Optimizing Outcomes in Home-Based Primary Care

优化家庭初级保健的结果

基本信息

批准号：
9501514
负责人：
Samuel T Edwards
金额：
--
依托单位：
PORTLAND VA MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-07-01 至 2023-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9501514
关键词：
Academic Detailing Address Ambulatory Care Area Caring Chronic Disease Clinical Complex Data Data Analyses Data Collection Development Effectiveness Elements Enrollment Evaluation Feedback Focus Groups Goals Group Structure Health Care Costs Health Services Health Services Administration Health Services Research Home environment Hospitalization Hospitals Intervention Interview Intuition Investigation Knowledge Learning Length Literature Medical Medication Management Mentors Mentorship Methods Modeling Multicenter Trials Nature Outcome Palliative Care Patient Care Patient Selection Patients Pattern Perception Performance Phase Physicians Primary Health Care Process Provider Quality of Care Reading Regression Analysis Research Research Methodology Research Personnel Selection Criteria Services Site Subgroup System Telephone Interviews Testing Training Training Programs Variant Veterans Vulnerable Populations Work base care coordination care delivery care providers career chronic care model clinical predictors cohort cost density design experience formative assessment health administration health care service utilization high risk hospitalization rates implementation science improved insight longitudinal analysis multi-component intervention multiple chronic conditions patient subsets prevent primary care services programs secondary analysis service delivery skills social social health determinants success support tools therapy development

项目摘要

Objective: This proposal is for a CDA-2 mentored training program that will transition Samuel Edwards, MD, MPH into an independent VA health services researcher who has special expertise in the design, function and evaluation of care models for medically and socially complex Veterans. The overarching objective of the research plan is explore what features of VA Home Based Primary Care (HBPC) drive its success in reducing hospitalizations for ambulatory care sensitive conditions, and use these insights to develop an intervention to promote best practices in HBPC. Research Plan: Dr. Edwards will conduct three studies using mixed methods. The research approach will draw upon the literature on patient complexity, core features of primary care, and the chronic care model. The Specific Aims of the proposed research are to: 1) Characterize patterns of enrollment and care delivery within HBPC, and determine clinical and systems correlates of preventable hospitalizations, 2) Assess HBPC providers perceptions of appropriate patient selection and care delivery patterns, core functions of HBPC, and barriers and facilitators to HBPC performance, and 3) Develop and test a pilot intervention to promote best practices in HBPC. Methods: Aims 1 and 2 will consist of an explanatory sequential mixed methods study exploring HBPC patient selection, care delivery patterns, core functions of HBPC. Aim 1, is a quantitative study consisting of four secondary analyses of national VHA data to (1) determine predictors of enrollment in HBPC, (2) define clinical subgroups of HBPC patients, (3) describe care delivery patterns within HBPC, and (4) determine association of patient subgroups and care delivery patterns with ambulatory care sensitive hospitalizations. Aim 2 is a two phase qualitative study. In the first phase, we will perform an in depth study of our local HBPC program using interviews, focus groups and structured observation. Second, we will perform interviews with program directors at other HBPC programs to gain a broader understanding of differences between sites. In both phases we will explore perceptions of the patient selection process, appropriate care delivery patterns, and the importance of core HBPC functions focusing on 5 proposed domains: 1) strong provider-patient relationships, 2) medication management 3) addressing social determinants of health, 4) integration of palliative care, and 5) coordination of care. We also plan to explore provider perspectives on barriers and facilitators on HBPC performance. Finally, Aim 3 will be the development of a pilot intervention to promote best practices in HBPC learned from Aims 1 and 2, which will be tested locally in a trial. We will perform a formative evaluation concurrently focused on acceptability and feasibility, with a preliminary look at efficacy. The expected outcome will be preliminary data to support a multicenter trial of a refined intervention to be tested at multiple HBPC sites. Career Plan: Dr. Edwards is a physician-investigator with training in health services research methods and expertise in primary care redesign, team based care, and HBPC. This proposal will deepen his theoretical understanding, content expertise, and research skills. Specific areas for training are: 1) Qualitative and advanced quantitative skills that can be applied to mixed methods approaches in health services research; 2) Content expertise in patient complexity and home based primary care; and 3) Implementation science and intervention development. The training plan will consist of coursework, seminars, and readings guided by the mentorship team. Ultimately, these efforts will assist in Dr. Edwards reaching his goal of becoming a national leader in conducting research and testing care models directed at medically and socially complex Veterans.

目标：本提案针对 CDA-2 指导培训计划，该计划将过渡 Samuel Edwards，医学博士， MPH 成为一名独立的 VA 健康服务研究员，在设计、功能和评估医疗和社会复杂的退伍军人的护理模式。该组织的总体目标是研究计划是探索 VA 家庭初级保健 (HBPC) 的哪些特点推动其成功减少因门诊护理敏感情况住院治疗，并利用这些见解制定干预措施推广 HBPC 的最佳实践。研究计划：爱德华兹博士将使用混合方法进行三项研究。研究方法将借鉴有关患者复杂性、初级护理核心特征和慢性护理模式的文献。这拟议研究的具体目标是： 1) 描述入组和护理服务的模式 HBPC，并确定可预防的住院治疗的临床和系统相关性，2) 评估 HBPC 提供者对适当患者选择和护理提供模式、HBPC 核心功能的看法，以及 HBPC 绩效的障碍和促进因素，以及 3) 开发和测试试点干预措施，以促进最佳效果 HBPC 的实践。方法：目标 1 和 2 将包括探索 HBPC 患者的解释性序贯混合方法研究选择、护理提供模式、HBPC 的核心功能。目标 1 是一项定量研究，包括四个部分对国家 VHA 数据进行二次分析，以 (1) 确定 HBPC 入组的预测因素，(2) 定义临床 HBPC 患者亚组，(3) 描述 HBPC 内的护理提供模式，以及 (4) 确定患者亚组和护理服务模式以及门诊护理敏感住院治疗。目标 2 是一个二阶段定性研究。在第一阶段，我们将使用以下方法对当地 HBPC 计划进行深入研究：访谈、焦点小组和结构化观察。其次，我们会对节目总监进行采访参加其他 HBPC 项目，以更广泛地了解站点之间的差异。在这两个阶段我们都会探讨对患者选择过程的看法、适当的护理提供模式以及 HBPC 核心职能侧重于 5 个拟议领域：1) 牢固的医患关系，2) 药物治疗管理 3) 解决健康的社会决定因素，4) 姑息治疗的整合，以及 5) 协调的照顾。我们还计划探讨提供商对 HBPC 性能障碍和促进因素的看法。最后，目标 3 将是制定试点干预措施，以推广从 HBPC 中学到的最佳实践目标 1 和 2 将在本地进行试验。我们将同时进行形成性评估可接受性和可行性，并初步考察功效。预期结果将是初步的数据支持在多个 HBPC 站点进行精细干预的多中心试验。职业规划：爱德华兹博士是一名医师研究员，接受过卫生服务研究方法和初级保健重新设计、基于团队的护理和 HBPC 方面的专业知识。这个建议将加深他的理论理解、内容专业知识和研究技能。培训的具体领域包括： 1) 定性和可应用于卫生服务研究中混合方法的高级定量技能； 2）患者复杂性和家庭初级保健方面的内容专业知识； 3) 实施科学和干预发展。培训计划将包括课程作业、研讨会和阅读材料，由老师指导导师团队。最终，这些努力将帮助爱德华兹博士实现成为国家级医生的目标针对医疗和社会复杂的退伍军人进行研究和测试护理模式的领导者。