Evaluation of Quality and Coordination of Outsourced Care for Women Veterans

女性退伍军人外包护理的质量和协调评估

• 批准号: 8398315
• 负责人: Lori A Bastian
• 金额: --
• 依托单位: DURHAM VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-03-01 至 2016-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8398315
• 关键词: Address; Agreement; Area; Caring; Communities; Comprehensive Health Care; Contract Services; Contracts; Decision Making; Diagnostic; Emergency Situation; Enrollment; Evaluation; Fees; Female; Gender; Head; Health Care Costs; Health Personnel; Health Planning; Health Services; Hospitals; Housing; Knowledge; Laws; Left; Link; Longevity; Mammography; Maps; Medical; Medical Records; Monitor; Patients; Perception; Play; Population Heterogeneity; Prenatal care; Process; Provider; Quality of Care; Reporting; Research; Rest; Role; Services; Site; Travel; Universities; Veterans; Woman; Women' s Health; Wrestling; base; clinical decision-making; experience; handbook; improved; meetings; satisfaction

DESCRIPTION (provided by applicant): The VA relies on outsourced care to provide services for Veterans for many reasons, though for women, the care is usually for specialized health services not provided within the VA, such as mammography and prenatal care. Recent evidence suggests that 34% of women Veterans (WVs) in VA care also utilize some fee basis care and the number of WVs using fee basis care for gender-specific conditions continues to increase on an annual basis. In FY 2010 alone, the VA spent $253 million on outsourced care for women Veterans. Outsourced care represents approximately 10% of total healthcare costs for women Veterans. Despite increasing numbers of women Veterans relying on outsourced care, little is known about the quality of outsourced care or perceptions and experiences of women Veterans who utilize such care. Understanding perceptions of women Veterans receiving outsourced care is important given previous research linking patient dissatisfaction and health plan exit. Moreover, recent studies of VA attrition among women Veterans suggests that 30% of all new women VA users leave the VA within 3 years of enrolling, which could be due, in part, with dissatisfaction with care coordination between VA and outsourced providers. Facility-level fee basis managers and VA women's health providers play central roles in facility-level fee decisions, and much of the responsibilityof care coordination between outsourced and VA providers rests in the hands of VA women's health providers. Thus, it is critical to begin to understand issues related to perceptions and experiences with outsourced care for women Veterans given the growing number of women Veterans that must use outsourced care for some of their medical needs and the centrality of providing comprehensive care for women Veterans. Understanding outsourced care utilization among women Veterans must begin with examining facility-level decisions regarding which services to provide in-house or via outsourced providers. Decisions regarding use of fee basis and contract care are made and monitored almost entirely within each VA facility (i.e., virtually no centralized oversight). Little is known about how community providers are selected or the quality of the care they provide. For example, although a majority (75%) of VA facilities contract with hospitals and other facilities for diagnostic mammograms, these non-VA facilities are not monitored for quality according to standards set forth in the Mammography Quality Standards Act of 1992 (PL 102-539). Given that mammography is the highest-volume gender-specific care for women (51,396 mammograms in FY09), understanding the quality of this type of care is of utmost importance as the VA continues to wrestle with the 'make vs. buy' decision for certain types of essential care. To address these critical issues, we propose the following aims: Aim #1: To understand providers' and fee basis managers' strategies for provision, coordination, and quality oversight of outsourced care. Aim #2: To understand perceptions and experiences with outsourced care among women Veterans. Aim #3: To evaluate the quality of gender-specific services for women Veterans using a case example mapped to VHA Handbook priorities (e.g., Do VA facilities utilizing outsourced care for mammography meet key quality standards compared to VA facilities providing in-house mammograms?)

描述（由申请人提供）： 退伍军人事务部依靠外包护理为退伍军人提供服务，原因有很多，但对妇女来说，这种护理通常是退伍军人事务部不提供的专门保健服务，如乳房X光检查和产前护理。最近的证据表明，34%接受退伍军人事务部护理的女退伍军人也利用一些收费护理，而且对特定性别的疾病使用收费护理的女退伍军人人数每年继续增加。仅在2010财年，退伍军人事务部就花费了2.53亿美元用于女性退伍军人的外包护理。外包护理约占女性退伍军人医疗保健总费用的10%。尽管越来越多的妇女退伍军人依靠外包护理，很少有人知道外包护理的质量或观念和经验的妇女退伍军人谁利用这种护理。了解女性退伍军人接受外包护理的看法是重要的，因为以前的研究将患者的不满和健康计划的退出联系起来。此外，最近的研究表明，所有新的女性退伍军人管理局用户的30%离开退伍军人管理局在3年内注册，这可能是由于，部分原因，与VA和外包服务提供者之间的护理协调不满。设施一级的收费基础管理人员和退伍军人管理局妇女保健提供者在设施一级的收费决定中发挥着核心作用，外包和退伍军人管理局提供者之间的护理协调的大部分责任掌握在退伍军人管理局妇女保健提供者手中。因此，它是至关重要的开始了解有关的观念和经验与妇女退伍军人的外包护理的问题，因为越来越多的妇女退伍军人，必须使用外包护理的一些医疗需求和中心提供全面的护理妇女退伍军人。了解妇女退伍军人之间的外包护理利用必须开始检查设施级的决定，提供内部或通过外包服务提供者。关于使用收费基础和合同护理的决定几乎完全在每个VA设施内做出和监测（即，实际上没有集中监督）。人们对如何选择社区提供者或他们提供的护理质量知之甚少。例如，尽管大多数（75%）退伍军人事务部设施与医院和其他设施签订了诊断性乳房X线摄影合同，但这些非退伍军人事务部设施没有根据1992年《乳房X线摄影质量标准法》（PL 102-539）规定的标准进行质量监测。鉴于乳房X光检查是针对女性的量最大的性别特异性护理（2009财政年度为51 396次乳房X光检查），了解这种类型的护理质量至关重要，因为退伍军人事务部继续为某些类型的基本护理做出“制造还是购买”的决定。为了解决这些关键问题，我们提出了以下目标：目标1：了解提供者和费用基础经理对外包护理的提供、协调和质量监督的策略。目标#2：了解女性退伍军人对外包护理的看法和经验。目标#3：使用VHA手册优先事项的案例（例如，与提供内部乳房X光检查的VA机构相比，使用乳房X光检查外包护理的VA机构是否符合关键质量标准？）