Virtual Specialty Care QUERI Program: Implementing and Evaluating Technology Facilitated Clinical Interventions to Improve Access to High Quality Specialty Care for Rural Veterans

虚拟专科护理 QUERI 计划：实施和评估技术促进的临床干预措施，以改善农村退伍军人获得高质量专科护理的机会

• 批准号: 10179488
• 负责人: JOHN C. FORTNEY
• 金额: --
• 依托单位: VA PUGET SOUND HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-10-01 至 2020-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10179488
• 关键词: Adoption; Ambulatory Care Facilities; Caring; Clinic; Clinical; Clinical effectiveness; Communication; Communities; Consult; Data Collection; Discipline; Effectiveness; Electronic Mail; Evaluation; Evidence based intervention; Evidence based practice; Funding; Geography; Goals; Health; Health Personnel; Health Resources; Health Services Accessibility; Health Services Research; Healthcare; Home environment; Improve Access; Internet; Intervention; Intervention Trial; Length; Logistics; Measures; Medical; Medical center; Methods; Modality; Modification; Nature; Outcome; Pathway interactions; Patient Care; Patient-Centered Care; Patients; Performance; Personal Satisfaction; Play; Policies; Population; Protocols documentation; Provider; Quality of Care; Randomized Controlled Trials; Research; Resources; Role; Rural; Rural Health; Secure; Services; Site; System; Technology; Text Messaging; Time; Transportation; Variant; Veterans; Videoconferencing; base; budget impact; care systems; clinical practice; compare effectiveness; cost; design; eHealth; ethnographic method; evidence base; health administration; implementation strategy; improved; improved outcome; innovation; mHealth; medical specialties; mobile application; new technology; patient portal; primary care services; programs; recruit; remote communities; remote location; routine care; routine practice; rural area; rural setting; telehealth; therapy design; virtual

 DESCRIPTION (provided by applicant): Anticipate Impacts on Veterans' Healthcare: The Veterans Health Administration (VHA) provides care to 3.3 million Veterans living in rural areas, comprising 36% of all VHA enrollees. In 1995, VHA began expanding its system of Community Based Outpatient Clinics (CBOCs) in order to improve access for the geographically dispersed Veteran population. There are now approximately 900 CBOCs delivering a range of services to approximately 64% of VHA enrollees. While these CBOCs have dramatically improved access to first class primary care services, it has been more challenging to deliver specialty care to rural Veterans. Evidence based specialty care practices developed for large VA Medical Centers are often not feasible to deploy in small CBOCs and thus not accessible to rural Veterans. The proposed QUERI Program will implement and evaluate technology-facilitated clinical interventions designed to improve outcomes for rural Veterans. Project Background: The Office of Rural Health's (ORH) Resource Centers are funded to examine the unique health care needs of rural Veterans and develop a pipeline of "promising practices" to better meet these needs. In order to improve access, these promising practices often utilize virtual care technologies (e.g., telehealth, eHealth, mHealth) developed by Telehealth Services (TS) and the Connected Health Office (CHO). Due to the remote locations of rural Veterans and the rapidly evolving technologies used in interventions designed to better serve them, it is extremely challenging to conduct traditional randomized controlled trials (RCTs). Consequently, there are relatively few RCTs establishing the evidence based for interventions designed to improve outcomes for rural Veterans. Even when the logistics of recruitment and data collection in rural remote settings can be overcome, the length of time it takes to conduct a RCT usually renders the technology used in the intervention obsolete. Consequently, ORH, TS and CHO need rigorous methods to evaluate promising practices as they are being initially deployed into the field and as they evolve over time. Project Objectives: The goal of the proposed QUERI Program is to implement and evaluate promising clinical practices incorporating virtual care technologies in order to improve access to high quality care for rural Veterans. To achieve this goal the proposed Virtual Specialty Care QUERI has three specific aims. The first aim is to develop, evaluate, and refine implementation strategies for the ORH, TS and CHO to roll out promising clinical practices that incorporate teleheath, ehealth, and mhealth virtual care technologies. The second aim is to evaluate and refine promising clinical practices that incorporate telehealth, ehealth, and mhealth virtual care technologies that have been developed at VHA Rural Resource Centers and elsewhere designed to improve access to high quality care for rural Veterans. The third aim is to measure implementation costs and assess the budget impact of rollout for operational partners. Project Methods: The projects proposed as part of the Virtual Specialty Care QUERI will compare enhanced implementation strategies to standard implementation strategies used by the ORH, TS and CHO. Enhanced implementation will include a variety of strategies including ethnographic methods to assess the existing clinical workflow at implementation sites, and modification of both the existing clinical workflow and the new clinical intervention to maximize fit. Evaluation of the implementation strategies will be assessed using qualitative and quantitative methods to measure provider adoption and sustainability. Population level effectiveness of the clinic intervention will be assessed using qualitative and quantitative methods to measure reach and outcomes. Given the dynamic nature of technology and the high degree of variability in context across clinics, we will employ methods that enable the new clinical intervention to be adapted from setting to setting and to be refined over time rather than focusing on fidelity to a manualized protocol.

