Bridging Care Gaps: Information Exchange Between VA and Non-VA Sites of Care

弥合护理差距：VA 和非 VA 护理地点之间的信息交换

• 批准号: 8867413
• 负责人: William W.,MPH, MD Hung
• 金额: --
• 依托单位: JAMES J PETERS VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-04-01 至 2016-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8867413
• 关键词: Accident and Emergency department; Acute; Adverse event; Ambulatory Care; Caring; Clinic; Clinical; Comprehensive Health Care; Data; Documentation; Emergency department visit; Enrollment; Event; Funding; Grant; Health; Healthcare Systems; Home environment; Hospitalization; Hospitals; Incidence; Individual; Intervention; Knowledge; Medicaid; Medical; Medical Errors; Medical center; Medicare; Medication Errors; Modeling; Monitor; Participant; Patients; Pharmaceutical Preparations; Physicians; Pilot Projects; Policies; Primary Health Care; Process; Provider; Quality of Care; Risk; Rural; Services; Site; Solutions; System; Testing; Veterans; Visit; Work; adverse outcome; care episode; care systems; cohort; follow-up; information organization; prevent; therapy design

 DESCRIPTION (provided by applicant): Prior studies of others and our data demonstrate that a large proportion of Veterans access multiple systems for care. Veterans who use both VA and non-VA services are at increased risk of adverse events, especially during transitions of care when changes in medications and plan of care may occur without the knowledge of VA physicians. Lacking access to adequate information of non-VA care among Veterans may limit ability of VA providers to provide levels of care of a medical home. Given that little is known about how information exchange occurs in Veterans accessing dual care, it is difficult to prescribe solutions to bridge the gap of VA and non-VA care. Understanding how information exchange occurs, the current gaps and reasons behind these gaps, may allow for developing solutions that will help bridge VA and non-VA care. The objectives of the project are to better understand how information exchange between VA and non-VA settings currently occurs and to assess the quality of information exchange between VA and non-VA providers. The specific aims of the study are (i) to describe how and to what extent information is exchanged with VA primary care teams among Veterans recently discharged from a non-VA hospital or emergency room; (ii) to determine the incidence of medical errors, defined as medication errors, test follow-up errors and work up errors, during the care transition process among these Veterans and (iii) to identify factors that are related to poor information exchange and with medical errors. The project will enroll Veterans from James J Peters VA Medical Center and Hudson Valley Health Care System, where up to 40% of Veterans have accessed non-VA care in the previous year. We will observe in a cohort of 200 Veterans in both urban and rural settings how information exchange occurs after a non-VA hospitalization or emergency room visit, and how and whether VA providers receive adequate information for ongoing care for Veterans. We will examine if the information exchange occurred according to VA dual care policy using a checklist derived directly from the dual care policy. We will then determine the incidence of medical errors, defined as medication errors, test follow-up errors and work up errors, during the care transition process from the review of documentation at the follow up visit at VA. We will then identify factors (Veteran, illness episode, and provider factors) that are associated with whether care was consistent with VA policy and with the incidence of medical errors.

 描述（由申请人提供）： 之前对其他人的研究和我们的数据表明，大部分退伍军人使用多个系统进行护理，同时使用退伍军人事务部和非退伍军人事务部服务的退伍军人发生不良事件的风险增加，特别是在护理过渡期间，当药物和计划发生变化时。由于人们对退伍军人如何进行信息交换知之甚少，因此无法在退伍军人中获得足够的非退伍军人护理信息可能会限制退伍军人管理局提供医疗之家的护理水平。获得双重护理，很难开处方弥合 VA 和非 VA 护理差距的解决方案 了解信息交换如何发生、当前的差距以及这些差距背后的原因，可能有助于制定有助于弥合 VA 和非 VA 护理差距的解决方案 该项目的目标是。为了更好地了解 VA 和非 VA 环境之间的信息交换目前如何进行，并评估 VA 和非 VA 提供者之间的信息交换质量，本研究的具体目的是 (i) 描述信息的方式和程度。最近从非退伍军人管理局退伍的退伍军人与退伍军人管理局初级保健团队进行交流医院或急诊室；(ii) 确定这些退伍军人在护理过渡过程中医疗错误的发生率，定义为用药错误、测试跟踪错误和检查错误；以及 (iii) 确定与以下因素相关的因素：贫穷的 该项目将招募来自 James J Peters VA 医疗中心和哈德逊谷医疗保健系统的退伍军人，我们将在队列中观察到高达 40% 的退伍军人在前一年接受过非 VA 护理。 200 名城市和农村退伍军人在非 VA 住院或急诊室就诊后如何进行信息交换，以及 VA 提供者如何以及是否获得足够的信息来为退伍军人提供持续护理 我们将检查信息交换是否按照 VA 进行。使用清单的双重护理政策然后，我们将直接从双重护理政策中得出医疗错误的发生率，定义为用药错误、测试随访错误和检查错误，在护理过渡过程中通过 VA 随访时的文件审查来确定。然后我们将确定因素（退伍军人、疾病发作和提供者） 因素）与护理是否符合 VA 政策以及医疗错误发生率相关。