Access to Specialty Care for Veterans with Complex Conditions

为病情复杂的退伍军人提供特殊护理

基本信息

批准号：
8865960
负责人：
TODD H WAGNER
金额：
--
依托单位：
VETERANS ADMIN PALO ALTO HEALTH CARE SYS
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-05-01 至 2018-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8865960
关键词：
Acute Alcohol or Other Drugs use Ambulatory Care Facilities Antiviral Agents Attention Automobile Driving Caring Chronic Clinical Communication Communities Comorbidity Complex Congestive Heart Failure Consultations Counseling Data Diagnosis Disease Enabling Factors Epilepsy Equilibrium Face Fees Foundations General Practitioners Growth Health Health Services Health Services Accessibility Healthcare Heart failure Hepatitis C Hepatitis C virus Improve Access Interview Lead Life Link Measures Mediating Medical Medicare Mental Health Methods Modeling Morbidity - disease rate Operative Surgical Procedures Outcome Participant Patients Pattern Physicians Policy Maker Price Primary Care Physician Primary Health Care Process Provider Qualitative Methods Quality of Care Recording of previous events Relapse Research Personnel Rest Role Rural Hospitals Services Specialist Structure Time Tracer Travel Vaccination Veterans Virus Work advanced disease base cost experience health care quality improved informant medical specialties mortality operation rural area

项目摘要

DESCRIPTION (provided by applicant): According to Former Secretary Shinseki, 3.3 million Veterans have difficulty accessing health care because they live far away from a Veterans Affairs (VA) medical facility. The problem is exacerbated for Veterans who need specialty care; specialty care is not typically available at community based outpatient clinics (CBOCs), forcing Veterans to rely on their primary care physician, seek a non-VA provider (e.g., through Fee Basis or Medicare) or travel to a tertiary VA facility. Preliminary evidence suggests that this can lead to delays in accessing care, and greater morbidity and mortality. To improve delivery of specialty care, VA operations needs to know more about when Veterans use VA specialty care, when they use Fee Basis care as a substitute, and how the mix of specialist and generalist care are associated with disease-specific quality of care and health outcomes. This project will provide a health services foundation that will inform policy makers and researchers about how to balance generalists and specialists. In this project, we will use observational methods to examine patterns of specialty care for Veterans diagnosed with one or more of the following complex conditions: congestive heart failure (CHF), hepatitis C (HCV), or epilepsy. These three conditions were selected because multiple medical, surgical, mental health and substance use specialists are likely to be needed for management. In addition, primary care providers have varied experience in managing these patients (epilepsy is low, HCV is moderate and CHF is higher). Finally, they present different treatment challenges: epilepsy is relapsing and remitting, CHF is a chronic condition, and HCV is a virus that can be treated. The implementation and dissemination of this work is enhanced with partnerships with three VA operational offices and two QUERI centers. We will stay connected with Operational offices with a technical advisory panel.

描述（由申请人提供）：据前任秘书Shinseki称，有330万退伍军人很难获得医疗保健，因为他们远离退伍军人事务（VA）医疗机构。对于需要专业护理的退伍军人来说，问题加剧了；通常在社区的门诊诊所（CBOC）中不可用专业护理，迫使退伍军人依靠其初级保健物理，寻求非VA提供商（例如，通过收费或医疗保险）或前往第三级VA设施。初步证据表明，这可能导致延迟获得护理，并更大的发病率和死亡率。为了提高专业护理的交付，VA运营需要更多地了解退伍军人何时使用VA专业护理，何时使用费用基础护理作为替代品，以及专家和通才护理的混合如何与特定于疾病的护理和健康成果有关。该项目将提供一个卫生服务基金会，该基金会将向政策制定者和研究人员提供有关如何平衡通才和专家的信息。在该项目中，我们将使用观察方法来检查诊断为患有以下一个或多个复杂条件的退伍军人的专业护理模式：充血性心力衰竭（CHF），丙型肝炎（HCV）或癫痫病。之所以选择这三个条件是因为管理可能需要多个医疗，外科，心理健康和药物使用专家。此外，初级保健提供者在管理这些患者方面具有不同的经验（癫痫病低，HCV中等，CHF较高）。最后，他们提出了不同的治疗挑战：癫痫病正在复发和恢复，CHF是一种慢性病，HCV是可以治疗的病毒。通过与三个VA运营办公室和两个QuERI中心建立合作伙伴关系，这项工作的实施和传播得到了增强。我们将与技术咨询小组与运营办公室保持联系。