Impacts of Organizational Variations on Access Management

组织差异对访问管理的影响

基本信息

批准号：
9717783
负责人：
Danielle Elise Rose
金额：
--
依托单位：
VA GREATER LOS ANGELES HEALTHCARE SYSTEM
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-01-01 至 2022-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9717783
关键词：
Address Aging Agreement Appointment Area Caring Characteristics Client satisfaction Clinic Communication Communities Community Networks Consensus Contracts Data Data Sources Development Evidence based practice Fostering Foundations Future Geography Group Practice Health Services Accessibility Healthcare Healthcare Systems Heart Diseases Hour Human Resources Improve Access Individual Intervention Leadership Link Location Long-Term Care Malignant Neoplasms Measures Mental Health Methods Morbidity - disease rate Outcome Patient Self-Report Patient-Focused Outcomes Patients Perception Performance Persons Policies Primary Care Physician Primary Health Care Process Provider Quality of life Recommendation Reporting Research Resources Role Rural Statutes and Laws Survey Methodology Surveys Techniques Time Traumatic Brain Injury Validation Variant Veterans Wait Time Whistle Blower Work base care coordination cohort contextual factors demographics evidence base evidence based guidelines experience improved indexing informant medical specialties meetings mortality novel strategies patient population physical conditioning post-traumatic stress rapid growth recruit response tool uptake virtual

项目摘要

Background: Delays in care (i.e., poor access to timely care) are associated with adverse impacts on morbidity, mortality and quality of life, as well as poor outcomes from physical and mental health conditions. The VHA healthcare system has long struggled with access issues, however, VHA's “access crisis” in 2014, where systemic access problems were identified after whistleblowers revealed intentional cover-ups of long delays, drew particular outrage as evidence emerged that Veterans had died waiting to see their VHA doctors. Improving Veterans' access to care continues to be among VHA's top priorities, and while expansion of access to community providers has been among the most visible approaches to reducing waits and delays, VHA has implemented numerous initiatives to improve Veterans' timely access to care within VHA as well. These include development of a group practice manager role to facilitate face-to-face and virtual appointment-making through call centers and access management tools (e.g., grid validation). Improving access management— effectively deploying clinic personnel, resources, and processes to achieve timely access—remains a major challenge nonetheless, especially across widely varying organizational and geographic contexts. Despite their importance, remarkably little is known about which of these strategies have been implemented, the factors that support or hinder their use, or their relationship to access metrics. Specific Aims: To address these gaps, we propose the following specific aims: Aim 1: To assess national variations in how local VA facilities manage primary care access. Aim 2: To evaluate how different access management strategies relate to access metrics. Aim 3: Building on results from Aims 1 and 2, to conduct a national expert panel to come to consensus on evidence-based practice and policy recommendations to improve access to care. Methods: For Aim 1, we propose to use key informant-based organizational surveys to assess implementation of access management strategies on a national basis. We will examine area and organizational determinants of their uptake, use and implementation by linking resulting survey data with Area Resource File measures (e.g., urban/rural, primary care shortage area), facility characteristics (e.g., complexity, academic affiliation), and other organizational measures (e.g., PACT Implementation Index). For Aim 2, we will then link data from Aim 1 to VHA access metrics, including both administrative (e.g., appointment wait times) and patient-reported access measures (e.g., obtained care when needed). For Aim 3, we will use modified Delphi panel techniques to bring together VA and non-VA experts in access management, primary care, care coordination and other areas to generate evidence-based recommendations based on data from Aims 1 and 2. Anticipated Impacts on Veterans' Healthcare: The proposed study will provide critical information for VA leadership to better understand which access management strategies have been implemented, what has driven uptake and implementation, the barriers and facilitators to their use, and which of them are in fact associated with better performance on access metrics. No other data sources are available to lay the groundwork for evidence-based approaches to solving VHA's access crisis on this scale despite the resources being applied. This study will yield multilevel targets for intervention and implementation in partnership with senior leaders and other stakeholders. Next Steps: We will work with leaders in Primary Care and Office of Veterans' Access to Care to disseminate findings to the field. During the Expert Panel, we will confer with panelists to identify optimal means of communication, including but not limited to issues briefs, toolkits, field guides, workgroups or other methods.

背景：护理延误（即难以获得及时护理）与对患者的不利影响有关。发病率、死亡率和生活质量，以及身心健康状况造成的不良后果。 VHA 医疗保健系统长期以来一直在与准入问题作斗争，然而，VHA 在 2014 年发生了“准入危机”，在举报人揭露故意掩盖长期信息后，发现了系统性访问问题当有证据表明退伍军人在等待看 VHA 医生的过程中死亡时，延误引起了特别的愤怒。改善退伍军人获得护理的机会仍然是 VHA 的首要任务之一，同时扩大获得护理的机会向社区提供者提供服务是减少等待和延误的最明显方法之一，VHA 已还实施了多项举措，以改善退伍军人在 VHA 内及时获得护理的机会。包括发展团队实践经理角色，以促进面对面和虚拟预约通过呼叫中心和访问管理工具（例如网格验证）。有效部署诊所人员、资源和流程以实现及时就诊仍然是一个主要任务尽管如此，挑战仍然存在，尤其是在不同的组织和地理环境中。重要性，令人难以置信的是，我们对其中哪些战略已实施、影响因素的因素知之甚少。支持或阻碍它们的使用，或者它们与访问指标的关系。具体目标：为了解决这些差距，我们提出以下具体目标：目标 1：评估当地 VA 机构管理初级保健服务的方式在全国范围内的差异。目标 2：评估不同的访问管理策略与访问指标的关系。目标 3：在目标 1 和 2 成果的基础上，召开国家专家小组会议，就以下问题达成共识：以证据为基础的实践和政策建议，以改善获得护理的机会。方法：对于目标 1，我们建议使用基于关键知情人的组织调查来评估实施情况我们将研究区域和组织决定因素。通过将调查结果数据与区域资源文件措施联系起来，了解其吸收、使用和实施情况（例如城市/农村、初级保健短缺地区）、设施特征（例如复杂性、学术背景）、对于目标 2，我们将链接来自的数据。目标 1 VHA 访问指标，包括管理（例如预约等待时间）和患者报告对于目标 3，我们将使用修改后的 Delphi 面板技术。汇集 VA 和非 VA 专家在准入管理、初级保健、护理协调和其他方面根据目标 1 和 2 的数据生成基于证据的建议。对退伍军人医疗保健的预期影响：拟议的研究将为退伍军人管理局提供关键信息领导层更好地了解已经实施了哪些访问管理策略，以及推动采用和实施、其使用的障碍和促进因素，以及其中哪些实际上是没有其他数据源可用于确定与更好的访问指标性能相关的信息。尽管资源有限，但仍为以证据为基础的方法解决如此规模的 VHA 准入危机奠定了基础这项研究将与合作产生多层次的干预和实施目标。高级领导人和其他利益相关者。后续步骤：我们将与初级保健和退伍军人获得护理办公室的领导者合作，传播在专家小组会议期间，我们将与小组成员讨论以确定最佳方法。沟通，包括但不限于问题简报、工具包、现场指南、工作组或其他方法。