 描述（由申请人提供）： 预期对退伍军人医疗保健的影响：退伍军人卫生管理局（VHA）为居住在农村地区的330万退伍军人提供护理，占所有VHA入学率的36％。 1995年，VHA开始扩大其基于社区的门诊诊所（CBOC）的系统，以改善地理位置分散的退伍军人人口的访问。现在，大约有900个CBOC向大约64％的VHA注册提供了一系列服务。尽管这些CBOC大大改善了对一流的初级保健服务的访问，但向粗糙的退伍军人提供专业护理是更大的挑战。为大型VA医疗中心开发的基于证据的专业护理实践通常不可行，因此在小型CBOC中部署，因此粗糙的退伍军人无法获得。拟议的Queri计划将实施和评估旨在改善粗糙退伍军人结果的技术知识临床干预措施。项目背景：农村卫生（ORH）资源中心的办公室被资助，以研究粗糙的退伍军人的独特医疗保健需求，并开发出“有希望的实践”的管道，以更好地满足这些需求。为了提高访问权限，这些有前途的实践经常利用远程医疗服务（TS）和Connected Health Office（CHO）开发的虚拟护理技术（例如远程医疗，eHealth，MHealth）。由于农村退伍军人的偏远地区以及用于更好地服务于他们的干预措施中的快速发展的技术，进行传统的随机对照试验（RCT）非常挑战。因此，相对较少的RCT建立了基于旨在改善农村退伍军人预后的干预措施的证据。即使可以克服在粗糙的远程设置中招募和数据收集的登录，进行RCT所需的时间通常会导致干预中使用的技术过时。因此，ORH，TS和CHO需要严格的方法来评估承诺实践，因为它们最初被部署到现场并随着时间的流逝而发展。项目目标：拟议的Queri计划的目标是实施和评估编码虚拟护理技术的承诺临床实践，以改善对粗糙退伍军人的高质量护理的机会。为了实现这一目标，拟议的虚拟专业护理Queri具有三个特定的目标。第一个目的是针对ORH，TS和CHO制定，评估和完善实施策略，以推出有希望的临床实践，这些临床实践结合了Teleheath，Ehealth和MHealth Virtual Care Technologies。第二个目的是评估和完善有希望的临床实践，这些临床实践融合了远程医疗，eHealth和MHealth虚拟护理技术，这些技术已在VHA农村资源中心和其他地方开发，旨在改善旨在改善资深退伍军人高质量护理的机会。第三个目的是衡量实施成本并评估推出对运营合作伙伴的预算影响。项目方法：作为虚拟专业护理QuERI的一部分提出的项目将将增强的实施策略与ORH，TS和CHO使用的标准实施策略进行比较。增强的实施将包括各种策略，包括民族志方法，以评估实施地点现有的临床工作流程，以及对现有的临床工作流程和新的临床干预进行修改以最大程度地提高拟合度。将使用定性和定量方法评估实施策略的评估，以衡量提供者的采用和可持续性。将使用定性和定量方法来评估临床干预的人口水平有效性以衡量覆盖范围和结果。鉴于技术的动态性质以及跨诊所上下文的高度可变性，我们将采用使新的临床干预措施从设置到设置的方法 专注于对手动协议的保真度。