Linking Clinician Interaction and Coordination to Clinical Performance in VA PACT

将临床医生的互动和协调与 VA PACT 中的临床表现联系起来

• 批准号: 8593577
• 负责人: SYLVIA J. HYSONG
• 金额: --
• 依托单位: MICHAEL E DEBAKEY VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-04-01 至 2017-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8593577
• 关键词: Accounting; Ambulatory Care; Bilateral; Businesses; Caring; Cervical Cancer Screening; Characteristics; Clinic; Clinical; Complex; Data; Data Sources; Depression screen; Discipline; Electronic Health Record; Elements; Ensure; Environment; Exhibits; Feedback; Focus Groups; Goals; Growth; Hand; Healthcare; Heart; Home environment; Human Resources; Individual; Industrial Psychology; Intervention; Link; Measures; Medical; Methods; Modeling; Nurses; Occupations; Outcome; Outpatients; Participant; Patients; Pattern; Peer Review; Performance; Primary Care Physician; Primary Health Care; Principal Investigator; Procedures; Provider; Psychology; Quality of Care; Research; Resource Allocation; Role; Structure; Surveys; Testing; Training; Variant; Veterans; Work; care delivery; clinical care; clinical practice; evidence base; experience; follow-up; improved; insight; meetings; member; programs; response; standard measure; tobacco screening

DESCRIPTION (provided by applicant): Project Background: Care coordination is a fundamental component of PACTs and lies at the heart of their ability to deliver higher quality care than what is possible with traditional clinic models. However, best practices on how to coordinate successfully in health care environments are scarce. Okhusen & Beckhy's integrative model of coordination identifies the mechanisms that make it possible for teams to work collectively (e.g., defining responsibilities for tasks, resource allocation, hand-off work), and is an excellent framework for developing best practices for coordination. Pilot research by the PI indicates that clinical performance measures requiring more complex interaction amongst clinical personnel (e.g., depression screening) take longer to reach target performance levels than those requiring simpler interactions (e.g., cervical cancer screening), regardless of clinical condition, and that considerable variation exists among VAMCs in their performance of measures at a given level of clinician interaction. It is therefore imperative to identify and understand the elements of coordination most accountable for performance variability, and thus most ripe for intervention. To help identify said practices, we will use Okhuysen & Bechky's framework as our criterion standard for measuring and characterizing coordination. Project Objectives: The goal of the proposed research is to test the proposition that elements of coordination (as defined by Okhuysen and Bekchy) will interact with clinician interaction to predict incremental variance in clinical performance. We intend to accomplish our research goals via the following objectives: 1. Determine the complexity of clinician interaction required for each outpatient clinical performance measure 2. Identify the specific practices employed by VA PACTs indicative of effective coordination as defined by Okhuysen and Bechky's model 3. Assess the extent to which the PACTs employing practices indicative of improved coordination exhibit improved clinical performance for outpatient measures of varying levels of clinician interaction. Project Methods: Aim 1 Participants: 6-8 geographically dispersed primary care physicians experienced in outpatient clinical quality performance measures (e.g., External Peer Review Program (EPRP), PACT Compass) will serve as subject matter experts (SMEs) to support assessment of clinician interaction. Aim 1 Procedure: Consistent with our previous pilot work (PPO 09-274), we will use functional job analysis (FJA) to assess each outpatient clinical performance measure on clinician interaction. We will conduct structured FJA focus groups with the SMEs to identify the tasks required to satisfy the performance criteria for each EPRP measure. We will rate each task using the worker interaction scale from FJA; finally, for each EPRP measure, we will calculate a composite rating of worker interaction from the individual tasks. Aim 2 Participants: Members of currently existing PACT teamlets (provider, nurse, clerk) at VAMCs nationwide. Aim 2 Procedure: We will develop and deploy an online survey of coordination practices as defined by Okhuysen & Bechky's model, to be completed by primary care PACT teamlet members at VAMCs nationwide. Aim 3 Data Source: We will obtain PACT-level outpatient clinical quality performance measure data from VA's Office of Quality and Performance (EPRP, PACT Compass), as well as Medical Home Builder Survey and related organizational characteristics to use as covariates in our models. Aim 3 Procedure: We will combine our clinician interaction ratings from Aim 1 with our survey responses from Aim 2 to predict improvements in clinical performance over a period of 1 year. Clinical performance measures will be stratified by level of clinician interaction. DATA ANALYSIS. We will employ growth curve models to test the proposition that elements of coordination will interact with clinician interaction to predict incremental variance in clinical performance.

描述（由申请人提供）： 项目背景：护理协调是PACTs的基本组成部分，是其提供比传统诊所更高质量护理的能力的核心 模型然而，关于如何在卫生保健环境中成功协调的最佳做法却很少。Okhusen & Beckhy的协调综合模型确定了使团队集体工作成为可能的机制（例如，确定任务责任、资源分配、交接工作），是制定最佳协调做法的极好框架。PI的初步研究表明，临床性能指标需要临床人员之间进行更复杂的互动（例如，抑郁症筛查）比那些需要更简单的交互（例如，宫颈癌筛查），无论临床状况如何，并且VAMC在给定水平的临床医生互动下的测量性能中存在相当大的差异。因此，必须确定和了解对业绩变动最负责任的协调要素，从而最适合进行干预。为了帮助识别上述实践，我们将使用Okhuysen & Bechky的框架作为衡量和表征协调的标准。项目目标：拟议研究的目标是测试协调元素（由Okhuysen和Bekchy定义）将与临床医生互动以预测临床表现的增量方差的命题。我们打算通过以下目标来实现我们的研究目标：1。确定每个门诊患者临床绩效指标所需的临床医生互动的复杂性2。确定VA PACTs所采用的具体做法，表明Okhuysen和Bechky模型3所定义的有效协调。评估采用表明协调改善的实践的PACTs在何种程度上表现出改善的临床表现，用于不同水平的临床医生互动的门诊测量。项目方法：目标1参与者：6-8名地理上分散的初级保健医生在门诊临床质量绩效指标方面经验丰富（例如，外部同行评审计划（EPRP，PACT Compass）将担任主题专家（SME），以支持临床医生互动的评估。目标1程序：与我们之前的试点工作（PPO 09-274）一致，我们将使用功能工作分析（FJA）来评估每个门诊临床医生互动的临床绩效指标。我们将与中小企业进行结构化的FJA焦点小组，以确定满足EPRP各项措施的绩效标准所需的任务。我们将使用来自FJA的员工互动量表对每个任务进行评分;最后，对于每个EPRP测量，我们将计算单个任务的员工互动综合评分。目标2参与者：全国VAMC现有PACT小组成员（提供者、护士、办事员）。目标2程序：我们将开发和部署一个由Okhuysen & Bechky模型定义的协调实践的在线调查，由全国VAMC的初级保健PACT小组成员完成。目标3数据来源：我们将从VA的质量和性能办公室（EPRP，PACT指南针）获得PACT级门诊临床质量性能指标数据，以及医疗家庭建设者调查和相关的组织特征，用作我们模型中的协变量。目标3程序：我们将联合收割机结合目标1中的临床医生互动评级和目标2中的调查答复，以预测1年内临床性能的改善。临床性能指标将按临床医生互动水平分层。数据分析我们将采用增长曲线模型来检验协调要素与临床医生互动的命题，以预测临床表现的增量方差。