TeleWound Practice Partnered Evaluation Initiative

背景资料。获得护理是退伍军人管理局的高度优先事项，特别是对生活在农村或农村地区的退伍军人来说 需要特殊护理的。护理糖尿病足部溃疡等伤口复杂、昂贵，并可能导致 严重的不良事件，包括住院、截肢甚至死亡。TeleWound练习，一种努力 为了改善需要特殊伤口护理的农村退伍军人的机会，被退伍军人事务部选中 为健康和卓越的传播(DOE)办公室的鲨鱼缸比赛作为金星实践将是 在全国范围内实施，从VISN 15开始。与美国能源部、护理服务办公室(ONS)合作，以及 互联护理办公室-远程医疗服务(OCC-TS)，我们建议与TeleWound Practice合作 评估倡议，以评估TeleWound做法的执行情况和影响。 明确的目标。TeleWound Practice PEI的目标是：(1)评估 通过检查利益相关者对促进者和障碍的看法、评估患者和 提供商满意度，观察流程和工作流程，并按数量测试计划的覆盖范围 患者使用TeleWound实践进行伤口护理，(2)评估TeleWound实践对以下方面的影响 与伤口护理相关的临床结果，以及(3)评估TeleWound实践对医疗保健的影响 与伤口护理相关的系统结果。 意义重大。使用技术支持获得医疗服务，促进患者参与，并接受 退伍军人的个人需求和偏好直接反映在退伍军人管理局当前的2018-2024年战略计划中 优先事项：(1)确保有更多的选择和更多的机会，(2)改善护理的及时性，以及(3) 使退伍军人制度现代化，包括卫生信息技术。 创新。退役军人维护系统的关键组成部分&加强综合外网建设 (使命)法案是利用虚拟护理来改善获得医疗服务的机会和质量，这一点尤为重要 因为超过37%的退伍军人通过退伍军人管理局接受护理，居住在农村和高度农村地区。弗吉尼亚的转型 要实现学习型医疗系统，需要使科学与临床优先事项保持一致，以更快、更快地 评估新计划(例如TeleWound)的有效性和/或实施情况的高效研究 实践)或涉及退伍军人管理局领导层优先事项的政策。当前工作的意义还在于 反映在退伍军人事务部的使命是促进开发以成果为导向的创新以提高质量， 为退伍军人提供医疗服务的途径和透明度。 方法：研究方法。我们提出了一种混合方法的评估。我们的目标是了解利益相关者的观点 关于影响TeleWound实践成功实施的障碍和促进者 VISN 15个医疗中心和退伍军人事务部门诊，使用调查和半结构化访谈(目标1)。 利益相关者包括设施领导层、医疗团队成员(即诊所经理、远程医疗工作人员和 伤口护理专家)和退伍军人。我们将在两个VISN 15医学中心和4个VISN 15医学中心进行现场考察 乡村门诊诊所观察进行伤口护理探访所涉及的流程和工作流程 远程医疗技术，并与参与TeleWound实践的人员交谈。使用国家统计局的数据 数据库，我们将测试TeleWound实践对接受伤口护理的患者数量的影响 超过远程医疗技术(目标1)、临床结果(目标2)和医疗保健系统结果(目标3)。 预期结果。由于目标是在明年在VISN 15中实施TeleWound练习， 考虑如何通过改进和加强实施战略来最好地建设能力将是一个主要问题 一旦PEI启动，我们的工作目标就会实现。 下一步(S)。我们与主要合作伙伴在TeleWound Practice PEI上的合作将有助于填补这一空白 关于未来实施战略的证据，以加强远程医疗在伤口护理方面的使用。

Background. Access to care is a high priority for VA, especially for Veterans living in rural or highly rural areas needing specialized care. Care of wounds such as diabetic foot ulcers is complex, costly, and can result in significant adverse events including hospitalization, amputation, and even death. TeleWound Practice, an effort to improve access for rural Veterans needing specialized wound care, was selected by the VA Under Secretary for Health and the Diffusion of Excellence (DOE) Office's Shark Tank competition as a Gold Star Practice to be implemented nationally, beginning in VISN 15. In partnership with DOE, Office of Nursing Services (ONS), and Office of Connected Care – Telehealth Services (OCC-TS), we propose the TeleWound Practice Partnered Evaluation Initiative to evaluate the implementation and impacts of the TeleWound Practice. Specific Aims. The aims of the TeleWound Practice PEI are to: (1) Evaluate the implementation of the TeleWound Practice by examining stakeholder perspectives of facilitators and barriers, assessing patient and provider satisfaction, observing processes and workflow, and testing reach of the program by number of patients using TeleWound Practice for wound care, (2) Assess the impact of the TeleWound Practice on clinical outcomes related to wound care, and (3) Assess the impact of the TeleWound Practice on healthcare system outcomes related to wound care. Significance. Using technology to support access to care, to promote patient engagement, and to embrace the individual needs and preferences of Veterans is directly reflected in VA's 2018-2024 Strategic Plan current priorities to (1) ensure greater choices and enhanced access, (2) improve timeliness of care, and (3) modernize VA systems, including health information technology. Innovation. A key component of the VA Maintaining Systems & Strengthening Integrated Outside Networks (MISSION) Act is the use of virtual care to improve access and quality of care, which is particularly important as over 37% of Veterans receiving care through VA reside in rural and highly rural areas. VA's transformation to a Learning Healthcare System involves aligning science with clinical priorities to conduct more rapid and efficient studies that evaluate the effectiveness and/or implementation of new programs (e.g., TeleWound Practice) or policies that address the priorities of VA leadership. The significance of the current work is also reflected in the mission of the VA to facilitate the development of results-driven innovations to improve quality, access, and transparency of care for Veterans. Methods. We propose a mixed-methods assessment. We aim to understand stakeholder perspectives regarding barriers and facilitators that influence successful implementation of the TeleWound Practice across VISN 15 medical centers and VA outpatient clinics using surveys and semi-structured interviews (Aim 1). Stakeholders include facility leadership, healthcare team members (i.e., clinic managers, telehealth staff, and wound care specialists), and Veterans. We will conduct site visits at two VISN 15 Medical Centers and four rural Outpatient Clinics to observe the processes and work flow involved in conducting wound care visits over Telehealth technologies and speak with those involved in the TeleWound Practice. Using data from national databases, we will test the impact of the TeleWound Practice on numbers of patients receiving wound care over telehealth technologies (Aim 1), clinical outcomes (Aim 2), and healthcare system outcomes (Aim 3). Expected Results. As the goal is to implement TeleWound Practice across VISN 15 over the next year, considering how best to build capacity through a refined and enhanced implementation strategy will be a main goal of our work as soon as the PEI is launched. Next Step(s). Our collaborations with key partners on the TeleWound Practice PEI will help fill the gap regarding evidence for future implementation strategies to enhance telehealth use for wound care delivery.