TeleWound Practice Partnered Evaluation Initiative

TeleWound Practice 合作评估计划

• 批准号: 10181068
• 负责人: Rachael N Martinez
• 金额: --
• 依托单位: EDWARD HINES JR VA HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-01 至 2021-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10181068
• 关键词: Address; Adverse event; Ambulatory Care Facilities; Americas; Amputation; Area; Caring; Cessation of life; Clinic; Clinical; Collaborations; Complex; Consultations; Data; Databases; Development; Diabetic Foot Ulcer; Diffusion; Discipline of Nursing; Ensure; Evaluation; Future; Geography; Goals; Gold; Health; Health Personnel; Health Services Accessibility; Healthcare Systems; Home; Hospitalization; Improve Access; Individual; Infrastructure; Institute of Medicine (U.S.); Interview; Leadership; Learning; Light; Mediation; Medical Care Team; Medical center; Methods; Mission; Modernization; Nature; Nursing Services; Nursing Staff; Office Nursing; Outcome; Patients; Policies; Population; Process; Provider; Quality of Care; Recording of previous events; Reporting; Research; Resources; Role; Rural; Science; Secure; Services; Shark; Site Visit; Specialist; Strategic Planning; Structure; Surveys; System; Technology; Telemedicine; Testing; Time; Veterans; Veterans Health Administration; Vision; Visit; Work; care delivery; connected care; cost; effectiveness evaluation; health information technology; implementation strategy; improved; innovation; member; patient engagement; patient oriented; preference; programs; remote delivery; rural area; satisfaction; scale up; stakeholder perspectives; telehealth; virtual healthcare; wound care; Address; Adverse event; Ambulatory Care Facilities; Americas; Amputation; Area; Caring; Cessation of life; Clinic; Clinical; Collaborations; Complex; Consultations; Data; Databases; Development; Diabetic Foot Ulcer; Diffusion; Discipline of Nursing; Ensure; Evaluation; Future; Geography; Goals; Gold; Health; Health Personnel; Health Services Accessibility; Healthcare Systems; Home; Hospitalization; Improve Access; Individual; Infrastructure; Institute of Medicine (U.S.); Interview; Leadership; Learning; Light; Mediation; Medical Care Team; Medical center; Methods; Mission; Modernization; Nature; Nursing Services; Nursing Staff; Office Nursing; Outcome; Patients; Policies; Population; Process; Provider; Quality of Care; Recording of previous events; Reporting; Research; Resources; Role; Rural; Science; Secure; Services; Shark; Site Visit; Specialist; Strategic Planning; Structure; Surveys; System; Technology; Telemedicine; Testing; Time; Veterans; Veterans Health Administration; Vision; Visit; Work; care delivery; connected care; cost; effectiveness evaluation; health information technology; implementation strategy; improved; innovation; member; patient engagement; patient oriented; preference; programs; remote delivery; rural area; satisfaction; scale up; stakeholder perspectives; telehealth; virtual healthcare; wound care

Background. Access to care is a high priority for VA, especially for Veterans living in rural or highly rural areas needing specialized care. Care of wounds such as diabetic foot ulcers is complex, costly, and can result in significant adverse events including hospitalization, amputation, and even death. TeleWound Practice, an effort to improve access for rural Veterans needing specialized wound care, was selected by the VA Under Secretary for Health and the Diffusion of Excellence (DOE) Office's Shark Tank competition as a Gold Star Practice to be implemented nationally, beginning in VISN 15. In partnership with DOE, Office of Nursing Services (ONS), and Office of Connected Care – Telehealth Services (OCC-TS), we propose the TeleWound Practice Partnered Evaluation Initiative to evaluate the implementation and impacts of the TeleWound Practice. Specific Aims. The aims of the TeleWound Practice PEI are to: (1) Evaluate the implementation of the TeleWound Practice by examining stakeholder perspectives of facilitators and barriers, assessing patient and provider satisfaction, observing processes and workflow, and testing reach of the program by number of patients using TeleWound Practice for wound care, (2) Assess the impact of the TeleWound Practice on clinical outcomes related to wound care, and (3) Assess the impact of the TeleWound Practice on healthcare system outcomes related to wound care. Significance. Using technology to support access to care, to promote patient engagement, and to embrace the individual needs and preferences of Veterans is directly reflected in VA's 2018-2024 Strategic Plan current priorities to (1) ensure greater choices and enhanced access, (2) improve timeliness of care, and (3) modernize VA systems, including health information technology. Innovation. A key component of the VA Maintaining Systems & Strengthening Integrated Outside Networks (MISSION) Act is the use of virtual care to improve access and quality of care, which is particularly important as over 37% of Veterans receiving care through VA reside in rural and highly rural areas. VA's transformation to a Learning Healthcare System involves aligning science with clinical priorities to conduct more rapid and efficient studies that evaluate the effectiveness and/or implementation of new programs (e.g., TeleWound Practice) or policies that address the priorities of VA leadership. The significance of the current work is also reflected in the mission of the VA to facilitate the development of results-driven innovations to improve quality, access, and transparency of care for Veterans. Methods. We propose a mixed-methods assessment. We aim to understand stakeholder perspectives regarding barriers and facilitators that influence successful implementation of the TeleWound Practice across VISN 15 medical centers and VA outpatient clinics using surveys and semi-structured interviews (Aim 1). Stakeholders include facility leadership, healthcare team members (i.e., clinic managers, telehealth staff, and wound care specialists), and Veterans. We will conduct site visits at two VISN 15 Medical Centers and four rural Outpatient Clinics to observe the processes and work flow involved in conducting wound care visits over Telehealth technologies and speak with those involved in the TeleWound Practice. Using data from national databases, we will test the impact of the TeleWound Practice on numbers of patients receiving wound care over telehealth technologies (Aim 1), clinical outcomes (Aim 2), and healthcare system outcomes (Aim 3). Expected Results. As the goal is to implement TeleWound Practice across VISN 15 over the next year, considering how best to build capacity through a refined and enhanced implementation strategy will be a main goal of our work as soon as the PEI is launched. Next Step(s). Our collaborations with key partners on the TeleWound Practice PEI will help fill the gap regarding evidence for future implementation strategies to enhance telehealth use for wound care delivery.

