Defining Successful Program Configurations in Home-Based Primary Care

定义家庭初级保健的成功计划配置

• 批准号: 10641551
• 负责人: Samuel T Edwards
• 金额: --
• 依托单位: PORTLAND VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2027-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10641551
• 关键词: Address; Adopted; Behavioral; Binding Sites; Caregiver support; Caregivers; Caring; Case Study; Characteristics; Chronic; Chronic Disease; Client satisfaction; Clinical; Cluster Analysis; Complex; Data; Development; Effectiveness; Emergency Care; Enrollment; Future; Geriatrics; Goals; Health; Health Care Costs; Home; Home visitation; Hospice Care; Hospitalization; Hospitals; Individual; Institution; Institutionalization; Intervention; Interview; Long-Term Care; Mathematics; Measures; Medical; Medicare; Methodology; Methods; Mission; Modeling; Nurses; Nursing Homes; Outcome; Outcome Measure; Patient-Focused Outcomes; Patients; Pattern; Patterns of Care; Performance; Population; Primary Care; Process; Quality of life; Recurrence; Regression Analysis; Research; Risk; Services; Site; Structure; Testing; Time; Urbanicity; Variant; Veterans; Visualization; Work; aging in place; analytical method; care delivery; clinical care; community based service; comorbidity; contextual factors; cost; demographics; effectiveness/implementation trial; end of life care; flexibility; high risk; holistic approach; improved; innovation; meetings; member; novel; palliative; patient home care; patient oriented; primary care clinician; primary care patient; primary care team; programs; social; success; theories

Background: Home-Based Primary Care (HBPC) is a unique home care program that provides comprehensive, longitudinal primary care to Veterans with complex chronic disease with an interdisciplinary team of VA staff. HBPC enrollment is associated with reduced hospitalizations, reduced health care costs, and high patient satisfaction, and is a critical component of the Office of Geriatrics and Extended Care’s (GEC’s) strategy to shift long term services and supports into home and community-based services. Significance: GEC plans to expand HBPC by 75 sites by 2026, but there is substantial variation in individual HBPC site structures, populations served, care delivery patterns, and clinical outcomes. It is unknown whether this variation represents variable fidelity to the HBPC clinical model and an opportunity to improve efficiency vs. appropriate flexibility and adaptation to varying patient needs and local contexts. Given planned expansion, a detailed understanding of program variation is needed to understand which configurations of program features are successful in what contexts and why. Innovation & Impact: This proposal uses configurational analysis, an emerging mixed-methods approach, to identify configurations of HBPC program and contextual characteristics associated with longer patient home time, a novel patient-centered outcome measure. Patient home time is a novel measure that captures a universal goal in HBPC, the time a Veteran can live independently at home. Results of this study will inform HBPC expansion and will help existing engage in context-tailored quality improvement efforts. Specific Aims: Aim 1: Assess variation among HBPC sites in contextual and modifiable factors, patient characteristics, and care delivery patterns, and identify site and patient level correlates of clinical outcomes. Aim 2: Assess HBPC team member and Veteran perspectives on potential mechanisms of success in sites that are high and low performing in patient home time. Aim 3: Identify factors that distinguish HBPC sites with higher versus lower performance in patient home time. Methodology: Aim 1 is a quantitative study in which we will build descriptive profiles of all 440 HBPC sites using VA and Medicare data and perform regression analysis and cluster analyses to examine site and patient level correlates of clinical outcomes. In Aim 2 we will perform qualitative interviews of HBPC clinicians, staff, and Veterans, and observation of work practices in 10 HBPC sites with high performance and 10 with low performance in patient home time. Aim 3 will use configurational analysis, a cross case analysis method rooted in mathematical set theory, to identify features identified in Aims 1 and 2 that are necessary and/or sufficient for longer patient home time. Next Steps/Implementation: We will work with partners in GEC to use identified configurations of HBPC site features to inform HBPC expansion, and to facilitate the development of a complexity informed, adaptive quality improvement intervention for use in existing HBPC sites.

背景：以家庭为基础的初级保健（HBPC）是一个独特的家庭护理计划， 综合，纵向初级保健，以退伍军人与复杂的慢性病与跨学科 VA工作人员团队。HBPC入组与住院率降低、医疗保健成本降低以及 高患者满意度，是老年病和延伸护理办公室（GEC）的重要组成部分 将长期服务和支持转变为家庭和社区服务的战略。 意义：GEC计划到2026年将HBPC扩大75个站点，但个体差异很大。 HBPC站点结构、服务人群、护理提供模式和临床结局。尚不清楚是否 这种变化代表了HBPC临床模型的可变保真度，并提供了提高效率的机会 vs.适当的灵活性和适应不同的患者需求和当地情况。考虑到计划的扩张， 需要详细了解程序变化，以了解程序的哪些配置 功能在什么情况下以及为什么会成功。 创新与影响：该提案使用了配置分析，这是一种新兴的混合方法， 识别HBPC程序配置和与较长患者居家时间相关的背景特征 时间，一种新的以患者为中心的结局指标。患者回家时间是一种新颖的测量方法， 在HBPC的普遍目标，退伍军人可以在家里独立生活的时间。这项研究的结果将告知 HBPC的扩张，并将帮助现有的从事量身定制的质量改进工作。 具体目的：目的1：评估HBPC部位在背景和可改变因素中的变异，患者 特征和护理提供模式，并识别临床结果的部位和患者水平相关性。 目标2：评估HBPC团队成员和退伍军人对研究中心潜在成功机制的看法 在病人在家的时候表现的好坏。目的3：确定区分HBPC位点与 患者在家时间的性能更高与更低。 方法：目标1是一项定量研究，我们将建立所有440个HBPC站点的描述性资料 使用VA和Medicare数据，并执行回归分析和聚类分析，以检查研究中心和患者 临床结果的水平相关性。在目标2中，我们将对HBPC的临床医生、工作人员、 和退伍军人，并观察10个高绩效HBPC站点和10个低绩效HBPC站点的工作实践 在患者家中的表现。目标3将使用结构分析，一个跨案例分析方法植根于 在数学集合论中，为了确定目标1和目标2中确定的必要和/或充分的特征， 更长的患者居家时间。 后续步骤/实施：我们将与GEC的合作伙伴合作，使用HBPC站点的已确定配置 功能，以通知HBPC扩展，并促进开发一个复杂的知情，自适应 在现有HBPC场所使用的质量改进干预措施。