Applying Relational Coordination to Implement a Pulmonary E-consult Intervention

应用关系协调来实施肺部电子咨询干预

• 批准号: 9934194
• 负责人: Seppo T Rinne
• 金额: --
• 依托单位: EDITH NOURSE ROGERS MEMORIAL VETERANS HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-01-01 至 2023-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9934194
• 关键词: Address; Affect; Caring; Chronic Obstructive Airway Disease; Clinical; Communication; Complement; Consensus; Consult; Consultations; Delphi Technique; Development Plans; Doctor of Philosophy; Electronic Health Record; Elements; Environment; Evidence based practice; Focus Groups; Goals; Health Services; Health system; Individual; Influentials; Informatics; Institutes; Interpersonal Relations; Interruption; Intervention; Interview; Knowledge; Lead; Lung; Lung diseases; Mentors; Methods; Modeling; Modernization; Outcome; Outcome Measure; Pathway Analysis; Patient Care; Patients; Pharmaceutical Preparations; Positioning Attribute; Process; Provider; Published Comment; Quality of Care; Recommendation; Research; Research Personnel; Research Training; Resources; Role; Scientific Advances and Accomplishments; Site; Social Network; Specialist; Structure; Surveys; System; Testing; Time; Time Series Analysis; Training; Update; Veterans; Visit; Wait Time; Work; Writing; base; care delivery; care providers; career; career development; design; effectiveness implementation study; experience; health care delivery; health care service organization; health communication; implementation efforts; implementation framework; implementation outcomes; implementation research; implementation science; implementation strategy; improved; insight; intervention effect; medical specialties; multidisciplinary; novel; programs; satisfaction; skills; theories

Introduction: This is the second submission of a VA HSR&D CDA proposal for Seppo Rinne, MD PhD. Dr. Rinne is a practicing VA Pulmonologist, Clinical Informaticist, and a Core Investigator in the HSR&D Center for Healthcare Organization and Implementation Research (CHOIR). This proposal incorporates extensive revisions to address prior reviewer comments, which has led to a refined research focus and a rigorous career development plan. Since the first CDA submission, Dr. Rinne transferred to a new VA research environment that is closely aligned with his career goals, updated his mentoring and advising team to support these new goals, and established strong working relationships with key operational partners. The current proposal builds on Dr. Rinne’s previous training experiences and preliminary research to improve multidisciplinary coordination of pulmonary care by developing and implementing a theoretically-based informatics intervention. Background: Access to specialty care is often insufficient to meet demand. To improve timeliness and efficiency of specialty care, VA implemented electronic consultations (e-consults), which allow asynchronous provider-provider coordination through the electronic health record. However, limited research has considered potential unintended consequences of e-consults on patients’ and providers’ relationships and their quality of communication. Relational Coordination (RC) Theory provides insight that can address these gaps in knowledge and inform the design and implementation of e-consult interventions. Objective: To combine RC Theory with an established implementation model to guide the following Aims: Aim 1: Explore patient, PCP, and pulmonologist perspectives of e-consults and relationships. Aim 2: Develop consensus on essential components of pulmonary e-consult communication. Aim 3: Design and implement a pulmonary E-consult-First intervention. Methods: Aim 1 will use semi-structured interviews to explore perspectives on how e-consults impact interpersonal relationships and how patients and providers develop high quality relationships in the context of frequent e-consult use. Aim 2 will use a multi-step process with Delphi panels and Veteran focus groups to develop consensus on essential components of pulmonary e-consult communication. Aim 3 will: (A) apply a novel implementation strategy using social network analysis to identify influential individuals who can act as change agents; (B) work with these individuals and other local stakeholders to adapt information from Aims 1 and 2 to develop an e-consult intervention; and (C) evaluate the effect of the intervention and implementation strategy by conducting interviews to assess implementation outcomes, interrupted time-series analysis to examine wait times, and patient and provider surveys on satisfaction and the quality of coordination. Expected results: The proposed research will identify evidence-based practices to build and maintain patient and provider relationships that support e-consult use and establish new communication norms. These findings will inform the design and implementation of a successful e-consult intervention grounded in RC Theory that will be highly transferrable and adaptable to local contexts. Conclusions: Informatics interventions that consider humanistic elements of relationships and communication will lead to better healthcare delivery. Research on pulmonary e-consults will act as a model to improve quality and efficiency across specialty care. Therefore, the research outlined in this proposal is highly relevant to VA priorities of improving the timeliness of care, modernizing systems, and focusing resources more efficiently. Dr. Rinne is supported by a robust mentoring team, strong operational partners, and an outstanding research environment. The research and training objective described in this CDA proposal will provide him with the necessary knowledge and skills to become a successful and independent VA investigator focused on improving multidisciplinary coordination through novel, informatics-based interventions.

