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：护理延迟（即获得及时护理的不良访问）与对发病率，死亡率和生活质量以及身心健康状况不佳的结果。 VHA医疗保健系统长期以来一直在访问问题上挣扎，但是，VHA在2014年的“访问危机”，在举报人揭示出长长的掩盖之后，发现了系统的访问问题延误，当有证据表明退伍军人去世，等待看他们的VHA医生时，引起了特别的愤怒。改善退伍军人的护理访问权继续是VHA的首要任务之一，并且在扩展访问权限的同时对于社区提供商而言，这是减少等待和延误的最明显的方法之一，VHA有实施了许多举措，以改善退伍军人在VHA内部及时获得护理。这些包括发展小组练习经理角色，以促进面对面和虚拟任命通过呼叫中心和访问管理工具（例如，网格验证）。改善访问管理 - 有效地部署诊所人员，资源和流程以及时访问尽管如此，挑战，尤其是在广泛不同的组织和地理环境中。尽管他们重要的是，对这些策略的实施中的哪一种知之甚少，这些因素是支持或阻碍他们的使用或访问指标的关系。具体目的：为了解决这些差距，我们提出以下具体目的：目标1：评估当地VA设施如何管理初级保健访问的国家变化。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：基于目标1和2的结果，进行国家专家小组以达成共识循证实践和政策建议，以改善获得护理的机会。方法：对于AIM 1，我们建议使用基于知情人的主要组织调查来评估实施国家访问管理策略的基础。我们将检查领域和组织决定者通过将结果调查数据与区域资源文件测量联系起来的吸收，使用和实施（例如，城市/农村，初级保健短缺区），设施特征（例如，复杂性，学术会员），和其他组织措施（例如，PACT实施指数）。对于AIM 2，我们将链接来自目标1到VHA访问指标，包括行政（例如，约会等待时间）和患者报告访问措施（例如，在需要时获得护理）。对于AIM 3，我们将使用修改的Delphi面板技术将VA和非VA访问管理，初级保健，护理协调和其他方面的专家汇集在一起根据目标1和2的数据生成基于证据的建议的领域。对退伍军人医疗保健的预期影响：拟议的研究将为VA提供关键信息领导才能更好地了解已实施了哪些访问管理策略，驱动吸收和实施，障碍和促进者的使用，实际上是哪些与访问指标上更好的性能相关。没有其他数据源可以放置尽管有资源被应用。这项研究将产生多层目标，以与高级领导人和其他利益相关者。下一步：我们将与初级保健和退伍军人办公室的领导人合作进行宣布传播田野的发现。在专家小组期间，我们将与小组成员会议，以确定沟通，包括但不限于问题简介，工具包，现场指南，工作组或其他方法。