Veteran and Staff Perceptions of VHA Large Scale Adverse Event Communications

退伍军人和工作人员对 VHA 大规模不良事件沟通的看法

基本信息

批准号：
8597963
负责人：
Anashua RANI Elwy
金额：
--
依托单位：
EDITH NOURSE ROGERS MEMORIAL VETERANS HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-06-01 至 2014-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8597963
关键词：
Address Adverse event Affect Anxiety Caring Clinical Colonoscopy Communicable Diseases Communication Communications Media Consultations Data Set Decision Making Dental Development Disclosure Distress Doctor of Philosophy Effectiveness Emergency Situation Emotional Event Family Future Guidelines HIV Health Hepatitis Infection Infection Control Injury Interview Language Lead Leadership Learning Letters Maintenance Medical center Medicare Methodology Modeling Notification Outcome Patients Perception Prevention Probability Procedures Process Prospective Studies Public Health Reporting Research Research Proposals Resolution Resources Risk Self Efficacy Series Services Severities Social Welfare Staging System Telephone Testing Time Trust Veterans Work base care seeking cost experience follow-up health care service utilization health economics improved patient oriented prevent response risk perception tool

项目摘要

DESCRIPTION (provided by applicant): The Department of Veterans Affairs (VA) recognizes three types of disclosure of adverse events: 1) clinical disclosure, 2) institutional disclosure and 3) large scale disclosure. Decision regarding notification of large scale adverse events, defined as involving three or more patients, are made by the Principal Deputy Under Secretary of Health (PDUSH) in consultation with the Clinical Review Board (CRB) following guidelines based on probability of exposure and severity of the event on Veterans' health outcomes. Large scale adverse event communication is unique in that many Veterans are potentially exposed but few are truly at risk of infectious disease. Working with our operational partners-Office of the PDUSH, Office of Public Health (10P3), HIV/Hepatitis QUERI and the Health Economics Resource Center (HERC)--we have developed key research questions which reflect VHA leadership concerns when making decisions to notify Veteran patients of potential risks of infection following infection control breaches. We will employ a conceptual model of Crisis and Emergency Risk Communication model to identify optimal, patient-centered communication strategies to minimize risk of harm and unintended consequences following large scale disclosure over several communication time points: (1) initial communication; (2) maintenance communication; (3) resolution communication and (4) follow-up /evaluative communication. Our current work on clinical disclosures shows that ideal communication occurs over several time points and serves different purposes at each time. Our four staged studies involving qualitative and quantitative methodologies will address three key short-term objectives in this Service Directed Research proposal: (1) To explore the effect of VA large scale adverse events on Veterans', their families', and VHA staff perceptions of VA services, risk to self, and emotional responses to notification; (2) To determine the impact of past VA notification procedures on unintended outcomes, such as Veterans' and VHA staff anxiety and distress, Veterans' trust in the VA, self-efficacy for action, perceptions of risk of harm, and changes and cost in VA healthcare utilizations; (3) To empirically test the effectiveness of different models of notification procedures and language based on evidence collected in the SDR on Veterans' trust in the VA, anxiety and distress, self-efficacy for action, perceptions of risk of harm and decreased or increased cost and utilization. Our long-term objective is to develop a large scale adverse event notification tool kit that can be distributed b the PDUSH, CRB and our 10P3 partners to VHA and medical center leadership for use when notifying Veterans of possible risk of infection following large scale adverse events that occurred in VHA facilities where they received care. Study 1 will involve a content analysis of media reports and past notification letters to inform media and communication strategies in future disclosures. Study 2 involves interviews with Veterans, their families, VHA staff and leadership at the six VHA facilities who have disclosed large scale adverse events in the past two years. These interviews will benefit from the experiences of users of the VHA system, their families, and the staff affected most by the adverse event and disclosure process, to understand more about what worked and what needs to be improved in future strategies. Study 3 will examine the unintended consequences of adverse event notification by analyzing VA and Medicare cost and health care utilization data sets. We will seek to understand whether Veterans stayed in the VHA system following disclosure, whether they sought care outside the VA, whether costs decreased or increased, and the time it took for any changes to return to baseline. Study 4 will build on the previous three studies by creating large scale disclosure vignettes depicting different infection risk levels (high vs. low), and different types of large scale adverse events (dental vs. colonoscopy) which will vary by the notification medium (phone call, letter or both from VHA facilities). We will experimentally manipulate these variables to determine the optimal responses to questions about perceptions of risk of harm, trust in VA, self-efficacy for action and distress levels. These findings will culminate in the development of a large scale adverse event tool kit for wide distribution through the Principal Deputy Under Secretary for Health and the Office of Public Health. A future prospective study is proposed to evaluate the dissemination and implementation of the tool kit during an actual large scale adverse event disclosure process.