简介：这是医学博士 Seppo Rinne 博士第二次提交 VA HSR&D CDA 提案。 Rinne 是一名执业 VA 肺科医生、临床信息学家以及 HSR&D 中心的核心研究员 医疗保健组织和实施研究 (CHOIR) 该提案包含广泛的内容。 针对先前审稿人意见进行的修订，导致了研究重点的明确和严谨的职业生涯 自第一次提交 CDA 以来，Rinne 博士转移到了新的 VA 研究环境。 这与他的职业目标密切相关，更新了他的指导和建议团队以支持这些新的 目标，并与主要运营合作伙伴建立了牢固的工作关系。 关于Rinne博士之前的培训经验和改善多学科协调的初步研究 通过开发和实施基于理论的信息学干预来进行肺部护理。 背景：获得专业护理往往不足以满足需求。 为了提高专业护理的效率，VA 实施了电子咨询（e-consults），允许异步 然而，只有有限的研究考虑过通过电子健康记录进行提供商与提供商之间的协调。 电子咨询对患者和提供者的关系及其质量的潜在意外影响 关系协调（RC）理论提供了可以解决这些差距的见解。 知识并为电子咨询干预措施的设计和实施提供信息。 目标：将 RC 理论与已建立的实施模型相结合，以指导以下目标： 目标 1：探索患者、PCP 和肺科医生对电子咨询和关系的看法。 目标 2：就肺部电子咨询通信的基本组成部分达成共识。 目标 3：设计并实施肺部电子咨询优先干预措施。 方法：目标 1 将使用半结构化访谈来探讨电子咨询如何影响的观点 人际关系以及患者和提供者如何在以下背景下建立高质量的关系 Aim 2 将使用德尔福小组和退伍军人焦点小组的多步骤流程来频繁使用电子咨询。 就肺部电子咨询通信的基本组成部分达成共识，目标 3 将： (A) 应用 使用社交网络分析来识别有影响力的个人的新颖实施策略 变革推动者；(B) 与这些个人和其他当地利益相关者合作，调整目标 1 中的信息 2 制定电子咨询干预措施；以及 (C) 评估干预措施和实施的效果 通过访谈来评估结果实施情况、中断时间序列分析来制定战略 检查等待时间以及患者和提供者对满意度和协调质量的调查。 预期结果：拟议的研究将确定基于证据的实践来建立和维持患者 支持电子咨询使用并建立新的沟通规范的提供商关系。 将为基于 RC 理论的成功电子咨询干预的设计和实施提供信息 将具有高度可移植性并适应当地情况。 结论：考虑关系和沟通的人文要素的信息学干预措施 将带来更好的医疗服务，肺部电子咨询研究将成为提高质量的典范。 因此，本提案中概述的研究与 VA 高度相关。 提高护理的及时性、现代化系统和更有效地集中资源是优先事项。 Rinne 得到强大的指导团队、强大的运营合作伙伴和出色的研究的支持 本 CDA 提案中描述的研究和培训目标将为他提供 成为一名成功且独立的 VA 调查员所需的知识和技能，重点关注 通过新颖的、基于信息学的干预措施改善多学科协调。