背景。对于VA来说，获得护理是一个重中之重，特别是对于居住在农村或高度农村地区的退伍军人而言 需要专业护理。护理诸如糖尿病足溃疡之类的伤口很复杂，昂贵，并且可能导致 重大不良事件，包括住院，截肢甚至死亡。远程实践，努力 为了改善需要专业伤口护理的退伍军人的访问权限 为了健康和卓越的扩散（DOE）办公室的鲨鱼坦克竞赛，作为金星练习 从全国实施，从VISN 15开始。与Doe，护理服务办公室（ONS）合作 互联护理办公室 - 远程医疗服务（OCC-TS），我们建议远程实践合作 评估倡议，以评估电视实践的实施和影响。 具体目标。电视实践的目的是：（1）评估实施 通过检查促进者和障碍的利益相关者的观点，评估患者和 提供者满意度，观察流程和工作流程以及按计划的测试范围 （2）评估远程练习对伤口护理的患者 与伤口护理有关的临床结果，以及（3）评估远图实践对医疗保健的影响 与伤口护理有关的系统结果。 意义。利用技术支持获得护理，促进患者参与并拥抱 退伍军人的个人需求和偏好直接反映在VA的2018 - 2024年战略计划中 （1）确保更大的选择和增强访问的优先级，（2）提高护理的及时性，（3） 现代化VA系统，包括健康信息技术。 创新。 VA维护系统和加强集成的外部网络的关键组成部分 （Mission）法案是使用虚拟护理来改善访问和护理质量，这尤其重要 由于超过37％的退伍军人在农村和高度农村地区接受护理。 VA的转型 学习医疗保健系统涉及使科学与临床优先级保持一致，以进行更快，并且 评估新计划的有效性和/或实施的有效研究（例如 实践）或解决VA领导优先事项的政策。当前工作的重要性也是 反映在VA的使命中，以促进成果驱动的创新以提高质量， 退伍军人的访问和透明度。 方法。我们提出了混合方法评估。我们旨在了解利益相关者的观点 关心的障碍和促进者影响成功实施电视实践 使用调查和半结构化访谈（AIM 1），Visn 15个医疗中心和VA门诊诊所。 利益相关者包括设施领导，医疗团队成员（即诊所经理，远程医疗人员，以及 伤口护理专家）和退伍军人。我们将在两个Visn 15个医疗中心和4个地点进行现场访问 农村门诊诊所观察进行伤口护理访问的过程和工作流程 远程医疗技术，并与参与电视实践的人进行交谈。使用来自国家的数据 数据库，我们将测试远程练习对接受伤口护理的患者人数的影响 远程医疗技术（AIM 1），临床结果（AIM 2）和医疗保健系统成果（AIM 3）。 预期结果。由于目标是在明年的VISN 15实施电视练习， 考虑如何通过精致和增强的实施策略最好地建立能力将是主要的 PEI启动后，我们的工作目标。 下一步。我们与关键合作伙伴在电视实践PEI上的合作将有助于填补空白 考虑未来实施策略的证据，以增强远程医疗用于伤口护理的使用。