Optimizing Patient-Centered Routine Care at a Distance for Veterans with Chronic Conditions

为患有慢性病的退伍军人优化以患者为中心的远程日常护理

• 批准号: 10315041
• 负责人: Abigail Baim-Lance
• 金额: --
• 依托单位: JAMES J PETERS VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-01 至 2023-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10315041
• 关键词: Affect; Aging; Anthropology; COVID-19; Caring; Chronic; Chronic Disease; Chronically Ill; Clinic; Complex; Consult; Data; Data Sources; Development; Diabetes Mellitus; Disease Management; Effectiveness; Eligibility Determination; Emergency Situation; Enrollment; Ensure; Environment; Equipment and supply inventories; Evaluation; Frequencies; Future; Goals; Guidelines; HIV; Health; Health Services Research; Healthcare; Intervention; Interview; Investigation; Knowledge; Maps; Measures; Medical; Medical center; Methods; New York; Outcome; Outpatients; Patient-Centered Care; Persons; Phase; Pilot Projects; Positioning Attribute; Primary Health Care; Process; Provider; Quality of Care; Readiness; Research Proposals; Services; Surveys; System; Techniques; Telephone; Testing; Time Study; To specify; Veterans; Veterans Health Administration; Visit; acceptability and feasibility; base; care delivery; care providers; comorbidity; comparative; coronavirus disease; design; experience; feasibility testing; follow-up; health care availability; health management; health record; human old age (65+); improved; innovation; medical appointment; medical specialties; novel; pandemic disease; patient oriented; primary care services; recruit; routine care; service delivery; social; stem; telehealth; telemonitoring; theories; virtual

Background: As a result of COVID-19, the VA has undergone a sizable transition to Care at a Distance in order to ensure the safe delivery of services. Components encompass expanded telehealth, distancing measures at routine face to face visits, and other practice changes. How Veterans with chronic conditions who regularly use VA healthcare experience these changes is unknown. This 18-month pilot study assesses a mixed methods approach to describe Care at a Distance for older, chronically ill Veterans, how service changes are experienced by Veterans, and how the experiences affect health management and outcomes. Significance/Impact: The unprecedented impact of COVID-19 provides an opportunity to advance novel Veteran-centered mixed methods to understand the pandemic’s effects on Veteran healthcare. Investigations can identify and test out Veteran-centered system improvements that support preparedness for future emergencies. This study aligns with VA’s strategic goals and objectives for FY2018-2024 to promote ‘customer service,’ and HSR&D’s scientific priorities to improve telehealth’s effectiveness, and to use primary care to optimize complex chronic disease management. It also aligns with ongoing activities in the Veterans Experience Office using journey mapping to understand Veteran experiences of VA care. Innovation: The proposed mixed methods pilot study is interdisciplinary, using novel methods in VA studies. By drawing upon theories and methods of medical anthropology and health services research, the pilot study is positioned to produce deep and actionable knowledge about COVID-19’s impact on Veterans and their care. Specific Aims: Aim 1: Describe components of Care at a Distance, to inform adapting an experience-based journey mapping template, which will describe how Care at a Distance affects the healthcare experiences of older Veterans with comorbidities, and their health outcomes. Aim 2: Test the feasibility and acceptability, and conduct an analysis, of embedding experienced-based journey mapping within in-depth qualitative interviews to describe Care at a Distance for older Veterans with comorbidities, and their routine care providers. Aim 3: Assess the utility of the mixed methods techniques to examine relationships among service changes, Veteran experiences, and health outcomes, incorporating chart review as a comparative and triangulating data source. Methods: The study uses a sequential design carried out at the James J. Peters VA in Bronx, NY and VA Hudson Valley Health Care in upstate, New York. In Aim 1, a documents analysis of VA Care at a Distance changes will be conducted to refine an inventory of components, key features, and their implementation. The inventory will inform an adapted experience-based journey map template and interview topic guide, and a medical chart analysis. In Aim 2, 40 Veterans will be recruited who are 65+ years old with two or more comorbidities (one being HIV or diabetes) and eligible for enrollment in the GeriPact, or HIV clinic. Interviews will use the experience-based survey mapping template to document service encounters and experiences before COVID- 19 (prior to March 2020), in the initial phase (March-May 2020), and during the Moving Forward period (June 2020-time of study). A follow-up interview will discuss feasibility and acceptability of mapping. 12 provider interviews will be conducted about implementation and Veteran experiences of Care at a Distance, and the feasibility of journey mapping. We will analyze for feasibility and acceptability, and conduct a qualitative thematic and process analysis. In Aim 3, a chart review will be performed to examine the record of health use and outcomes, and a comparative analysis will be performed between charts and the maps. Implementation/ Next Steps: Findings will be used to develop an IIR research proposal to: 1) describe Care at a Distance impact across VA facilities; and 2) test out and evaluate interventions to improve care for Veterans, particularly those aging with chronic health conditions. The VA Veteran Experience Office will partner on this study, and continuous Veteran input will be sought.

