VA Video Connect to Improve Access to Multi-disciplinary Specialty Care

VA 视频连接可改善获得多学科专业护理的机会

• 批准号: 9721402
• 负责人: Thomas P Giordano
• 金额: --
• 依托单位: MICHAEL E DEBAKEY VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-01-01 至 2023-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9721402
• 关键词: Address; Adherence; Adoption; Affect; Ambulatory Care Facilities; Annual Reports; Appointment; Area; Biometry; Blood Pressure; Caring; Chronic; Chronic Disease; Clinic; Clinic Visits; Clinical; Clinical effectiveness; Communicable Diseases; Communities; Complex; Computer software; Computers; Data; Development; Devices; Diagnosis; Effectiveness; Enrollment; Evaluation; Fostering; Funding; Gold; HIV; HIV Infections; HIV diagnosis; Health; Health Services Accessibility; Healthcare; Hepatitis; Home environment; Hospitals; Hybrids; Improve Access; Intervention; Interview; Knowledge; Lead; Leadership; Location; Logistics; Measures; Medical; Medical center; Medicine; Mental Health; Methodology; Methods; Modeling; Modernization; Monitor; Outcome; Participant; Patients; Peripheral; Persons; Phase; Physiologic pulse; Primary Health Care; Privatization; Process; Provider; Randomized; Readiness; Research; Rural; Rural Health; Safety; Secure; Services; Social Work; Stethoscopes; Technology; Telemedicine; Testing; Time; Training Support; Travel; United States; Veterans; Videoconferencing; Viral; Virus Diseases; Visit; Weight; Work; antiretroviral therapy; base; behavioral health; care systems; effectiveness implementation study; effectiveness trial; encryption; evidence base; experience; falls; formative assessment; glucose monitor; handheld mobile device; health care delivery; health disparity; heart rate monitor; high risk; implementation strategy; improved; innovation; mHealth; medical specialties; multidisciplinary; primary outcome; programs; remote location; routine care; secondary outcome; social stigma; telehealth; transmission process; uptake

Background: Improving retention in human immunodeficiency virus (HIV) care and increasing the proportion of Veterans with persistent HIV suppression is one of the 4 national priorities outlined in the VHA HIV, Hepatitis and Related Conditions Program’s 2016 Annual Report. Treatment of complex conditions like HIV requires multidisciplinary care and monitoring at regular clinic visits with multiple providers. In VHA that care is located and delivered primarily in VA medical centers, posing logistic and stigma related barriers to Veterans’ access to multidisciplinary HIV care. VA Video Connect (VVC), a VA-supported mobile health video technology that allows Veterans and providers to complete clinical visits from any remote location including the home, has the potential to transform delivery of multidisciplinary care for HIV and other chronic conditions by increasing access to care. VA leadership wants 5% of Veterans to receive care via VVC in FY2018, but less than 0.1% of Veterans with HIV have used VVC. VVC could help fill these gaps in care. Specific Aims: The aims are: Aim 1-Clinical Effectiveness: To determine the effectiveness of VVC-delivered, multidisciplinary HIV care compared to routine care on retention in care. Aim 2-Implementation: To conduct a mixed-methods formative evaluation to refine and evaluate our implementation facilitation (IF) strategy to improve the reach of VVC-delivered HIV care, increase provider and Veteran adoption, and determine potential for sustainability. Exploratory Aim: To assess the implementation potential of VVC- delivered HIV care across 6 diverse VHA settings and identify contextually specific barriers and facilitators to adoption. Significance to Veterans’ Health: The VA is one of the largest providers of HIV care in the US, and improving retention in care and HIV suppression is associated with improved survival with HIV. Priority areas: Improving access to care, modernization of VA, healthcare equity and health disparities. Innovation: While VVC is gaining a foothold in mental health care, it has not been widely used in specialty medical care. We will determine if multidisciplinary care delivered by VVC can improve retention in care and clinical outcomes for vulnerable Veterans in need of specialty medical care. The research will provide models and evidence for a transformative solution to increase Veterans' access to multidisciplinary care. Methodology: Aim 1 will be achieved with a pragmatic, Hybrid Type II effectiveness-implementation study within the Michael E. DeBakey VA Medical Center infectious diseases clinic, which cares for nearly 1000 Veterans with HIV. We will deploy an IF strategy to facilitate uptake of VVC and randomize Veterans to either be offered or not offered VVC. The study will enroll 360 Veterans and is powered to detect a 12% absolute improvement in retention in care, the primary outcome. Secondary outcomes include adherence to antiretroviral therapy, HIV suppression, and safety measures. Guided by the RE-AIM QuEST framework, Aim 2 layers a mixed-method evaluation on top of the effectiveness trial, enrolling 40 Veteran participants and numerous staff in in-depth interviews at all phases of the trial. The Exploratory Aim will be conducted working with 6 diverse VA HIV clinics and includes assessing organizational readiness, deploying the IF strategy, conducting in-depth interviews, and assessing reach and adoption of VVC in these clinics. Expected Results: We hypothesize that VVC will improve engagement and clinical outcomes and be acceptable to patients and providers. We will generate extremely valuable data and experience on implementation of VVC outside mental health care, regardless of impact on HIV care, and identify IF strategies that could be used in later implementation of VVC. Next Steps: If successful, we will work with partners to disseminate and implement VVC for multi-disciplinary HIV care throughout VA. We will also foster work in other chronic medical conditions. Our results could lead to accelerated uptake of VVC, improved access to care, and improved health for many Veterans.

