Veteran Access to Emergency Care

退伍军人获得紧急护理

• 批准号: 10827365
• 负责人: Anita A Vashi
• 金额: --
• 依托单位: VETERANS ADMIN PALO ALTO HEALTH CARE SYS
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-05-01 至 2023-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10827365
• 关键词: Accident and Emergency department; Accountability; Accounting; Address; Advocate; Ambulatory Care Facilities; Area; Bypass; California; Caring; Chest Pain; Chronic; Communities; Community Healthcare; Complex; Confusion; Country; Data; Decision Making; Eligibility Determination; Emergency Care; Emergency Medicine; Emergency Situation; Emergency department visit; Enrollment; Ensure; Equipment and supply inventories; Equity; Failure; Family; Fostering; Funding; Future; Gender; Government; Gunshot wound; Health; Health Services Accessibility; Health system; Healthcare; Healthcare Systems; Home; Housing; Improve Access; Infrastructure; Institute of Medicine (U.S.); Insurance; Intervention; Interview; Knowledge; Medical emergency; Medicare; Methods; Myocardial Infarction; Outcome; Patients; Phase; Policies; Primary Care; Provider; Qualitative Methods; Quality of Care; Reporting; Research; Resources; Services; Structure; Surveys; System; Translating; United States; Variant; Veterans; Visit; Wife; Woman; Work; accountable care organization; acute care; care seeking; care systems; cohort; contextual factors; cost; design; experience; health care availability; health care service; improved; innovation; military veteran; preference; prevent; rural area; rurality; safety net; service organization

Significance: This project evaluates access to emergency care for Veterans with particular emphasis on: assessing resources and capabilities of VA EDs to care for Veterans during times of crisis, determining where care is provided (VA vs. non-VA EDs), and understanding how and why Veterans make decisions regarding where to seek emergency care. The objectives of this proposal are directly responsive to HSRD priority areas (Access and Health systems change) and three of the VA Breakthrough priority areas (Improve Access to Health Care, Improve Community Care, and Improve the Veteran Experience). We also address Secretary Shulkin's priority areas (Choice Act, improve infrastructure). Dr. Vashi and her team have strong ties to VA and non-VA operational and policy partners, including the VA National Director of Emergency Medicine, which will be instrumental in translating research findings into meaningful improvements in policy. Background and Innovation: Emergency care is a critical but understudied part of the continuum of health care services offered to Veterans by the VA. While the VA is committed to providing timely and high- quality emergency care, surprisingly little is known about Veteran access to acute care or about the quality of care provided. Variations in VA emergency care resources are not well understood and prevent Veterans from making informed choices. Moreover, eligibility for non-VA ED care is confusing, complex and can translate to delays in treatment and poor outcomes. VA estimates that current VA users get, on average, only about 38% of their ED visits from VA, yet no study to date has examined emergency care Veterans receive in non-VA settings. While use of non-VA EDs may sometimes be appropriate, there are other times when the ED care could have been provided at the VA and use of the non-VA ED may result in duplicative care and delays. This dual use matters to the VA because, like an Accountable Care Organization, the VA is still responsible for the overall health of the Veteran and often the expenses even when Veterans receive care outside of the VA. Aims: Objectives of this proposal are: (1) To create survey items that facilitate a comprehensive inventory of VA ED resources and capabilities; (2) to calculate VA and non-VA ED utilization rates and identify the patient, facility, and community-level predictors of VA ED use and VA reliance; and (3) to characterize Veterans' preferences, resources and contextual factors that influence ED setting choice (i.e. VA, non-VA). Methods: We will build on pilot work and convene an advisory panel to create and add survey items to the next ED survey to assess VA ED resources and capabilities and determine how they vary (e.g. region, rurality, complexity). Using an innovative linkage method, we will use VA, Medicare, and California data to examine ED use across groups. Further, we will assess the patient, facility, and community level predictors of Veterans' choice of delivery system and VA reliance. All analyses will be conducted for three cohorts: a national accountable veteran population (Veterans 65+), residents of California (Veterans 65+), and residents of California (Veterans 18-64). Finally, we will conduct semi-structured interviews with Veterans to better understand why Veterans choose to receive their ED care inside or outside the VA. As underscored by the Secretary, our methods rely on “what Veterans actually tell us” and lay the groundwork for future comparisons of VA and non-VA ED quality metrics. Expected results: We will determine capabilities of VA EDs nationwide and examine the impact of these factors on VA ED use and reliance. Further by analyzing data and speaking with Veterans, we will better understand where and why Veterans access the acute care system (in both VA and non-VA settings) and will identify barriers in access amendable to future intervention and policy changes. Once we can identify patients receiving care outside the VA and determine why they made that decision, we can then develop interventions to keep Veterans “in-network” when appropriate.

