Developing a patient inventory to facilitate patient-centered care delivery

描述(由申请人提供)： 背景：退伍军人管理局正在经历一次重大变革，以改善提供护理的方式。这一转变的两个方面是强调以患者为中心的护理，以及使用新的护理模式，增加提供护理的机会和选择。为了便于提供以患者为中心的护理，可能包括通过技术提供的护理，我们不仅要了解患者的医疗状况，而且还要了解他或她的背景因素和偏好，这一点很重要。该项目涉及开发和测试患者清单，该清单可以补充现有信息(例如，病史和身体状况)，以确定并向患者和提供者提供信息，以支持协作决策和以患者为中心的最佳护理交付。1.确定影响以患者为中心的护理交付的背景因素(例如，患者偏好、情景特征、资源)。A)从患者的角度确定影响提供以患者为中心的护理的背景因素。)确定提供者认为对提供以患者为中心的护理非常重要的患者背景因素。2.从患者和提供者的角度研究技术在医疗保健提供中的作用。A)评估患者的经验、资源、对使用技术提供护理的认识和意愿。B)评估提供者对通过技术提供的护理的知识和经验。3.开发和测试患者清单，以促进患者和提供者之间的协作决策，并通过在患者/提供者会面期间提供上下文信息和偏好来支持以患者为中心的护理的交付。A)开发可使用iPad或其他设备(如Kiosk)部署的患者清单工具。B)对退伍军人进行随机试验，以评估在使用患者清单时是否有更多以患者为中心的护理和协作决策。我们假设，将患者背景信息整合到患者/提供者遭遇中会导致更多以患者为中心的护理和协作决策。作为一个探索性目标，我们将检查使用患者清单所涉及的工作量流程和时间，以评估这种干预的潜在工作流程和成本影响。方法：分三个阶段：焦点小组和与患者和提供者的访谈，利益相关者的德尔菲小组，患者清单工具与常规护理的随机对照试验。

DESCRIPTION (provided by applicant): Background: VA is undergoing a major transformation to improve how care is delivered. Two aspects of this transformation are an emphasis on patient-centered care, and the use of new models of care that increase access to and choice for care delivery. To facilitate delivery of patient-centered care that may include care delivered through technology, it is important that we understand not only the patient's medical condition but also his or her contextual factors and preferences. This project involves the development and testing of a patient inventory that can complement existing information (e.g., history and physical) to identify and make available to patients and providers information to support collaborative decision making and optimal patient-centered care delivery. 1. To identify contextual factors (e.g., patient preferences, situational characteristics, resources) that influence the delivery of patient-centered care. a) Identify contextual factors that affect delivery of patient-centered care from the patient's perspective. ) Identify patient contextual factors that providers believe are important in delivery of patient- centered care. 2. To examine the role of technology in health care delivery from patient and provider perspectives. a) To assess patients' experiences, resources, awareness of and willingness, to use technology for care delivery. b) To assess providers' knowledge of and experiences with care delivered through technology. 3. To develop and test a patient inventory that facilitates collaborative decision-making between patients and providers, and supports the delivery of patient-centered care by making contextual information and preferences available during the patient/provider encounter. a) To develop a patient inventory tool that can be deployed using an iPad or other device (e.g. kiosk). b) To conduct a randomized trial of Veterans to assess whether there is greater patient- centered care and collaborative decision making when the patient inventory is used. We hypothesize that incorporating patient contextual information into the patient/provider encounter results in care that is more patient-centered and decision making that is collaborative. As an exploratory aim, we will examine workload processes and time involved in utilizing the patient inventory to assess potential workflow and cost impacts of this intervention. Methods: Three phases: focus groups and interviews with patients and providers, Delphi panel with stakeholders, randomized control trial of patient inventory tool v. usual care.