背景：改善人类免疫缺陷病毒（HIV）护理的保留率并增加了比例 VHA HIV中概述的4个国家优先事项之一是持续的HIV抑制艾滋病毒的退伍军人的肝炎 和相关条件计划的2016年年度报告。诸如艾滋病毒之类的复杂条件的治疗需要 在定期与多个提供者的诊所访问时进行多学科护理和监测。在VHA中，护理位于 并主要在VA医疗中心交付，对退伍军人的访问构成了逻辑和污名障碍 进行多学科艾滋病毒护理。 VA视频Connect（VVC），一种由VA支持的移动健康视频技术 允许退伍军人和提供者从包括房屋在内的任何遥远位置完成临床访问， 通过增加艾滋病毒和其他慢性病的多学科护理的潜力 获得护理。 VA领导人希望5％的退伍军人在2018财年通过VVC接受护理，但不到不到0.1％ 艾滋病毒的退伍军人使用了VVC。 VVC可以帮助填补这些空白。 具体目的：目的是：目标1-临床有效性：确定vvc递送的有效性， 多学科的艾滋病毒护理与保留护理的常规护理相比。目标2实施：进行 混合方法形成评估，以完善和评估我们的实施设施（如果）策略 改善VVC销售的艾滋病毒护理的影响范围，增加提供者和退伍军人的收养，并确定潜力 为了可持续性。探索目的：评估VVC递送的艾滋病毒护理的实施潜力6 各种VHA设置，并确定具有上下文特定的障碍和促进者的采用。 对退伍军人的健康意义：VA是美国最大的艾滋病毒护理提供者之一，并改善 保留护理和HIV抑制与HIV的生存率提高有关。 优先领域：改善获得护理的机会，VA现代化，医疗保健和健康分配。 创新：虽然VVC在精神卫生保健方面取得了立足点，但它并未被广泛用于专业 医疗。我们将确定VVC提供的多学科护理是否可以改善护理中的保留率和 需要专业医疗服务的弱势退伍军人的临床结果。该研究将提供模型 以及一种变革性解决方案的证据，以增加退伍军人获得多学科护理的机会。 方法：AIM 1将通过务实的II型有效性研究实现 在Michael E. Debakey VA医疗中心传染病诊所中，它关心近1000 艾滋病毒的退伍军人。我们将部署一项策略，以促进VVC的吸收，并随机将退伍军人随机化为 提供或不提供VVC。该研究将招募360名退伍军人，并有助于检测绝对的12％ 改善护理保留率，这是主要结果。次要结果包括遵守 抗逆转录病毒疗法，HIV抑制和安全措施。在Re-Aim Quest框架的指导下，AIM 2 在有效性试验之外，将有40名老将参与者和 在审判的各个阶段，许多员工进行了深入的访谈。探索目的将进行 拥有6个潜水员VA HIV诊所，包括评估组织准备，部署IF策略， 进行深入的访谈，并评估这些诊所中VVC的影响力和采用。 预期结果：我们假设VVC将改善参与度和临床结果，并成为 患者和提供者可以接受。我们将生成极其有价值的数据和经验 无论对艾滋病毒护理的影响如何 这可以用于以后实施VVC。 下一步：如果成功，我们将与合作伙伴合作传播和实施VVC，以进行多学科 整个VA的艾滋病毒护理。我们还将在其他慢性医疗状况中培养工作。我们的结果可能导致 加速VVC的吸收，改善了医疗服务的机会，并改善了许多退伍军人的健康。