意义：该项目评估退伍军人获得紧急护理的情况，特别强调： 评估 VA ED 在危机时期照顾退伍军人的资源和能力，确定在哪里 提供护理（VA 与非 VA ED），并了解退伍军人如何以及为何做出以下决定： 该提案的目标直接响应 HSRD 优先领域。 （获取和卫生系统的变化）和 VA 突破性优先领域的三个（改善获得服务的机会） 医疗保健、改善社区护理和改善退伍军人体验）。 Shulkin 的优先领域（选择法案、改善基础设施） Vashi 博士和她的团队与 VA 和 VA 有着密切的联系。 非退伍军人管理局的业务和政策合作伙伴，包括退伍军人管理局国家急诊医学主任，它将 有助于将研究成果转化为有意义的政策改进。 背景和创新：紧急护理是连续性的一个关键但尚未得到充分研究的部分 退伍军人管理局向退伍军人提供医疗保健服务，同时退伍军人管理局致力于提供及时和优质的服务。 令人惊讶的是，人们对退伍军人获得急性护理的机会或医疗服务的质量知之甚少。 退伍军人管理局紧急护理资源的变化尚未得到充分了解，这阻碍了退伍军人的护理。 此外，非 VA ED 护理的资格是令人困惑、复杂的，并且可能会转化为 VA 估计，目前 VA 用户的平均治疗效果只有 38% 左右。 退伍军人管理局就诊的急诊室就诊人数，但迄今为止还没有研究检查退伍军人在非退伍军人管理局接受的紧急护理 虽然使用非 VA 急诊室有时可能是合适的，但有时也需要急诊室护理。 本可以在 VA 提供，但使用非 VA 急诊室可能会导致重复护理和延误。 双重用途对 VA 很重要，因为与责任医疗组织一样，VA 仍然负责 退伍军人的整体健康状况以及费用，即使退伍军人在退伍军人管理局之外接受护理也是如此。 目的：本提案的目标是：(1) 创建有助于全面清查的调查项目 VA ED 资源和能力；(2) 计算 VA 和非 VA ED 利用率并确定 患者、机构和社区层面的 VA ED 使用和 VA 依赖的预测因素； 退伍军人的偏好、资源和背景因素会影响 ED 环境选择（即 VA、非 VA）。 方法：我们将在试点工作的基础上召集一个顾问小组来创建调查项目并将其添加到 下一次 ED 调查，评估 VA ED 资源和能力，并确定它们如何变化（例如地区、农村、 使用创新的关联方法，我们将使用 VA、Medicare 和加利福尼亚州的数据来检查 ED。 此外，我们将评估退伍军人的患者、设施和社区层面的预测因素。 交付系统的选择和 VA 依赖性 所有分析都针对三个队列进行：全国队列。 负责任的退伍军人群体（65 岁以上退伍军人）、加利福尼亚州居民（65 岁以上退伍军人）以及 加利福尼亚州（退伍军人 18-64 岁）。最后，我们将对退伍军人进行半结构化访谈。 更好地了解为什么退伍军人选择在退伍军人管理局内部或外部接受急诊护理。 部长说，我们的方法依赖于“退伍军人实际告诉我们的内容”，并为未来奠定基础 VA 和非 VA ED 质量指标的比较。 预期结果：我们将确定全国 VA ED 的能力并检查这些能力的影响 进一步通过分析数据并与退伍军人交谈，我们将更好地了解 VA ED 使用和依赖的因素。 了解退伍军人在何处以及为何进入急症护理系统（在 VA 和非 VA 环境中），并将 一旦我们能够确定患者的障碍，就可以确定可对未来干预措施和政策变化进行修正的情况。 在 VA 之外接受护理并确定他们做出该决定的原因，然后我们可以制定干预措施 在适当的时候让退伍军人保持在“网络内”。