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：在这些“超级利用者”中，10% 的患者占急症护理费用的 70%。 对于患者来说，无家可归是急症护理利用的一个强有力的社会决定因素。 仪表板和临床辅助工具，热点分析程序协助患者协调护理团队 (PACT) 为最需要的无家可归的退伍军人提供针对性的护理然而，许多退伍军人被确定。 分析不参与降低急症护理利用风险的支持服务。 是一支高价值的劳动力队伍，可以促进退伍军人参与护理工作，但仍需要加强。 PS 角色采用结构化方法，可以利用已知的护理参与促进者 无家可归的退伍军人的整体健康辅导（WHC）就是这样一种方法，通过关注患者的价值观和 WHC 减少了患者对其护理需求的耻辱感，而不是针对特定病症的治疗 并提高患者的积极性和福祉，从而提高对支持服务的参与度。 意义：通过以患者为中心的护理方法培训高价值劳动力，从而促进 通过参与支持性服务，我们提出的研究可以减少无家可归的退伍军人对紧急服务的依赖 护理服务，从而最大限度地减少这些患者对护理系统造成的经济负担。 响应多项 VA HSR&D 研究重点，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体健康，以及 VA 相关的立法优先事项（使命法案）。 创新和影响：这项研究的一个关键创新是使用数据驱动的流程（Hot Spotter 分析），以便更好地针对 VHA 中高需求、无家可归的退伍军人提供针对性护理。 它还具有创新性，因为它寻求将分析与劳动力 (PS) 和护理方法 (WHC) 相结合 我们的目标干预措施的这些特点是在整个退伍军人事务部范围内迅速扩大的初级保健服务。 符合美国国家医学院关于为高需求者提供高质量护理的建议 最后，重点关注与患者的个人健康目标相一致的发展。 WHC 是为无家可归退伍军人现有 VHA 服务添加的一项关键创新。 具体目标：该项目的目标是将热点分析与受过培训的同行专家结合起来 全面健康指导 (PS-WHC) 并评估这种方法是否可以减少无家可归的退伍军人 目标 1：进行随机对照试验以测试是否接受 PS-WHC（与增强型普通疗法相比）。 护理；EUC）预测 (1a) 较低的急性护理利用率，(1b) 更好的健康相关结果，以及 (1c) 是否 PS-WHC 对 1a 和 1b 的影响是通过增加 (i) 患者的活力和幸福感，以及 (ii) 目标 2：进行过程评估，了解 VA 的广泛应用潜力。 在 PACT 上实施热点分析 + PS-WHC 目标 3：进行预算影响分析 (BIA)。 确定实施 PS-WHC 对 VA 护理总成本的影响。 方法：在帕洛阿尔托和贝德福德 VA 使用混合 1 型设计，220 名退伍军人参与 PACT 面板 (i) 在 VA 无家可归者登记处，以及 (ii) 长期使用紧急护理的人将完成 基线访谈，被随机分配到 EUC（通常的 PACT 护理 + 热点分析和文本提醒 预约）或 EUC 加上 12 周内的 12 次 PS-WHC 会议，并在 3、6 和 9 点重新面试 对于目标 2，CFIR 框架将指导对 7 名 PACT 员工/领导者和 12 名关键知情者进行访谈。 对于 BIA，我们将仅包括来自 VA、收费基础护理和选择护理的 VA 费用。 将从随机开始并持续 9 个月的所有治疗的费用估算为每位患者。 后续步骤/实施：根据结果，我们将与全国范围内的 VACO 合作伙伴合作 退伍军人无家可归中心、以患者为中心的护理和文化转型办公室，以及 心理健康和自杀预防办公室进行了大规模的多地点实施试验。