了改善可获得性，这些有希望的做法通常利用由远程保健服务(TS)和互联健康办公室(CHO)开发的虚拟保健技术(例如，远程保健、电子保健、移动保健)。由于农村退伍军人的偏远地区，以及用于更好地为他们服务的干预措施所使用的快速发展的技术，进行传统的随机对照试验(RCT)是极其具有挑战性的。因此，为旨在改善农村退伍军人结局的干预措施建立证据基础的随机对照试验相对较少。即使可以克服农村偏远地区的招聘和数据收集的后勤问题，进行随机对照试验所需的时间长度通常也会使干预中使用的技术过时。因此，ORH、TS和CHO需要严格的方法来评估有前景的实践，因为它们最初被部署到现场，并且随着时间的推移而发展。项目目标：建议的QUERI计划的目标是实施和评估结合虚拟护理技术的有前途的临床实践，以改善农村退伍军人获得高质量护理的机会。为了实现这一目标，拟议的虚拟专科护理QUERI有三个具体目标。第一个目标是开发、评估和改进ORH、TS和CHO的实施战略，以推出融合远程医疗、电子健康和mHealth虚拟医疗技术的有前途的临床实践。第二个目标是评估和改进有前景的临床实践，这些实践结合了VHA农村资源中心和其他地方开发的远程医疗、电子健康和mHealth虚拟医疗技术，旨在改善农村退伍军人获得高质量医疗服务的机会。第三个目标是衡量执行费用，并评估推广对业务伙伴的预算影响。项目方法：作为虚拟专科护理QUERI的一部分提出的项目将比较增强的实施战略与ORH、TS和CHO使用的标准实施战略。加强实施将包括各种战略，包括在实施地点评估现有临床工作流程的人种学方法，以及修改现有临床工作流程和新的临床干预措施，以最大限度地适应。将使用定性和定量方法对执行战略进行评估，以衡量提供者的采用率和可持续性。将使用定性和定量方法评估临床干预措施的人群水平效果，以衡量覆盖范围和结果。鉴于技术的动态性质和不同诊所之间的高度变异性，我们将采用使新的临床干预措施能够从一个环境适应到另一个环境，并随着时间的推移而改进的方法，而不是 专注于对手动协议的保真度。