Investigating the Impact of Person-Centered Home-Based Palliative Care on Providers

项目总结/摘要 这个提议的K99/R 00独立之路奖的主要目标是建立在PI的基础上， 目前的技能和强大的研究基础，以提高她的发展成为一个训练有素的 调查员这将通过培训、指导、正规教育和专业培训来实现。 K99/R 00奖的机会，并将促进PI的过渡到终身教职职位。的 PI提出了一个雄心勃勃的研究，指导和培训议程，旨在填补她目前的差距， 技能预期的结果是一个充满活力，训练有素，混合方法的调查员，将很好地定位 以满足姑息治疗，以人为本的护理和卫生系统研究的不断变化的需求， 老年人和患有严重疾病的人。PI的职业目标是获得终身教职 在研究型大学的位置，进行高影响力的独立研究项目，并 卫生系统和实施研究的国际领导者。 这项研究将致力于解决在提供姑息治疗的两个方面的差距， 美国（偶发性护理和不一致的融资结构）。这将通过实施基于证据的 以家庭为基础的姑息治疗（HBPC）模式-最初是在管理式护理中发展起来的-变成了初级收费模式， 服务作为覆盖的健康福利;这是美国私人健康保险公司对这一模式的第一次翻译。 本研究的目的是调查供应商和组织层面的影响， 在初级保健中实施可偿还的HBPC，目标是描述一套 执行战略和引出关键机制，如何广泛复制以人为本， 在全国各地的初级保健机构中实施可报销的HBPC。为此，我们提出了七个研究问题。 将回答与可行性、障碍、促进者、人员有关的研究目的， 以人为本和工作满意度。在创新扩散理论的指导下， 在实施HBPC干预或加强常规护理（电话病例）的四个研究中心中， 管理）提出。方法论包括两个部分：1）初级收集 和分析定性焦点小组数据在每个研究地点，和专题分析的电话 在两个干预现场进行辅导; 2）制定、验证和实施 量化工具，以衡量以人为本的护理和工作满意度之间的供应商。主要成果 定性部分包括翻译HBPC可行性、障碍和促进因素，以及 与HBPC扩散率和实施战略相关的特征。结局 定量部分包括经验证的测量工具，用于提供者对以人为本的护理的看法， 工作满意度该项目挑战了我们目前的收费姑息治疗方法，并寻求 改变目前的研究。预计将在全国范围内推广可偿还HBCP模式。

PROJECT SUMMARY/ABSTRACT The primary goal of this proposed K99/R00 Pathway to Independence Award is to build on the PI’s current skillset and strong research foundation to enhance her development into a uniquely-trained investigator. This will be made possible by the training, mentoring, formal education, and professional opportunities of the K99/R00 award and will facilitate the PI’s transition into a tenure-track faculty position. The PI has set forth an ambitious research, mentoring, and training agenda that aims to fill current gaps in her skillset. The expected result is a dynamic, well-trained, mixed-methods investigator that will be well positioned to meet the changing needs of palliative care, person-centered care, and health systems research related to older adults and those with serious illness. The PI’s career goals are to obtain a tenure-track faculty position at a research-oriented university, conduct high-impact independent research projects, and be an international leader in health systems and implementation research. This study will undertake an effort to address the two-pronged gap in providing palliative care in the U.S. (episodic care and misaligned financing structures). This will be done by implementing an evidence-based Home-Based Palliative Care (HBPC) model—originally developed in managed care—into primary fee-for- service as a covered health benefit; the very first translation of this model by a private health insurer in the U.S. The purpose of the present study is to investigate the provider and organizational-level impact of implementing reimbursable HBPC in primary care with the goal of characterizing a set of implementation strategies and eliciting key mechanisms on how to widely replicate person-centered, reimbursable HBPC in primary care settings across the country. To this end, seven research questions will be answered that address the study purpose pertaining to feasibility, barriers, facilitators, person- centeredness, and job satisfaction. Guided by the Diffusion of Innovations theory, a matched-control design among four study sites implementing either the HBPC intervention or enhanced usual care (telephonic case management) is proposed. The methodological approach consists of two components: 1) Primary collection and analysis of qualitative focus group data at each study site, and thematic analysis of telephone-based mentoring sessions at the two intervention sites; and 2) Development, validation, and implementation of quantitative tools to measure person-centered care and job satisfaction among providers. Key outcomes for the qualitative component include feasibility, barriers, and facilitators of translating HBPC, as well as characteristics associated with rate of HBPC diffusion and implementation strategies. Outcomes for the quantitative piece include validated measurement tools for provider perceptions of person-centered care and job satisfaction. This project challenges our current approach to fee-for-service palliative care and seeks to shift current research. Nation-wide replication of reimbursable HBCP models is anticipated.