Assessing Treatment Delay and Resource Use to Improve Value of Pre-Surgical Care

评估治疗延迟和资源使用以提高术前护理的价值

基本信息

批准号：
10415946
负责人：
Erika D Sears
金额：
--
依托单位：
VETERANS HEALTH ADMINISTRATION
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-04-01 至 2023-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10415946
关键词：
Accountability Address Ambulatory Care Attention Caring Carpal Tunnel Syndrome Clinic Clinical Communities Consultations Consumption Data Decision Making Development Diagnosis Diagnostic tests Expenditure Future Goals Health Care Reform Health Care Visit Healthcare Healthcare Systems Hospitalization Improve Access Injections Intervention Interview Lead Measurement Measures Medical center Methodology Methods Modeling Monitor Network-based Neurology Newly Diagnosed Occupational Therapy Operative Surgical Procedures Organizational Change Orthopedic Surgery Outcome Pain management Pathway interactions Patient Care Patient Outcomes Assessments Patient-Focused Outcomes Patients Performance Phase Physical Medicine Physical Rehabilitation Plastic Surgical Procedures Postoperative Care Preparation Primary Health Care Process Provider Quality of Care Recurrence Research Training Resources Series Specialist Steroids Structure Symptoms System Testing Time Touch sensation Training Programs Variant Veterans Visit Work base bundled payment care coordination care costs care episode care outcomes care providers career chronic pain clinical care community based care design disability health care delivery health care service health care service utilization health care settings improved innovation inpatient service medical specialties multidisciplinary nerve damage neurosurgery patient oriented persistent symptom pilot test preference programs prospective randomized trial recruit reduce symptoms rehabilitation management

项目摘要

Episode-based (“bundled”) approaches have been promoted for performance measurement to encourage shared accountability for the quality and efficiency of healthcare delivery among all of the providers involved in a patient's care. Most episode-based pilot programs use relatively narrow episode definitions, with the typical episode trigger starting at the time of a hospitalization or surgery. However, little attention has been paid to measuring quality and value of pre-surgical care. Although inpatient and postoperative care are costly, outpatient care accounts for the greatest utilization of health care resources in terms of visits and expenditures. This pre-surgical period, during which patients often have multiple touches with the healthcare system, is an important time to identify opportunities to improve coordination and quality of care for Veterans. The studies proposed as part of this CDA will facilitate development of innovative strategies to improve coordination, access, and value of care for Veterans with carpal tunnel syndrome (CTS), particularly in the pre- surgical period. Treatment for CTS is an ideal context to develop measurement models of care quality and utilization between primary care and specialty providers, given that approximately 40,000 Veterans per year are newly diagnosed with CTS and often receive care from one or more providers from primary care, occupational therapy, orthopedic surgery, plastic surgery, neurosurgery, physical medicine and rehabilitation, or pain management. Although a variety of nonoperative treatments can be appropriate under certain clinical circumstances, these same treatments can be low value if they lead to delays for patients who would benefit from surgery. This series of studies to evaluate and improve quality and utilization of CTS pre-surgical care will advance an understanding of how to optimize coordination of patient-centered surgical care more broadly. This project will have 3 aims: Aim 1: Using VHA national data, facility-level variation in CTS pre-surgical value will be assessed by examining both quality/access (inappropriate delay of surgery) and resource utilization (number of pre-surgical encounters), while evaluating the impact of key structural and process variables, including referral to community providers. Aim 2: Semi-structured interviews with patients and clinicians will be conducted to further identify and better understand factors associated with pre-surgical episode quality and utilization. Clinicians and patients will be recruited from 2 facilities with the highest and 2 facilities with the lowest performance on both pre-surgical measures (quality and utilization) to evaluate perspectives, preferences, organizational factors, and care goals of key stakeholders (patients and providers) who impact decision-making across phases of pre-surgical CTS care. Aim 3: Findings from Aim 1 and Aim 2 will be used to design and pilot a multi-disciplinary CTS clinical care pathway that addresses systemic barriers and processes impacting pre-surgical episode quality/access and utilization of CTS-related care provided across primary care and specialty clinics. Pilot testing will assess the intervention's feasibility, acceptability, and potential to improve facility-level pre-surgical episode value in preparation for an anticipated randomized trial. These methods, refined for CTS, will be applied in future work to examine variation in quality and utilization of pre-surgical care for other conditions, with the goal of optimizing use of health care services and maximizing outcomes for Veterans who receive surgical care. In anticipation of greater Veteran access to community- based care, this initiative will also be beneficial for monitoring and better coordinating the quality and value of care across diverse healthcare settings.

