Bridging Care Gaps: Information Exchange Between VA and Non-VA Sites of Care

 描述（由申请人提供）： 之前对其他人的研究和我们的数据表明，很大一部分退伍军人访问多个系统进行护理。使用VA和非VA服务的退伍军人发生不良事件的风险增加，特别是在治疗过渡期间，药物和治疗计划的变化可能在VA医生不知情的情况下发生。缺乏对退伍军人中的非VA护理的充分信息的访问可能会限制VA提供者提供医疗之家的护理水平的能力。鉴于很少有人知道如何信息交换发生在退伍军人访问双重护理，这是很难规定解决方案，以弥合差距的VA和非VA护理。了解信息交换是如何发生的，目前的差距和这些差距背后的原因，可以帮助开发解决方案，这将有助于桥梁VA和非VA护理。该项目的目标是更好地了解VA和非VA设置之间的信息交流目前发生，并评估VA和非VA供应商之间的信息交流的质量。该研究的具体目的是（i）描述最近从非VA医院或急诊室出院的退伍军人如何以及在何种程度上与VA初级保健团队交换信息;（ii）确定医疗差错的发生率，医疗差错定义为用药差错、检查随访差错和检查差错，在这些退伍军人的护理过渡过程中，（iii）确定与贫困有关的因素 信息交流和医疗差错。该项目将招收退伍军人从詹姆斯J彼得斯退伍军人医疗中心和哈德逊谷医疗保健系统，其中高达40%的退伍军人已获得非退伍军人护理在前一年。我们将观察在城市和农村环境中的200名退伍军人的队列中，在非VA住院或急诊室就诊后如何进行信息交换，以及VA提供者如何以及是否获得足够的信息来持续护理退伍军人。我们将检查是否根据VA双重护理政策使用直接来自双重护理政策的检查表进行信息交换。然后，我们将通过审查VA随访访视时的文件，确定护理过渡过程中医疗错误（定义为用药错误、检查随访错误和检查错误）的发生率。然后，我们将确定因素（退伍军人、疾病发作和提供者 这些因素与护理是否符合VA政策以及医疗差错的发生率有关。

 DESCRIPTION (provided by applicant): Prior studies of others and our data demonstrate that a large proportion of Veterans access multiple systems for care. Veterans who use both VA and non-VA services are at increased risk of adverse events, especially during transitions of care when changes in medications and plan of care may occur without the knowledge of VA physicians. Lacking access to adequate information of non-VA care among Veterans may limit ability of VA providers to provide levels of care of a medical home. Given that little is known about how information exchange occurs in Veterans accessing dual care, it is difficult to prescribe solutions to bridge the gap of VA and non-VA care. Understanding how information exchange occurs, the current gaps and reasons behind these gaps, may allow for developing solutions that will help bridge VA and non-VA care. The objectives of the project are to better understand how information exchange between VA and non-VA settings currently occurs and to assess the quality of information exchange between VA and non-VA providers. The specific aims of the study are (i) to describe how and to what extent information is exchanged with VA primary care teams among Veterans recently discharged from a non-VA hospital or emergency room; (ii) to determine the incidence of medical errors, defined as medication errors, test follow-up errors and work up errors, during the care transition process among these Veterans and (iii) to identify factors that are related to poor information exchange and with medical errors. The project will enroll Veterans from James J Peters VA Medical Center and Hudson Valley Health Care System, where up to 40% of Veterans have accessed non-VA care in the previous year. We will observe in a cohort of 200 Veterans in both urban and rural settings how information exchange occurs after a non-VA hospitalization or emergency room visit, and how and whether VA providers receive adequate information for ongoing care for Veterans. We will examine if the information exchange occurred according to VA dual care policy using a checklist derived directly from the dual care policy. We will then determine the incidence of medical errors, defined as medication errors, test follow-up errors and work up errors, during the care transition process from the review of documentation at the follow up visit at VA. We will then identify factors (Veteran, illness episode, and provider factors) that are associated with whether care was consistent with VA policy and with the incidence of medical errors.