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：在初级保健中发生的慢性疾病和预防保健被延迟或推迟 急性Covid-19危机预计将对VA患者的健康产生深远的影响。在 回应，VHA初级保健办公室（OPC）于3月发起了预防健康计划（PHI） 2021年1月1日，以支持初级保健提供所需的初级保健服务。这种创新的护理协调 干预利用三个主要组成部分：1）使用10的电子仪表板开发电子仪表板 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的虚拟护理 访问； 3）使用结构化电子健康记录记录模板完全需要护理。我们的目前 工作显示了大量的PHI使用和扩散。但是，关于实施和 Phi吸收的结果。我们的建议将解决这些知识差距，并提供所需的证据 OPC支持缓解策略。 意义/影响力：这项研究将基于VA的OPC与健康服务之间的持续合作 研究人员并提供了所需的证据，表明VA卫生系统可以用来更好地为退伍军人服务 持续的大流行反应和恢复。我们工作的关键组成部分将评估国家是否努力 大流行的减轻影响可有效减少健康影响。 创新：我们的工作将是第一个评估多组分护理协调的实施的工作 干预以支持由 大流行。 具体目的：目标1：确定与使用PHI在1年使用的关键因素作为护理协调 在初级保健目标中改善慢性和预防性疾病协调的干预措施2：了解 从a）诊所前线工作人员的角度实施PHI来提供慢性和预防保健 （领导者，PCP和护士护理经理）和B）接受PHI的退伍军人。目标3：检查的影响 PHI初级保健质量（糖尿病，高血压和结肠癌筛查）以及可能 可预防的利用。 方法论：这种快速循环评估将使用定量和定性方法 了解OPC PHI干预的实施和结果。目标1：我们将使用多 检查phi使用率的患者级别差异的水平建模方法，以确定该程度的程度 资深人士，提供者或临床因素解释了这种变化。目标2：我们将进行半结构化访谈 在诊所工作人员中，了解PHI和资深PHI指导护理经验的实施。目的 3：我们将进行诺言得分的匹配分析，将接受PHI干预的患者与 没有收到PHI来估算使用A的影响的比较组 一系列差异差异回归模型。 实施/下一步：从这些目的的工作将为VA决策者提供关键证据 关于大规模护理协调干预对减轻对慢性和慢性影响的影响的影响 预防保健。