COVID-19 Preventive Health Inventory: Evaluating a primary care approach to catching-up on needed chronic and preventive care for Veterans

背景：在初级保健中发生的慢性病和预防性保健在2009年被推迟或推迟。 严重的COVID-19危机，预计将对VA患者的健康产生深远影响。在 作为回应，VHA初级保健办公室（OPC）于3月10日启动了预防性健康倡议（PHI）。 2021年1月1日，支持初级保健提供所需的初级保健服务。这种创新的护理协调 干预措施利用三个主要组成部分：1）利用10 常见的慢性病和预防性护理质量措施; 2）使用护士护理经理进行主动虚拟护理 访问;和3）使用结构化的电子健康记录笔记模板来完成所需的护理。我们目前 工作已经显示出大量的PHI使用和扩散;然而，对实施和 从PHI摄取的结果。我们的建议将解决这些知识差距，并提供必要的证据， OPC支持的缓解策略。 意义/影响：这项研究将建立在VA的OPC和卫生服务之间正在进行的合作基础上 研究人员，并提供所需的证据，退伍军人管理局卫生系统可以用来更好地为退伍军人服务， 正在进行的大流行病应对和恢复。我们工作的一个关键组成部分将评估各国是否努力 减轻大流行病的影响，有效地减少了对健康的不利影响。 创新：我们的工作将是第一个评估多组分护理协调的实施 干预措施，以支持慢性病和预防性护理后，造成的中断，初级保健提供 流行病 具体目标：目标1：确定与1年时使用PHI作为护理协调相关的关键因素 改善初级保健中慢性病和预防性疾病协调的干预措施目标2： 从a）诊所前线人员的角度，推行公共健康保险计划，提供长期及预防性护理服务 （领导、PCP和护理经理）和B）接受PHI的退伍军人。目标3：审查 关于初级保健质量（糖尿病、高血压和结肠癌筛查）的PHI工具， 可预防的利用。 方法：这一快速周期评价将采用定量和定性方法， 了解OPC公共卫生设施干预的实施情况和结果。目标1：我们将使用多- 水平建模方法，检查PHI使用率的患者水平变化，以确定 退伍军人，供应商或临床因素解释了这种变化。目标2：我们将进行半结构化面试 以了解公共健康保险的实施情况和退伍军人对公共健康保险指导的护理经验。目的 3：我们将进行倾向评分匹配分析，将接受PHI干预的患者与 比较组谁没有收到PHI估计对质量和利用措施的影响，使用 一系列差分回归模型。 实施/后续步骤：这些目标的工作将为VA政策制定者提供关键证据 关于大规模护理协调干预对减轻COVID-19对慢性和 预防保健。

Background: Chronic disease and preventive care that occurs within primary care was delayed or deferred in the acute COVID-19 crisis, which is expected to have profound impacts on the health of VA patients. In response, the VHA Office of Primary Care (OPC) launched the Preventative Health Initiative (PHI) on March 1st, 2021 to support primary care in delivering needed primary care services. This innovative care coordination intervention leverages three main components: 1) development of an electronic dashboard utilizing 10 common chronic and preventive care quality measures; 2) using nurse care managers for proactive virtual care visits; and 3) the use of structured electronic health record note template to complete needed care. Our current work has shown substantial PHI use and diffusion; however, little is known about implementation and outcomes from PHI uptake. Our proposal will address these knowledge gaps and provide needed evidence on mitigation strategies being supported by the OPC. Significance/Impact: This study will build on ongoing collaborations between VA’s OPC and health services researchers and provide needed evidence that the VA health system can use to better serve Veterans in ongoing pandemic response and recovery. A key component of our work will assess whether national efforts to mitigate effects of the pandemic were effective in reducing adverse health impacts. Innovation: Our work will be the first to evaluate the implementation of a multi-component care coordination intervention to support chronic and preventive care after the disruption to primary care delivery caused by the pandemic. Specific Aims: Aim 1: Identify key factors associated with use of PHI at 1 year as a care coordination intervention to improve coordination of chronic and preventive disease in primary care Aim 2: Understand implementation of the PHI to deliver chronic and preventive care from the perspectives of a) clinic frontline staff (leaders, PCPs, and nurse care managers) and b) Veterans who received the PHI. Aim 3: Examine impact of PHI tool on primary care quality (diabetes, hypertension, and colon cancer screening) and potentially preventable utilization. Methodology: This rapid-cycle evaluation will use both quantitative and qualitative approaches to understanding the implementation and outcomes from the OPC’s PHI intervention. Aim 1: We will use a multi- level modeling approach to examine patient-level variation in rates of PHI-use to identify the extent to which Veteran, provider, or clinic-factors explain this variation. Aim 2: We will conduct semi-structured interviews among clinic staff to understand the implementation of PHI and Veteran experience of PHI-directed care. Aim 3: We will conduct a propensity scored matched analysis, matching patients who received PHI intervention to a comparison group who did not receive PHI to estimate the impacts on quality and utilization measures using a series of difference-in-differences regression models. Implementation/Next Steps: Together, work from these aims will provide key evidence for VA policymakers on the impact of a large-scale care coordination intervention on mitigating the impact COVID-19 on chronic and preventive care.