Pandemic-Related Disruptions in care for Veterans on Insulin Pumps (PD-VIP): A Mixed Methods Analysis

与流行病相关的胰岛素泵退伍军人护理中断 (PD-VIP)：混合方法分析

• 批准号: 10637010
• 负责人: Jamie Estock
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-06-01 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10637010
• 关键词: Accounting; Address; Adverse effects; Adverse event; Appointment; COVID-19 pandemic; Caring; Clinic; Clinical; Data; Devices; Diabetes Mellitus; Education; Endocrinology; Enrollment; Equipment Malfunction; Exclusion; Glycosylated hemoglobin A; Goals; Health Services Accessibility; Health care facility; Improve Access; Injury; Insulin Infusion Systems; Interview; Joints; Knowledge; Medical Device; Methodology; Methods; Modeling; Outcome; Patients; Prevention; Process; Provider; Quality of Care; Recommendation; Recovery; Remote management; Reporting; Research; Research Priority; Risk; Rural Community; Rural Health; Sampling; Service delivery model; Specific qualifier value; Structure; Technology; Time; United States Food and Drug Administration; Veterans; adverse event risk; care delivery; clinical development; connected care; design; evidence base; experience; high risk; improved; interest; medical complication; medical specialties; operation; pandemic disease; pandemic impact; pandemic response; post-pandemic; programs; remote delivery; remote health care; research and development; satisfaction; telehealth; tool; virtual healthcare

Background: Prior to the pandemic, the approximately 10,000 Veterans on insulin pumps (VIPs) were excluded from VA telehealth programs due to the complexity of their care and their risk of adverse events (AEs). The lack of enrollment of VIPs in VA telehealth programs resulted in a gap in knowledge of best practices for remote insulin pump management, making pandemic-related disruptions in care especially difficult and riskier for these Veterans. The urgency to switch all Veterans to telehealth for non-emergent care during the pandemic resulted in the need for VIPs and providers to adapt to new care processes and quickly “piece together” data-sharing technologies to overcome barriers and maintain safe and effective care. The objective of this study is to address the gap in knowledge of best practices for remote insulin pump management to mitigate adverse effects the ongoing pandemic has on high-risk VIPs. The long-term goal of this research is to establish an evidence-based telehealth program for safe and effective remote insulin pump management to improve access to remote care for VIPs and meet the growing demand for insulin pump therapy. Significance: This study will inform the advancement of telehealth processes and tools for remote insulin pump management that will: (1) benefit vulnerable Veterans living in rural communities and other Veterans who face access challenges, (2) expand care options for Veterans with diabetes who may be candidates for insulin pump therapy but are unable to access VA specialty care, and (3) enhance VIPs ability to connect with their care team for critical real-time troubleshooting of unexpected device failures and prevention of AEs. Expanding Veteran access to remote insulin pump management assures continued quality care and connection for VIPs and supports VA's clinical and legislative goals of improving Veteran access to care. Specific Aims: 1. Characterize the pandemic's impact on VIP outcomes, including process of care and clinical outcomes. Using a longitudinal observational design, we will examine VIP process of care and clinical outcomes over a 3-year period beginning 1.5 years prior to onset of the pandemic. We will use mixed effects and Cox regression models to compare outcomes before and during the pandemic while accounting for practice, provider, and patient-level covariates that are likely to influence the outcomes of interest. 2. Examine VIPs' and providers' experiences and satisfaction with insulin pump management before and during the COVID-19 pandemic and identify barriers to and facilitators of safe and effective remote care. We will conduct structured interviews with a VIPs and providers and apply rapid qualitative analysis to examine experiences and satisfaction with insulin pump management before and during the COVID-19 pandemic and identify barriers to and facilitators of safe and effective remote care. 3. Develop recommendations to advance telehealth processes and tools for safe and effective remote insulin pump management. We will integrate our findings from Aims 1 and 2 using joint displays and review them with a VA Expert Advisory Panel and VIP representatives to generate recommendations for immediate improvement to remote insulin pump management and for future research. Methodology: We selected a mixed-methods design to expand the breadth of our inquiry by obtaining an account of pandemic-related outcomes through our quantitative analysis and a sense of the process of transitioning VIPs to telehealth through our qualitative analysis. We will use our integrated findings to generate recommendations to improve how VA delivers remote care to VIPs moving forward. Next Steps/Implementation: Our partners at the VA National Endocrinology/Diabetes Program Office, VA Office of Rural Health, and VA Office of Connected Care will provide guidance and support throughout our study and facilitate the rapid dissemination of our findings across VA.

背景：大流行之前，胰岛素泵（VIP）的大约10,000名退伍军人是 由于其护理的复杂性和广告活动的风险，从VA远程医疗计划中排除了 （AES）。 VA远程医疗计划中缺乏VIP的入学率导致了最佳知识的差距 远程胰岛素泵管理的实践，使与大流行有关的护理中断特别困难 对于这些退伍军人而言，风险更大。将所有退伍军人转为远程医疗的紧迫性 大流行导致需要VIP和提供者适应新的护理过程，并迅速“零件 共同的“数据共享技术，以克服障碍并保持安全有效的护理。目标 这项研究的是解决远程胰岛素泵管理最佳实践知识的差距 缓解持续大流行对高风险VIP的不利影响。这项研究的长期目标是 建立一个基于证据的远程医疗计划，用于安全有效的远程胰岛素泵管理 改善远程护理的贵宾，并满足不断增长的胰岛素泵治疗需求。 意义：这项研究将为远程胰岛素的远程医疗过程和工具的进步提供信息 泵管理将：（1）利益居住在农村社区和其他退伍军人的弱势退伍军人 谁面临访问挑战，（2）扩大可能是候选人的糖尿病的退伍军人的护理选择 胰岛素泵疗法，但无法获得VA专业护理，（3）增强了VIP的能力 他们的护理团队对意外设备故障和预防AES进行严格的实时故障排除。 扩大资深人士进入远程胰岛素泵管理可确保持续的优质护理和 VIP的连接和支持VA的临床和立法目标，即改善退伍军人获得护理。 具体目的： 1。表征大流行对VIP结果的影响，包括护理过程和临床 结果。使用纵向观察设计，我们将检查VIP护理和临床的VIP过程 从大流行开始前1。5年开始的3年期间的结果。我们将使用混合 效果和COX回归模型，以比较大流行期间的结果 对于实践，提供者和患者级的协变量可能会影响感兴趣的结果。 2。在之前检查VIPS和提供商的经验和满意胰岛素泵管理 并在19日期大流行期间，确定安全有效的障碍和促进者 远程护理。我们将对贵宾和提供商进行结构化访谈，并应用快速定性 分析以检查经验和满足对胰岛素泵管理的满意 Covid-19-19大流行，并确定安全有效远程护理的障碍和促进者。 3。开发建议，以推进远程医疗流程和工具，以安全有效远程 胰岛素泵管理。我们将使用关节显示和 使用VA专家咨询面板和VIP代表来审查它们，以生成建议 立即改善远程胰岛素泵管理和未来的研究。 方法论：我们选择了混合方法设计，以扩大我们的查询广度 通过我们的定量分析和对大流行有关的结果的解释以及 通过我们的定性分析将VIP过渡到远程医疗。我们将使用我们的集成发现来生成 建议改善VA如何提供远程护理以向前发展的VIP。 下一步/实施：弗吉尼亚州弗吉尼亚州国家内分泌学/糖尿病计划办公室的合作伙伴 农村卫生办公室和VA Connected Care办公室将在我们的整个过程中提供指导和支持 研究并促进我们在VA中的发现的快速传播。