Virtual Care Coordination in VA Primary Care-Mental Health Integration

退伍军人事务部初级保健-心理健康一体化中的虚拟护理协调

基本信息

批准号：
10639607
负责人：
Lucinda B Leung
金额：
--
依托单位：
VA GREATER LOS ANGELES HEALTHCARE SYSTEM
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-08-01 至 2025-09-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10639607
关键词：
Accident and Emergency department Address Adoption Affect Ambulatory Care Facilities Applications Grants Appointment Area Award COVID-19 COVID-19 pandemic Caring Characteristics Clinic Clinic Visits Clinical Communities Data Day Care Discipline Electronic Health Record Ethnic Origin Funding Future Goals Health Personnel Health Services Accessibility Healthcare Systems Intervention Interview Knowledge Learning Linear Models Measures Medical Medical Care Team Medical center Mental Health Mental Health Services Methodology Methods Modality Modeling Outcome Patient Care Patient-Focused Outcomes Patients Performance Persons Pilot Projects Primary Care Provider Quality of Care Race Reporting Research Risk Role Rural Sampling Scientific Advances and Accomplishments Services Specific qualifier value Structure Suicide prevention Telephone Time Urban Health Veterans Veterans Health Administration Visit care coordination cohort connected care design experience follow-up handbook health care settings improved innovation medical specialties primary care clinic primary care practice primary care provider primary care team research study rural healthcare telehealth therapy development urgent care video chat virtual virtual healthcare virtual patient virtual visit

项目摘要

Background: Among newly initiated Primary Care-Mental Health Integration (PC-MHI) patients, same day access to PC-MHI from primary care or other select medical clinics (e.g., emergency department/urgent care) is a Veterans Health Administration (VA) Strategic Analytics for Improvement and Learning (SAIL) performance measure (mnemonic: pcmhi7). Prompt initiation of mental health care after a medical visit increases the likelihood of subsequent mental health follow-up visits, enhancing quality of care. Yet, despite the rapid VA virtual care expansion during COVID-19, factors that influence virtual same day access to PC-MHI are unknown. Significance: Preliminary studies from this research group found that in a large VA medical center, PC-MHI same day access rates were nearly twice as high for in-person visits compared to virtual visits. Accordingly, PC-MHI patients who initiate care virtually may experience poorer medical and mental health outcomes from loss to follow-up. This finding reflects a knowledge gap that exists across disciplines in both VA and non-VA settings regarding effective strategies for virtual care coordination. The proposed study addresses multiple HSR&D Priority Areas: Access to Care, Mental Health, Primary Care Practice, Virtual Care/Telehealth. Innovation & Impact: The proposed research would be the first to characterize factors that influence same day access to PC-MHI among patients who use virtual care to initiate mental health services, including mutable clinic characteristics that may be amenable to intervention. By identifying specific predictors of same day access to PC-MHI from primary care, the proposed study will advance understanding of factors that affect virtual same day access while also identifying specific targets for future interventions, improving quality of care, and relatedly, medical and mental health outcomes, for Veterans who seek PC-MHI care virtually. Moreover, the study will advance scientific knowledge by providing data to inform strategies for effective interdisciplinary virtual care coordination. Specific Aims: 1) Identify multi-level characteristics associated with virtual and in-person PC-MHI same day access in a national VA sample. 2) Assess barriers, facilitators, and strategies for successful virtual care coordination in PC-MHI. Methodology: The study will use a mixed methods design. For Aim 1 (Quantitative), a national cohort of Veterans who initiated PC-MHI mental health services during FY2019 − FY2021 will be identified. PC-MHI same day access will be determined based on the presence or absence of a primary care or other select medical clinic visit on the same day as the initial PC-MHI appointment, per the Mental Health SAIL definition. A multi-level generalized linear model will be used to evaluate predictors of virtual and in-person same day access. For Aim 2 (Qualitative), semi-structured qualitative interviews with PC-MHI mental health providers and primary care providers from two VA healthcare systems (one urban, one rural) will be conducted to identify barriers, facilitators, and strategies for virtual care coordination in PC-MHI. Next Steps/Implementation: In partnership with the Office of Mental Health and Suicide Prevention, the Office of Connected Care, and the Office of Primary Care, the findings will be applied toward an HSR&D Merit Review Award grant proposal to develop an intervention to improve virtual care coordination in PC-MHI.

背景：在新发起的初级护理健康整合（PC-MHI）患者中，可以使用PC-MHI 在初级保健或其他精选医疗诊所（例如急诊科/紧急护理）中是退伍军人卫生管理（VA）改进和学习的战略分析（SAIL）绩效测量（疯子：PCMHI7）。医疗访问后迅速的心理保健计划增加了随后的心理健康随访，提高了护理质量。然而，策略快速的VA虚拟护理在COVID-19期间的扩展，影响实际上对PC-MHI的虚拟访问的因素尚不清楚。意义：该研究小组的初步研究发现，在一个大型VA医疗中心，PC-MHI 与虚拟访问相比，面对面访问的访问率几乎是两倍。根据PC-MHI的说法从损失到后续。这一发现反映了VA和非VA设置中跨学科的知识差距关于虚拟护理协调的有效策略。拟议的研究解决了多个HSR＆D 优先领域：获得护理，心理健康，初级保健实践，虚拟护理/远程医疗。创新与影响：拟议的研究将是第一个表征影响当天访问PC-MHI的因素的研究在使用虚拟护理开始心理健康服务的患者中，包括可变的诊所特征这可能适合干预。通过确定当天从初级保健获得PC-MHI的特定预测因素，拟议的研究将提前了解影响虚拟当天访问的因素，同时还确定了特定目标未来的干预措施，改善护理质量以及相关的医疗和心理健康成果，几乎寻求PC-MHI关心的退伍军人。此外，该研究将通过提供科学知识来提高科学知识数据以告知有效跨学科虚拟护理协调的策略。具体目的： 1）确定与虚拟和面对面PC-MHI访问相关的多层次特征国家弗吉尼亚州样本。 2）评估PC-MHI成功虚拟护理协调的障碍，促进者和策略。方法论：该研究将使用混合方法设计。对于AIM 1（定量），一位国家的退伍军人队列将确定2019财年的PC-MHI心理健康服务。 PC-MHI访问将根据初级保健或其他精选医疗诊所的存在或不存在根据心理健康帆的定义，与最初的PC-MHI预约同一天。多层次广义线性模型将用于评估虚拟和面对面访问的预测指标。目的 2（定性），半结构化的定性访谈与PC-MHI心理健康提供者和初级保健将开展来自两个VA医疗保健系统（一个城市，一个粗糙）的提供者，以识别障碍， PC-MHI中的促进者和虚拟护理协调策略。下一步/实施：与心理健康和预防自杀办公室合作，互联护理办公室以及初级保健办公室，调查结果将适用于HSR＆d优异审查奖励授予提案开发一种干预措施，以改善PC-MHI的虚拟护理协调。