基于情节（“捆绑”）的方法已被推广用于绩效衡量，以鼓励所有参与的提供者共同承担医疗保健服务质量和效率的责任大多数基于事件的试点项目使用相对狭窄的事件定义，具有典型的事件定义。然而，很少有人关注住院或手术时的发作触发因素。衡量术前护理的质量和价值尽管住院和术后护理费用昂贵，从就诊次数和支出来看，门诊护理在医疗保健资源中的利用率最高。手术前的这段时期是患者经常与医疗保健系统进行多次接触的时期。寻找改善退伍军人护理协调和质量的机会的重要时刻。作为本 CDA 的一部分提出的研究将促进创新战略的制定，以改善患有腕管综合症 (CTS) 的退伍军人的协调、获取和护理价值，特别是在康复前 CTS 的治疗是开发护理质量和测量模型的理想背景。鉴于每年大约 40,000 名退伍军人新诊断出患有 CTS，并且经常接受来自初级保健的一名或多名提供者的护理，职业治疗、骨科手术、整形外科、神经外科、物理医学和康复、尽管在某些临床情况下多种非手术治疗可能是合适的。在这种情况下，如果这些相同的治疗导致本应受益的患者的延误，那么它们的价值可能很低这一系列研究旨在评估和提高 CTS 术前护理的质量和利用率。了解如何更广泛地优化以患者为中心的手术护理的预先协调。项目将有 3 个目标：目标 1：使用 VHA 国家数据，CTS 术前价值的设施水平变化将通过以下方式进行评估：检查质量/可及性（手术不当延误）和资源利用（手术前的数量）遭遇），同时评估关键结构和流程变量的影响，包括参考社区提供者。目标 2：将对患者和僧侣进行半结构化访谈，以进一步识别和更好地了解与术前事件质量和利用率相关的因素。从术前绩效最高的 2 家机构和绩效最低的 2 家机构招募评估观点、偏好、组织因素和护理目标的措施（质量和利用率）影响术前 CTS 各阶段决策的关键利益相关者（患者和提供者）关心。目标 3：目标 1 和目标 2 的研究结果将用于设计和试点多学科 CTS 临床护理解决影响术前事件质量/访问的系统性障碍和过程的途径利用初级保健和专科诊所提供的 CTS 相关护理将评估效果。干预措施的可行性、可接受性以及提高设施级术前事件价值的潜力为预期的随机试验做准备。这些针对 CTS 进行改进的方法将在未来的工作中应用，以检查质量和利用率的变化针对其他病症的术前护理，目的是优化医疗保健服务的使用并最大限度地利用接受手术护理的退伍军人的结果预期退伍军人有更多机会进入社区。基于护理，这一举措还将有利于监测和更好地协调护理的质量和价值跨不同医疗保健环境的护理。

项目成果

期刊论文数量（25）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Out-of-Pocket Spending for Thumb Carpometacarpal Arthritis: Capitation Matters.

拇指腕掌关节炎的自付费用：按人头付费很重要。

DOI：
10.1177/1558944720906503
发表时间：
2021
期刊：
Hand (New York, N.Y.)
影响因子：
0
作者：
Billig,JessicaI;Lu,Yu-Ting;Kelley,BrianP;Chung,KevinC;Sears,ErikaD
通讯作者：
Sears,ErikaD

Pathology Evaluation of Reduction Mammaplasty Specimens and Subsequent Diagnosis of Malignant Breast Disease: A Claims-Based Analysis.

缩小乳房整形术标本的病理学评估和恶性乳腺疾病的后续诊断：基于索赔的分析。

DOI：
10.1007/s00268-019-04931-1
发表时间：
2019
期刊：
World journal of surgery
影响因子：
2.6
作者：
Sears,ErikaD;Lu,Yu-Ting;Chung,Ting-Ting;Momoh,AdeyizaO;Chung,KevinC
通讯作者：
Chung,KevinC

Use of Preoperative Mammography During Evaluation for Nononcologic Breast Reduction Surgery.

在非肿瘤性乳房缩小手术评估过程中使用术前乳房X线照相术。

DOI：
10.1001/jamasurg.2018.4875
发表时间：
2019
期刊：
JAMA surgery
影响因子：
16.9
作者：
Sears,ErikaD;Lu,Yu-Ting;Swiatek,PeterR;Chung,Ting-Ting;Kerr,EveA;Chung,KevinC
通讯作者：
Chung,KevinC

Carpal Tunnel Syndrome as a Test Case for Value Assessment During the Presurgical Period: The Impact of Structure and Processes of Care.

腕管综合症作为术前价值评估的测试用例：护理结构和过程的影响。

DOI：
10.1097/mlr.0000000000001790
发表时间：
2023
期刊：
Medical care
影响因子：
3
作者：
Sears,ErikaD;Evans,Richard;Burns,Jennifer;Chung,KevinC;Hayward,RodneyA;Kerr,EveA
通讯作者：
Kerr,EveA

Comparison of Safety and Insurance Payments for Minor Hand Procedures Across Operative Settings.