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

• 批准号: 8322214
• 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
• 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/8322214
• 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

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）承认不良事件的三种类型的披露：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通知的决定，定义为涉及三名或更多患者，是由卫生局局长（PDUSH）在与临床审查委员会（CRB）协商的指导方面做出的，该决定是基于指导方针的，基于对退伍军人健康状况事件的暴露概率和严重性的可能性。大规模的不良事件沟通是独一无二的，因为许多退伍军人可能会暴露出来，但很少有真正有传染病的风险。 与我们的PDUSH的运营合作伙伴办公室，公共卫生办公室（103），HIV/Hepatitis Queri和Health Economics Resource Center（HERC）合作 - 我们开发了关键的研究问题，这些问题反映了VHA领导层的关注，这些问题在将潜在的感染控制侵害后的潜在感染风险通知退伍军人时会担心。 我们将采用危机和紧急风险通信模型的概念模型来确定最佳，以患者为中心的沟通策略，以最大程度地减少在多个通信时间点进行大规模披露后的伤害风险和意外后果的风险：（1）初始交流； （2）维护沟通； （3）解决方案沟通和（4）随访 /评估通信。我们目前在临床披露方面的工作表明，理想的沟通在几个时间点上发生，并且每次都有不同的目的。我们的四项涉及定性和定量方法的研究将解决这项服务中的三个关键的短期目标，指导了研究建议：（1）探讨VA大规模不良事件对退伍军人的影响，其家庭和VHA员工对VA服务，对自我的风险以及对通知的情绪反应的影响； （2）确定过去的VA通知程序对意外结果的影响，例如退伍军人和VHA员工焦虑和困扰，退伍军人对VA的信任，对行动的自我效能感，对伤害风险的看法以及VA医疗保健利用的变化和成本； （3）基于SDR中对退伍军人对VA，焦虑和困扰的信任的证据，在经验上检验不同模型的通知程序和语言的有效性，行动的自我效能， 对伤害风险，减少或增加成本和利用的看法。我们的长期目标是开发一个大规模的不良事件通知工具套件，该套件可以分配给PDUSH，CRB和我们的10P3合作伙伴，向VHA和医疗中心领导层，以通知在发生大规模不良事件后可能有感染风险的退伍军人 在他们受到照顾的VHA设施中。研究1将涉及媒体报告和过去的通知信的内容分析，以告知将来披露的媒体和沟通策略。研究2涉及在过去两年中披露了大规模不良事件的六个VHA设施的退伍军人，他们的家人，VHA员工和领导层的访谈。这些访谈将受益于VHA系统的用户，其家人以及受到不利事件和披露过程影响最大的员工的经验，以更多地了解在未来策略中有效和需要改善的方法。研究3将通过分析VA和Medicare成本和医疗保健利用数据集来检查不良事件通知的意外后果。我们将寻求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，成本下降还是增加，以及任何更改返回基线所花费的时间。研究4将基于前三项研究，通过创建描述不同感染风险水平（高与低）以及不同类型的大规模不良事件（牙齿与结肠镜检查）的大规模披露小插图，这将因通知介质而异（电话，通话，字母或VHA设施与VHA设施）。我们将在实验中操纵这些变量，以确定对有关伤害风险，信任VA，行动自我效能和行动和 遇险水平。这些发现将在开发大型不良事件工具套件的开发中，通过卫生局长和公共卫生办公室的主要副副副副套件。提出了一项未来的前瞻性研究，以评估实际的大规模不良事件披露过程中工具包的传播和实施。