背景：由于Covid-19的结果，VA经历了相当大的过渡，以在一定距离内进行护理 为了确保安全提供服务。组件包括扩展的远程医疗，远处 常规面对面的措施和其他实践发生了变化。长期条件的退伍军人如何 通常使用VA医疗保健经验这些变化是未知的。这个18个月的试点研究评估 混合方法的方法来描述远距离的护理，以适用于年龄较大的长期疾病的退伍军人，服务方式 退伍军人经历了变化，以及经验如何影响健康管理和成果。 意义/影响：Covid-19的前所未有的影响为推进小说提供了机会 以资深人士为中心的混合方法了解大流行对资深医疗保健的影响。调查 可以识别并测试以资深人士为中心的系统改进，以支持未来的准备 紧急情况。这项研究符合VA的战略目标和目标2018-2024的目标，以促进'客户 服务’和HSR＆D的科学重点，以提高远程医疗的有效性，并使用初级保健 优化复杂的慢性疾病管理。它还与退伍军人正在进行的活动保持一致 使用旅程映射的经验办公室来了解VA护理的资深体验。创新： 提出的混合方法使用VA研究中的新方法是跨学科研究。通过吸引 医学人类学和健康服务研究的理论和方法，试点研究定位为 关于Covid-19对退伍军人的影响及其护理的深刻而可行的知识。具体目的： 目标1：描述远距离护理组件，以告知适应基于体验的旅程映射 模板，它将描述远距离的护理如何影响老年退伍军人的医疗保健经历 合并症及其健康成果。目标2：测试可行性和可接受性，并进行分析， 在深入的定性访谈中嵌入经验丰富的基于经验的旅程映射，以描述一个护理 具有合并症的老年退伍军人及其常规护理提供者的距离。目标3：评估效用 混合方法技术以检查服务变化，退伍军人体验和健康之间的关系 结果，将图表审查作为比较和三角调节的数据源。方法：研究 使用在纽约州布朗克斯的James J. Peters VA和VA Hudson Valley Health进行的连续设计 纽约州北部的护理。在AIM 1中，将在距离上进行VA护理的文档分析将变化 旨在完善组件，关键功能及其实施的清单。库存将 告知基于经验的基于经验的旅程地图模板和面试主题指南，以及医学图表 分析。在AIM 2中，将招募40名退伍军人，他们65岁以上，有两种或更多的合并症（一种 为HIV或糖尿病），并有资格参加Geripact或HIV诊所的入学。访谈将使用 基于经验的调查映射模板，以记录服务的相遇和经验 19（2020年3月之前），最初的阶段（2020年3月至3月），在前进期间（6月 2020年的学习）。后续采访将讨论映射的可行性和可接受性。 12提供商 访谈将进行有关远距离的实施和老将的护理经验，以及 旅程映射的可行性。我们将分析可行性和可接受性，并进行定性 主题和过程分析。在AIM 3中，将进行图表审查以检查健康使用记录 和结果，以及图表和地图之间将进行比较分析。执行/ 下一步：发现将用于制定IIR研究建议：1）描述远距离的护理 跨VA设施的影响； 2）测试和评估干预措施以改善退伍军人的护理，特别是 那些患有慢性健康状况的衰老。 VA老兵经验办公室将合作参加这项研究，并 连续的退伍军人投入将被弥补。