Improving Access and Outcomes for Rural Veterans with HIV

描述(由申请人提供)： 迫切需要改善农村退伍军人获得专门护理的机会。CDA-2将为被提名者提供必要的技能，以设计、评估和实施战略，在农村地区提供无障碍和高质量的特殊护理。拟议的研究重点是人类免疫缺陷病毒(艾滋病毒)感染，将其作为需要有经验的提供者提供专门护理的条件的模型。先前的工作描述了在退伍军人事务部内外对农村艾滋病毒携带者的护理方面的差距。三个项目将利用现有的退伍军人管理局资源，开发一种创新的交付模式，以改善对携带艾滋病毒的农村退伍军人的护理的可及性、质量和结果。第一个项目对现有的退伍军人管理局艾滋病毒临床病例登记(CCR)数据进行二次分析，以详细说明对感染艾滋病毒的农村退伍军人的护理差距。因变量将包括在退伍军人管理局跟踪的一系列艾滋病毒护理过程和结果衡量标准。项目2采用定性方法和对退伍军人、退伍军人管理局提供者和管理人员的半结构化访谈，以确定改善对感染艾滋病毒的农村退伍军人的护理的机会。访谈将侧重于农村艾滋病毒感染退伍军人对护理的感知需求、能够提供影响护理机会的资源、为农村地区服务的低艾滋病毒感染地点对额外资源的需求以及改善护理的具体机会。第三个项目将应用这些发现来开发和评估一种创新的、基于远程保健的提供模式，以填补农村艾滋病毒感染退伍军人护理方面的差距。在这项工作中，被提名者将获得1)评估农村人口卫生保健质量的技能；2) 发展将定性和混合研究方法应用于卫生保健干预措施设计和评估的专门知识；3)发展针对农村慢性病患者的远程卫生干预方面的专门知识；4)发展准实验和随机试验方面的专门知识，以确定卫生保健干预措施对结果和成本的影响；5)熟练掌握实施科学。三名有经验的退伍军人管理局调查人员将提供指导。Eli Perencevich博士是传染病专家，也是HSR&D资助的卫生服务研究员。Bonnie Wakefield博士是国家公认的远程医疗干预措施设计和评估方面的权威。艾米·贾斯蒂斯博士将在艾滋病毒结果研究领域提供指导。在退伍军人管理局的研究生涯中，被提名者将应用在这次CDA中获得的技能，以改善患有传染病需要特殊护理的农村退伍军人的护理机会和质量。因此，本申请中的研究和职业发展目标直接涉及退伍军人管理局的业务任务和高铁发展优先事项，以改善农村退伍军人的机会。 公共卫生相关性： 迫切需要制定创新战略，改善居住在农村地区的退伍军人获得专门医疗保健的机会。CDA-2申请中提议的工作将开发和评估一种创新的交付模式，以改善感染人类免疫缺陷病毒(HIV)的农村退伍军人获得护理的机会和质量，这是一种需要经验丰富的提供者提供专门护理的慢性疾病。在这项工作中，被提名者将获得制定、评估和实施改善农村医疗保健提供的战略所需的技能。在退伍军人管理局的职业生涯中，他将应用这些技能来改善患有一系列需要特殊护理的传染病的农村退伍军人的机会。因此，本申请中的研究和职业发展目标直接涉及退伍军人管理局的业务任务和高铁发展优先事项，以改善农村退伍军人的机会。

DESCRIPTION (provided by applicant): There is pressing need to improve access to specialized care for rural veterans. This CDA-2 will provide the nominee with the skills necessary to design, evaluate, and implement strategies to deliver accessible and high-quality specialty care in rural areas. Proposed research focuses on human immunodeficiency virus (HIV) infection as a model for conditions requiring specialized care from experienced providers. Prior work has described gaps in care for rural persons with HIV, both outside of and within VA. Three projects will leverage existing VA resources to develop an innovative delivery model to improve the accessibility, quality, and outcomes of care for rural veterans with HIV. The first project applies secondary analysis of existing VA HIV Clinical Case Registry (CCR) data to provide a detailed description of gaps in care for rural veterans with HIV. Dependent variables will include a series of process and outcome measures of HIV care tracked in VA. Project #2 employs qualitative methods and semi-structured interviews with veterans, VA providers, and administrators to identify opportunities to improve care for rural veterans with HIV. Interviews will focus on perceived needs for care among rural veterans with HIV, enabling resources that influence care access, needs for additional resources in low HIV-volume sites serving rural areas, and specific opportunities to improve care. The third project will apply these findings to develop and evaluate an innovative, telehealth-based delivery model to close gaps in care for rural veterans with HIV. During this work the nominee will 1) acquire skills for assessing health care quality for rural populations; 2) develop expertise applying qualitative and mixed research methods to the design and evaluation of healthcare interventions; 3) develop expertise in telehealth interventions for rural persons with chronic conditions; 4) develop expertise in quasi-experimental and randomized trials to determine the impact of healthcare interventions on outcomes and costs; and 5) acquire fluency in implementation science. Three accomplished VA investigators will provide mentorship. Dr. Eli Perencevich is an infectious disease specialist and HSR&D funded health services researcher. Dr. Bonnie Wakefield is a nationally recognized authority in the design and evaluation of telehealth interventions. Dr. Amy Justice will provide mentorship in the area of HIV outcomes research. Over the course of his research career in VA, the nominee will apply the skills gained during this CDA to improve the accessibility and quality of care for rural veterans with infectious diseases requiring specialized care. Thus, the research and career development goals in this application directly address the VA operational mandate and HSR&D priority to improve access for rural veterans. PUBLIC HEALTH RELEVANCE: There is pressing need to develop innovative strategies to improve access to specialized healthcare for veterans living in rural areas. The work proposed in this CDA-2 application will develop and evaluate an innovative delivery model to improve the accessibility and quality of care for rural veterans with human immunodeficiency virus (HIV) infection, a chronic condition that requires specialized care from experienced providers. During this work the nominee will acquire skills necessary to develop, evaluate, and implement strategies to improve rural healthcare delivery. Over the course of his career in VA, he will apply these skills to improve access for rural veterans with a range of infectious diseases that require specialized care. Thus, the research and career development goals in this application directly address the VA operational mandate and HSR&D priority to improve access for rural veterans.