Assessing VHA patient and provider perceptions of Point of Care research (POCr)

描述(由申请人提供)： 最近，VHA启动了一项计划，通过建立护理点研究(POCR)试验来启动临床研究的创新重新设计。新的创新将需要采用新的基础设施和研究流程。这项研究的目的是为确保退伍军人事务部POCR计划的成功提供信息。这项提案将产生可交付成果，为营销、教育、实施和信息学指导方针的设计提供信息。目标将是提供者、患者、管理人员和工作人员。具体目标1.确定采用POCR研究创新计划的障碍和促进者。评估患者、提供者、工作人员和管理人员对隐私、患者-提供者关系、伦理问题的看法和态度，以及对患者登记、实施和CPRS功能的等价性的担忧。具体目标2.为VHA制定POCR实施指南，重点是：1)有效的实施策略和工作流程修改；2)为克服已确定的采用障碍提供量身定制的建议；3)提供者的营销和教育内容要求；4)对患者的营销和教育要求；5)机构政策要求，以及6)使用CPRS支持POCR患者识别、跟踪和决策支持的关键功能要求。方法：将在已经使用POCR的2个VA Vanguard站点和另外3个站点对患者、提供者、工作人员和管理人员进行认知访谈，以了解与POCR实施相关的基本问题、关注事项、语言和工作流程模式。这些访谈的信息将被用来构建相关的小插曲和焦点小组剧本。在试点之后，将在15个退伍军人管理局地点进行30个重点小组(1个针对患者，另一个针对提供者/工作人员/管理人员)，这些地点的规模和地理位置各不相同。将对焦点小组转录的录音带进行定性分析。分析的关键问题可能包括POCR对供方-患者关系、工作流程、隐私、护理质量和其他问题的影响。目标2将利用反馈和与利益相关者的讨论来设计用于传播的营销、教育和实施指南。

DESCRIPTION (provided by applicant): Recently, VHA has embarked on a program to launch an innovative re-design of clinical research by instituting point of care research (POCr) trials. The new innovation will require the adoption of new infrastructure and research processes. The goal of this study is to provide information that will ensure the success of the VA POCr program. This proposal will result in deliverables that will inform the design of marketing, education, implementation and informatics guidelines. The targets will be providers, patients, administrators and staff. Specific Aim 1. Identify the barriers and facilitators to adoption of a POCr research innovation program. Assess the perceptions and attitudes of patients, providers, staff and administrators regarding privacy, patient-provider relationships, ethical issues, and concerns regarding the equivalence of care, workflow, and barriers to patient enrollment, implementation, and CPRS functionality Specific Aim 2. Produce guidelines for VHA regarding implementation of POCr, focusing on: 1) effective implementation strategies and workflow modifications; 2) tailored recommendations for overcoming identified barriers to adoption; 3) requirements for marketing and education content for providers; 4) requirements for marketing and education for patients; 5) institutional policy requirements, and 6) key functional requirements for utilizing CPRS to support POCr patient identification, tracking and decision support. Methods: Cognitive interviewing of patients, providers, staff and administrators will be conducted at 2 VA Vanguard sites already using POCr followed by 3 additional sites to understand basic issues, concerns, language and workflow patterns relevant to implementation of POCr. Information from these interviews will be used to construct relevant vignettes and a focus group script. Following piloting, 30 focus groups (1 for patients and another for providers/staff/ administrators) will be conducted at 15 VA sites selected for diversity in size and geography. Qualitative analysis will be conducted on transcribed audio-tapes from the focus groups. Key issues for analysis will likely include the impact of POCr on provider-patient relationships, workflow, privacy, quality of care and other issues. Aim 2 will use feedback and discussion with stakeholders to design marketing, education, and implementation guidelines for dissemination.