描述（由申请人提供）：退伍军人事务部 (VA) 认可三种类型的不良事件披露：1) 临床披露，2) 机构披露和 3) 大规模披露。关于大规模不良事件（定义为涉及三名或三名以上患者）通知的决定由卫生部首席副部长 (PDUSH) 与临床审查委员会 (CRB) 协商后根据暴露概率和严重程度的指导方针做出。关于退伍军人健康结果的活动。大规模不良事件沟通的独特之处在于，许多退伍军人都可能受到感染，但真正面临传染病风险的人却很少。与我们的业务合作伙伴（PDUSH 办公室、公共卫生办公室 (10P3)、HIV/肝炎 QUERI 和卫生经济资源中心 (HERC)）合作，我们制定了关键研究问题，这些问题反映了 VHA 领导层在做出通知决定时所关心的问题违反感染控制措施后存在潜在感染风险的退伍军人患者。我们将采用危机和紧急风险沟通模型的概念模型来确定最佳的、以患者为中心的沟通策略，以最大限度地减少在多个沟通时间点进行大规模披露后造成伤害和意外后果的风险：（1）初始沟通； (2)维护通讯； (3) 决议沟通和 (4) 后续/评估沟通。我们目前在临床披露方面的工作表明，理想的沟通发生在多个时间点，并且每次都有不同的目的。我们涉及定性和定量方法的四阶段研究将解决本服务导向研究提案中的三个关键短期目标：(1) 探讨 VA 大规模不良事件对退伍军人、其家人和 VHA 工作人员看法的影响VA 服务、自我风险以及对通知的情绪反应； (2) 确定过去 VA 通知程序对意外结果的影响，例如退伍军人和 VHA 工作人员的焦虑和痛苦、退伍军人对 VA 的信任、行动的自我效能、对伤害风险的看法以及变化和成本VA 医疗保健利用； (3) 根据 SDR 中收集的关于退伍军人对 VA 的信任、焦虑和痛苦、行动自我效能的证据，实证测试不同通知程序和语言模型的有效性，对伤害风险以及成本和利用率降低或增加的看法。我们的长期目标是开发一个大规模不良事件通知工具包，可以由 PDUSH、CRB 和我们的 10P3 合作伙伴分发给 VHA 和医疗中心领导层，以便在通知退伍军人大规模不良事件后可能存在的感染风险时使用发生的事情他们在 VHA 设施中接受护理。研究一将涉及对媒体报道和过去通知信的内容分析，以便为未来披露的媒体和沟通策略提供信息。研究 2 采访了退伍军人及其家人、VHA 工作人员以及六个 VHA 设施的领导层，他们在过去两年中披露了大规模的不良事件。这些访谈将受益于 VHA 系统用户、他们的家人以及受不良事件和披露流程影响最大的工作人员的经验，以更多地了解哪些是有效的，哪些是未来策略中需要改进的。研究 3 将通过分析 VA 和医疗保险成本以及医疗保健利用率数据集来检验不良事件通知的意外后果。我们将设法了解退伍军人在披露后是否留在 VHA 系统中，他们是否在 VA 之外寻求护理，费用是否减少或增加，以及任何变化恢复到基线所需的时间。研究 4 将建立在前三项研究的基础上，通过创建大规模披露小插图来描述不同的感染风险水平（高与低）以及不同类型的大规模不良事件（牙科与结肠镜检查），这些事件将因通知媒介（电话）而异来自 VHA 机构的电话、信件或两者兼而有之）。我们将通过实验操纵这些变量，以确定对伤害风险认知、对 VA 的信任、行动的自我效能和遇险程度。这些发现最终将开发出一个大规模的不良事件工具包，并通过卫生部首席副部长和公共卫生办公室广泛分发。建议进行一项未来的前瞻性研究，以评估该工具包在实际大规模不良事件披露过程中的传播和实施。