Access to Care for Veterans with Chronic Lower Limb Wounds

为患有慢性下肢伤口的退伍军人提供护理

• 批准号: 8600173
• 负责人: Gregory J. Raugi
• 金额: --
• 依托单位: VA PUGET SOUND HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-04-01 至 2013-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8600173
• 关键词: Accounting; Activities of Daily Living; Address; Ambulatory Care Facilities; Americas; Amputation; Area; Caring; Chronic; Chronic Care; Clinic; Clinical; Code; Communities; Complex; Current Procedural Terminology Codes; Data; Databases; Diabetes Mellitus; Disease; Evidence based practice; Fees; Foundations; Future; Geography; Goals; Healed; Health; Health Care Costs; Health Services Accessibility; Healthcare; ICD-9; Improve Access; Institution; Investigator-Initiated Research; Limb structure; Link; Lower Extremity; Measures; Medical; Medical Records; Medical center; Methods; Modeling; Outcome; Outpatients; Parents; Patients; Performance; Prevention; Primary Health Care; Provider; Publishing; Quality of life; Research; Research Priority; Risk; Rural; Rural Health; Sampling; Site; Specialist; Study models; Surveys; Time; TimeLine; Ulcer; Veterans; Work; austin; base; burden of illness; care systems; cohort; disability; evidence base; hazard; healing; improved; instrument; medical specialties; microsystems; prevent; programs; rural area; sound; symposium; therapy design; wound

PROJECT SUMMARY / ABSTRACT Background: Access to necessary specialty care is a VA priority and a major barrier for rural veterans. Barriers to specialist care include geography, time, clinical culture, financial issues, and specialist availability. Chronic lower limb wounds are a complex problem and a leading cause of disability. These wounds impact overall disease burden, quality of life, ability to perform activities of daily living, and health care costs for thousands of veterans. Given the intensity and complexity of outpatient medical management required to heal chronic wounds and prevent subsequent wounds from occurring, the issue of access to care is of paramount importance in rural areas. There are no studies on access to care for these veterans. Project Aims: Aim 1: Identify and characterize an urban cohort and a rural cohort of VISN 20 veterans with at least one complex chronic lower limb wound in FY 2007. Aim 2: Compare findings from a medical record review in a random sample of rural and urban veterans identified in Aim 1 to determine: (a) if the veteran received evidence-based good wound care; (b) if the care was organized; (c) if the care was coordinated, and (d) the clinical outcomes. Secondary Aim: Compare amputation rates between the rural and urban veterans. Project Methods: Aim 1: We will identify a cohort of unique veterans with chronic lower limb wounds at each primary care site in VISN 20 using Austin data repository and the Consumer Health Information and Performance Set (CHIPS) database supplemented with VA Fee-Basis data. In order to improve the reliability of extracted administrative data we will: (1) conduct a confirmatory medical record review of veterans identified as having chronic wounds in a reliable clinic log maintained by an established organized wound care program at the rural Walla Walla VA center; (2) identify an optimum combination of chronic wound-relevant ICD-9 and CPT codes, that when applied to administrative data, yield an accurate reflection of clinic log data; (3) apply the best combination of codes to all VISN 20 administrative data; (4) validate the data extraction by review of a random sample of medical records from each primary care site; and (5) develop a timeline for care of each veteran's first incident chronic ulcer in FY 2007, describing medical complexity, access to care, time to healing, complications, and amputations. Aim 2: We will survey a retrospective cohort of wound care providers at each VISN 20 facility operational in FY '07 by video conference adapting instruments used in a prior VA survey, to ascertain whether a "high" or "low" level of organized wound care was available mid-year FY '07. Cox proportional hazards will be used to account for competing risks to model time to healing, proportion healed, outcomes, and amputation rates. Anticipated Impact: The results of this study will be the foundation for future interventions designed to improve access to evidence-based, organized, coordinated care for rural veterans with chronic lower limb wounds.

项目摘要 /摘要 背景：获得必要的专业护理是VA的优先事项，也是农村退伍军人的主要障碍。 专业护理的障碍包括地理，时间，临床文化，财务问题和专家 可用性。慢性下肢伤口是一个复杂的问题，也是残疾的主要原因。这些 伤口会影响整体疾病负担，生活质量，进行日常生活活动的能力以及健康 成千上万的退伍军人的护理费用。考虑到门诊医疗的强度和复杂性 治疗需要治愈慢性伤口并防止随后的伤口发生，问题 在农村地区，获得护理至关重要。没有关于获得护理的研究 这些退伍军人。 项目目的：目标1：确定和描述一个城市队列和乡村队列的Visn 20退伍军人 在2007财年至少有一个复杂的慢性下肢伤口。目标2：比较医疗的发现 在AIM 1中确定的农村和城市退伍军人的随机样本中记录审查，以确定：（a）是否 退伍军人获得了循证的良好伤口护理； （b）如果组织了护理； （c）如果护理 协调，（d）临床结果。次要目的：比较农村的截肢率 和城市退伍军人。 项目方法：AIM 1：我们将确定一群具有慢性下肢伤口的独特退伍军人 VISN 20中的每个初级保健网站都使用Austin数据存储库和消费者健康信息以及 辅助VA费用数据数据的性能集（芯片）数据库。为了改善 提取的行政数据的可靠性我们将：（1）对 退伍军人被确定为在可靠的诊所日志中慢性伤口 Walla Walla VA中心的有组织的伤口护理计划； （2）确定最佳组合 与慢性伤口相关的ICD-9和CPT代码，当应用于管理数据时，会产生 准确反映临床对数数据； （3）将代码的最佳组合应用于所有Visn 20 数据; （4）通过审查每个主要的医疗记录的随机样本来验证数据提取 护理网站； （5）制定一个时间表来照顾每个退伍军人在2007财年的慢性溃疡， 描述医疗复杂性，获得护理，康复时间，并发症和截肢。目标2： 我们将调查每个Visn 20设施在FY中运营的可追溯性伤口护理提供者 '07由视频会议会议调整仪器在先前的VA调查中使用，以确定是“高”还是 “低”有组织的伤口护理可用于07财年中期。考克斯比例危害将是 用于考虑竞争风险，以建模时间以进行康复，比例治愈，结果和 截肢率。 预期的影响：这项研究的结果将是旨在将来干预措施的基础 改善慢性较低的农村退伍军人的循证，有组织，协调的护理 肢体伤口。