Using Data Analytics and Targeted Whole Health Coaching to Reduce Frequent Utilization of Acute Care among Homeless Veterans

使用数据分析和有针对性的整体健康指导来减少无家可归的退伍军人对紧急护理的频繁使用

• 批准号: 10312596
• 负责人: Daniel Michael Blonigen
• 金额: --
• 依托单位: VETERANS ADMIN PALO ALTO HEALTH CARE SYS
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-01-01 至 2025-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10312596
• 关键词: Academy; Algorithms; Ambulatory Care; Appointment; Caring; Chronic; Clinical; Communities; Complex; Consolidated Framework for Implementation Research; Data; Data Analytics; Development; Disease Management; Emergency medical service; Fees; Financial Hardship; Future; Goals; Health; Health Care Costs; Healthcare; Healthcare Systems; Homelessness; Hospitalization; Housing; Informatics; Intervention; Interview; Link; Mediating; Medical; Medicine; Mental Health; Mental disorders; Methodology; Modeling; Outcome; Patient-Centered Care; Patients; Personal Satisfaction; Pilot Projects; Premature Mortality; Primary Health Care; Process; Quality of Care; Randomized; Randomized Controlled Trials; Recommendation; Registries; Reporting; Research; Research Priority; Resources; Risk; Role; Services; Site; Specialist; Structure; Suicide prevention; Testing; Text; Text Messaging; Time; Traction; Training; Use Effectiveness; Veterans; Work; acute care; base; budget impact; care costs; care systems; comorbidity; cost; dashboard; data format; effectiveness implementation study; experience; health goals; high risk; hybrid type 1 design; implementation trial; informant; innovation; inpatient service; patient oriented; peer; physical conditioning; prediction algorithm; primary care services; primary outcome; process evaluation; programs; psychosocial rehabilitation; recruit; social determinants; social stigma; substance use; suicidal risk; treatment as usual

Background: Ten percent of patients account for up to 70% of acute care costs. Among these “super-utilizer” patients, homelessness is a robust social determinant of acute care utilization. Through a field-based dashboard and clinical aids, the Hot Spotter Analytic program assists Patient Aligned Care Teams (PACT) with targeting and tailoring care for the highest-need homeless Veterans. However, many Veterans identified by the Analytics do not engage in supportive services that reduce risk for acute care utilization. Peer Specialists (PS) are a high-value workforce that can facilitate Veterans’ engagement in care. Yet, there is a need to enhance the PS role with a structured approach that can capitalize on known facilitators of care engagement among homeless Veterans. Whole Health Coaching (WHC) is one such approach. By focusing on patients’ values and goals rather than treatment of specific conditions, WHC reduces patients’ stigma regarding their care needs and increases patient activation and well-being, which can increase engagement in supportive services. Significance: By training a high-value workforce in a patient-centered approach to care that facilitates engagement in supportive services, our proposed research can reduce homeless Veterans’ reliance on acute care services, thereby minimizing the financial burden these patients exert on the care system. This proposal responds to several VA HSR&D Research Priorities including Mental Health, Healthcare Value, Primary Care Practice, Healthcare Informatics, and Whole Health, as well as VA-related Legislative Priorities (MISSION Act). Innovation and Impact: A critical innovation of this research is use of data-driven processes (Hot Spotter Analytics) to better target and tailor care for high-need, homeless Veterans in VHA. Our proposed research is also innovative in that it seeks to integrate the Analytics with a workforce (PS) and approach to care (WHC) that are rapidly expanding in primary care services VA-wide. These features of our target intervention are consistent with the National Academy of Medicine’s recommendations for high-quality care for high-need patients. Finally, by focusing on the development of personal health goals that are aligned with patients’ priorities and values, WHC is a key innovation to be added to existing VHA services for homeless Veterans. Specific Aims: The goal of this project is to integrate use of Hot Spotter Analytics with Peer Specialists trained in Whole Health Coaching (PS-WHC) and evaluate whether this approach reduces homeless Veterans’ frequent use of acute care. Aim 1: Conduct an RCT to test whether receipt of PS-WHC (vs. Enhanced Usual Care; EUC) predicts (1a) lower acute care utilization, (1b) better health-related outcomes, and whether (1c) the effects of PS-WHC on 1a and 1b are mediated by increased (i) patient activation and well-being, and (ii) access to supportive services. Aim 2: Conduct a process evaluation to inform VA's potential widespread implementation of Hot Spotter Analytics + PS-WHC on PACTs. Aim 3: Conduct a Budget Impact Analysis (BIA) to determine the impact on total costs of VA care due to implementing PS-WHC. Methodology: Using a Hybrid Type 1 design at the Palo Alto and Bedford VAs, 220 Veterans on PACT panels who are (i) on the VA Homeless Registry, and (ii) persistent super-utilizers of acute care will complete a baseline interview, be randomized to either EUC (usual PACT care + Hot Spotter Analytics and text reminders of appointments) or EUC plus 12 sessions of PS-WHC over 12 weeks, and be re-interviewed at 3, 6, and 9 months. For Aim 2, the CFIR framework will guide key informant interviews with 7 PACT staff/leaders and 12 patients from each site. For the BIA, we will include only VA costs from VA, Fee Basis care, and Choice care. Costs will be estimated per patient for all treatment beginning with randomization and continuing for 9 months. Next Steps/Implementation: Depending on the results, we will work with our VACO partners in the National Center for Homelessness Among Veterans, the Office of Patient Centered Care & Cultural Transformation, and the Office of Mental Health & Suicide Prevention to conduct a large multisite implementation trial.

