COVID-19 Preventive Health Inventory: Evaluating a primary care approach to catching-up on needed chronic and preventive care for Veterans

COVID-19 预防性健康清单：评估初级保健方法，以赶上退伍军人所需的慢性和预防性护理

• 批准号: 10538144
• 负责人: Ashok Reddy
• 金额: --
• 依托单位: VA PUGET SOUND HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-10-01 至 2024-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10538144
• 关键词: Acute; Address; Adoption; Blood Pressure; COVID-19; COVID-19 impact; COVID-19 pandemic; Care given by nurses; Caring; Case Manager; Chronic; Chronic Care; Chronic Disease; Clinic; Collaborations; Data; Development; Diabetes Mellitus; Diffusion; Disease; Disease Management; Early Diagnosis; Effectiveness; Electronic Health Record; Electronics; Emergency department visit; Equipment and supply inventories; Evaluation; Frontline worker; Glycosylated hemoglobin A; Health; Health Services; Health system; Hospitalization; Hypertension; Infrastructure; Intervention; Interview; Knowledge; Licensing; Managed Care; Measurement; Measures; Methodology; Modeling; Monitor; Morbidity - disease rate; Outcome; Patients; Policy Maker; Prevention; Preventive; Preventive care; Preventive healthcare; Primary Care; Provider; Quality of Care; Quasi-experiment; Recovery; Research Design; Research Personnel; Screening for cancer; Series; Services; Structure; Team Nursing; Telephone; Testing; United States Department of Veterans Affairs; Variant; Veterans; Veterans Health Administration; Visit; Work; care coordination; care delivery; cohort; colon cancer screening; colorectal cancer screening; comparison group; dashboard; electronic structure; experience; implementation evaluation; improved; improved outcome; innovation; insight; member; mortality; multilevel analysis; pandemic disease; pandemic impact; pandemic response; patient centered medical home; primary care clinic; primary care patient; primary care services; primary care team; programs; response; screening; service delivery; tool; uptake; video visit; virtual; virtual delivery; virtual healthcare

Background: Chronic disease and preventive care that occurs within primary care was delayed or deferred in the acute COVID-19 crisis, which is expected to have profound impacts on the health of VA patients. In response, the VHA Office of Primary Care (OPC) launched the Preventative Health Initiative (PHI) on March 1st, 2021 to support primary care in delivering needed primary care services. This innovative care coordination intervention leverages three main components: 1) development of an electronic dashboard utilizing 10 common chronic and preventive care quality measures; 2) using nurse care managers for proactive virtual care visits; and 3) the use of structured electronic health record note template to complete needed care. Our current work has shown substantial PHI use and diffusion; however, little is known about implementation and outcomes from PHI uptake. Our proposal will address these knowledge gaps and provide needed evidence on mitigation strategies being supported by the OPC. Significance/Impact: This study will build on ongoing collaborations between VA’s OPC and health services researchers and provide needed evidence that the VA health system can use to better serve Veterans in ongoing pandemic response and recovery. A key component of our work will assess whether national efforts to mitigate effects of the pandemic were effective in reducing adverse health impacts. Innovation: Our work will be the first to evaluate the implementation of a multi-component care coordination intervention to support chronic and preventive care after the disruption to primary care delivery caused by the pandemic. Specific Aims: Aim 1: Identify key factors associated with use of PHI at 1 year as a care coordination intervention to improve coordination of chronic and preventive disease in primary care Aim 2: Understand implementation of the PHI to deliver chronic and preventive care from the perspectives of a) clinic frontline staff (leaders, PCPs, and nurse care managers) and b) Veterans who received the PHI. Aim 3: Examine impact of PHI tool on primary care quality (diabetes, hypertension, and colon cancer screening) and potentially preventable utilization. Methodology: This rapid-cycle evaluation will use both quantitative and qualitative approaches to understanding the implementation and outcomes from the OPC’s PHI intervention. Aim 1: We will use a multi- level modeling approach to examine patient-level variation in rates of PHI-use to identify the extent to which Veteran, provider, or clinic-factors explain this variation. Aim 2: We will conduct semi-structured interviews among clinic staff to understand the implementation of PHI and Veteran experience of PHI-directed care. Aim 3: We will conduct a propensity scored matched analysis, matching patients who received PHI intervention to a comparison group who did not receive PHI to estimate the impacts on quality and utilization measures using a series of difference-in-differences regression models. Implementation/Next Steps: Together, work from these aims will provide key evidence for VA policymakers on the impact of a large-scale care coordination intervention on mitigating the impact COVID-19 on chronic and preventive care.

背景：初级保健中发生的慢性病和预防保健在 严重的 COVID-19 危机预计将对 VA 患者的健康产生深远影响。 对此，VHA 初级保健办公室 (OPC) 于 3 月启动了预防性健康倡议 (PHI) 2021 年 1 月 1 日，支持初级保健提供所需的初级保健服务。 干预利用三个主要组成部分：1) 开发电子仪表板，利用 10 常见的慢性和预防性护理质量措施；2) 使用护士护理经理进行主动虚拟护理 访问；以及 3）使用结构化电子健康记录笔记模板来完成我们当前所需的护理。 研究表明 PHI 的大量使用和传播；然而，人们对 PHI 的实施和传播知之甚少。 我们的提案将解决这些知识差距并提供所需的证据。 OPC 支持的缓解策略。 意义/影响：这项研究将建立在 VA OPC 和卫生服务机构之间持续合作的基础上 研究人员并提供必要的证据，证明退伍军人事务部卫生系统可以用来更好地为退伍军人提供服务 我们工作的一个关键组成部分将评估各国是否做出了努力 减轻大流行的影响有效地减少了对健康的不利影响。 创新：我们的工作将首先评估多组成部分护理协调的实施情况 在初级保健服务中断后，支持长期和预防性护理的干预措施 大流行。 具体目标： 目标 1：确定与一年内使用 PHI 作为护理协调相关的关键因素 改善初级保健中慢性病和预防性疾病协调的干预措施 目标 2：了解 实施 PHI，从 a) 诊所一线工作人员的角度提供长期和预防性护理 （领导者、PCP 和护理管理人员）和 b) 接受 PHI 的退伍军人 目标 3：检查 PHI 的影响。 关于初级保健质量（糖尿病、高血压和结肠癌筛查）的 PHI 工具以及潜在的 可预防的利用。 方法：这种快速周期评估将使用定量和定性方法 了解 OPC 的 PHI 干预的实施和结果 目标 1：我们将使用多种方法。 水平建模方法，用于检查 PHI 使用率的患者水平变化，以确定使用 PHI 的程度 退伍军人、医疗服务提供者或诊所因素解释了这种差异 目标 2：我们将进行半结构化访谈。 向诊所工作人员了解 PHI 的实施情况以及退伍军人 PHI 导向护理的经验。 3：我们将进行倾向评分匹配分析，将接受 PHI 干预的患者与 未收到 PHI 的对照组使用以下方法来估计对质量和利用措施的影响： 系列双重差分回归模型。 实施/后续步骤：这些目标的共同努力将为 VA 政策制定者提供关键证据 大规模护理协调干预措施对减轻 COVID-19 对慢性病和慢性病的影响的影响 预防性护理。