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
基本信息
- 批准号:8696657
- 负责人:
- 金额:--
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2013
- 资助国家:美国
- 起止时间:2013-03-01 至 2017-02-28
- 项目状态:已结题
- 来源:
- 关键词:AddressAgreementAreaCaringCommunitiesComprehensive Health CareContract ServicesContractsDecision MakingDiagnosticEmergency SituationEnrollmentEvaluationFeesFemaleGenderHeadHealth Care CostsHealth PersonnelHealth PlanningHealth ServicesHospitalsHousingKnowledgeLawsLeftLinkLongevityMammographyMapsMedicalMedical RecordsMonitorPatientsPerceptionPlayPopulation HeterogeneityPrenatal careProcessProviderQuality of CareReportingResearchRestRoleServicesSiteTravelUniversitiesVeteransWomanWomen&aposs HealthWrestlingbaseclinical decision-makingexperiencehandbookimprovedmeetingssatisfaction
项目摘要
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):
退伍军人管理局出于许多原因依赖外包护理为退伍军人提供服务,尽管对于妇女来说,这些护理通常是退伍军人管理局没有提供的专门卫生服务,如乳房X光检查和产前护理。最近的证据表明,退伍军人中34%的女性退伍军人(WVS)也使用一些收费基础护理,针对性别具体情况使用收费基础护理的WVS数量每年继续增加。仅在2010财年,退伍军人管理局就花费了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总医疗费用的10%。尽管越来越多的女性退伍军人依赖外包护理,但人们对外包护理的质量或使用这种护理的女性退伍军人的看法和经验知之甚少。鉴于之前的研究将患者的不满与健康计划的退出联系起来,了解退伍军人接受外包护理的看法是重要的。此外,最近关于退伍军人中退伍军人流失的研究表明,所有新的退伍军人管理局女性使用者中有30%在注册后3年内离开退伍军人管理局,这可能部分是因为对退伍军人管理局和外包提供者之间的护理协调不满意。设施级收费管理人员和退伍军人事务部妇女保健提供者在设施一级的收费决定中发挥核心作用,而外包和退伍军人事务部之间护理协调的大部分责任掌握在退伍军人事务部妇女保健提供者手中。因此,鉴于越来越多的女退伍军人必须使用外包护理来满足其某些医疗需求,以及为女退伍军人提供全面护理的中心地位,开始了解与对女退伍军人外包护理的看法和经验有关的问题是至关重要的。要了解女性退伍军人对外包护理的利用情况,必须首先检查设施级别的决定,即哪些服务是由内部提供的,还是通过外包提供者提供的。关于使用收费基础和合同护理的决定几乎完全在每个退伍军人管理局机构内做出和监督(即,几乎没有集中监督)。关于社区提供者是如何选择的,或者他们提供的护理质量如何,人们知之甚少。例如,尽管大多数(75%)退伍军人管理局设施与医院和其他诊断乳房X光检查设施签订了合同,但这些非退伍军人管理局设施没有按照1992年《乳房摄影质量标准法》(PL 102-539)规定的标准进行质量监测。鉴于乳房X光检查是为女性提供的数量最多的性别特定护理(2009财年为51,396例),了解此类护理的质量至关重要,因为退伍军人管理局仍在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:了解提供者和收费基础管理者对外包护理的提供、协调和质量监督的战略。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:使用与VHA手册优先事项对应的案例实例,评估为退伍军人提供的针对性别的服务的质量(例如,与提供内部乳房X光检查的VA机构相比,利用外包服务进行乳房X光检查的VA机构是否符合关键质量标准?)
项目成果
期刊论文数量(0)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
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Lori A Bastian其他文献
Opioid Prescription and Risk of Atrial Fibrillation in Younger Veterans: Opioid Use and Risk of Atrial Fibrillation.
阿片类药物处方和年轻退伍军人心房颤动的风险:阿片类药物的使用和心房颤动的风险。
- DOI:
10.1016/j.ahj.2023.11.001 - 发表时间:
2023 - 期刊:
- 影响因子:4.8
- 作者:
Philip W Chui;A. Khokhar;K. Gordon;J. Dziura;Matthew M Burg;Cynthia A Brandt;Sally G Haskell;Brian Malm;Lori A Bastian;P. Gandhi - 通讯作者:
P. Gandhi
Lori A Bastian的其他文献
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{{ truncateString('Lori A Bastian', 18)}}的其他基金
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 - 财政年份:2013
- 资助金额:
-- - 项目类别:
Internet-Based Smoking Cessation for OEF/OIF Veterans
OEF/OIF 退伍军人基于互联网的戒烟
- 批准号:
8195233 - 财政年份:2010
- 资助金额:
-- - 项目类别:
Internet-Based Smoking Cessation for OEF/OIF Veterans
OEF/OIF 退伍军人基于互联网的戒烟
- 批准号:
8510561 - 财政年份:2010
- 资助金额:
-- - 项目类别:
Internet-Based Smoking Cessation for OEF/OIF Veterans
OEF/OIF 退伍军人基于互联网的戒烟
- 批准号:
7893781 - 财政年份:2009
- 资助金额:
-- - 项目类别:
Internet-Based Smoking Cessation for OEF/OIF Veterans
OEF/OIF 退伍军人基于互联网的戒烟
- 批准号:
7747730 - 财政年份:2009
- 资助金额:
-- - 项目类别:
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