背景：10％的患者占急性护理费用的70％。在这些“超级灭绝机”中 患者无家可归是急性护理利用的强大社会决定因素。通过基于场的 仪表板和临床辅助工具，热门摄影师分析计划协助患者对齐护理团队（PACT） 针对最受欢迎的无家可归者的目标和调整护理。但是，许多由 分析不会从事降低急性护理利用风险的支持服务。同伴专家（PS） 是一名高价值劳动力，可以促进退伍军人参与护理。但是，有必要增强 PS的角色具有结构化方法，可以利用已知的促进者的护理参与者 无家可归的退伍军人。整个健康教练（WHC）就是一种方法。通过关注患者的价值观和 WHC的目标而不是治疗特定疾病，减少了患者对他们的护理需求的污名 并增加患者的激活和福祉，这可以增加参与支持服务。 意义：通过以患者为中心的护理方法培训高价值劳动力 参与支持服务，我们提出的研究可以减少无家可归的退伍军人对急性的救济 护理服务，从而最大程度地减少了这些患者在护理系统上施加的金融伯恩的金融服务。这个建议 对几个VA HSR＆D研究重点的回应，包括心理健康，医疗保健价值，初级保健 实践，医疗保健信息学和整个健康以及与VA相关的立法优先事项（Mission Act）。 创新和影响：这项研究的关键创新是使用数据驱动过程（热点摄 分析），以更好地针对VHA的高需求，无家可归的退伍军人进行定位和量身定制护理。我们提出的研究是 同样创新的是，它试图将分析与劳动力（PS）和护理方法（WHC）相结合 在范围内，初级保健服务正在迅速扩展。我们目标干预的这些特征是 与国家医学院对高质量护理的建议一致 患者。最后，通过关注与患者保持一致的个人健康目标的发展 优先级和价值，WHC是为无家可归者的现有VHA服务添加的关键创新。 具体目的：该项目的目标是将热门点分析的使用与受过同行专家培训的使用 在整个健康教练中（PS-WHC），并评估这种方法是否减少了无家可归的退伍军人 经常使用急性护理。目标1：进行RCT测试是否收到PS-WHC（与增强的平常 关心; EUC）预测（1A）较低的急性护理利用，（1B）更好的健康相关结果，以及（1C）是否（1C） PS-WHC对1A和1B的影响是通过（i）患者激活和幸福感介导的，以及（ii） 获得支持服务。目标2：进行过程评估以告知VA潜在的宽度 在协议上实施热点分析 + PS-WHC。目标3：进行预算影响分析（BIA） 确定由于实施PS-WHC而导致的VA护理总成本的影响。 方法论：在帕洛阿尔托和贝德福德VAS上使用混合动力1型设计，Pact面板上有220名退伍军人 谁是（i）在VA无家可归的注册表上，以及（ii）急性护理的持续超级利用者将完成 基线访谈，随机分配到EUC（通常的PACT CARE + HOT POSTETER分析和文本提醒 约会）或EUC加上12个PS-WHC的12个会话，并在3、6和9中重新审视 月份。对于AIM 2，CFIR框架将指导与7个协定员工/领导人和12个协定人员的关键知情人面试 每个站点的患者。对于BIA，我们将仅包括VA，费用基础护理和选择护理的VA费用。 从随机化开始并持续9个月开始，所有患者的费用将被估算为每名患者的成本。 下一步/实施：根据结果，我们将与国家的Vaco合作伙伴合作 退伍军人中无家可归的中心，以患者为中心的护理和文化转型办公室以及 心理健康与自杀预防办公室，以进行大型多站点实施试验。