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

• 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
• 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

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： 在新启动的初级保健-心理健康一体化 (PC-MHI) 患者中，当天即可获得 PC-MHI 来自初级保健或其他精选医疗诊所（例如急诊科/紧急护理）的退伍军人 健康管理局 (VA) 改进和学习战略分析 (SAIL) 绩效衡量 （助记符：pcmhi7）就诊后立即开始心理保健会增加出现以下情况的可能性： 随后的心理健康随访，提高了护理质量 然而，尽管退伍军人事务部进行了快速的虚拟护理。 在 COVID-19 期间进行扩展时，影响虚拟当日访问 PC-MHI 的因素尚不清楚。 意义： 该研究小组的初步研究发现，在一家大型 VA 医疗中心，PC-MHI 当天 与虚拟访问相比，亲自访问的访问率几乎是虚拟访问的两倍。 开始虚拟护理的患者可能会因失去亲人而经历较差的医疗和心理健康结果 这反映了退伍军人事务部和非退伍军人事务部跨学科存在的知识差距。 关于虚拟护理协调的有效策略拟议的研究涉及多个 HSR&D。 优先领域：获得护理、心理健康、初级护理实践、虚拟护理/远程医疗。 创新与影响： 拟议的研究将首次描述影响当日访问 PC-MHI 的因素 使用虚拟护理启动心理健康服务的患者，包括可变的诊所特征 这可能会受到干预。 通过确定初级保健当天获得 PC-MHI 的具体预测因素，拟议的研究将 了解影响虚拟提前当天访问的因素，同时确定具体目标 未来的干预措施，提高护理质量以及相关的医疗和心理健康结果， 此外，该研究还将通过提供虚拟方式寻求 PC-MHI 护理的退伍军人来推进科学知识。 数据为有效的跨学科虚拟护理协调策略提供信息。 具体目标： 1) 识别与虚拟和现场 PC-MHI 当日访问相关的多级特征 国家 VA 样本。 2) 评估 PC-MHI 中成功进行虚拟护理协调的障碍、促进因素和策略。 方法论： 该研究将采用混合方法设计，目标 1（定量）是一个全国退伍军人队列。 2019 财年至 2021 财年期间启动的 PC-MHI 心理健康服务将确定当日访问。 将根据是否存在初级保健或其他选定的医疗诊所就诊来确定 根据心理健康 SAIL A 多级定义，与首次 PC-MHI 预约同一天。 广义线性模型将用于评估 For Aim 当天虚拟访问和现场访问的预测因素。 2（定性）对 PC-MHI 心理健康提供者和初级保健人员进行半结构化定性访谈 来自两个 VA 医疗保健系统（一个城市，一个农村）的提供者将接受调查，以确定障碍， PC-MHI 中虚拟护理协调的促进者和策略。 后续步骤/实施： 与心理健康和自杀预防办公室、互联护理办公室以及 初级保健办公室，调查结果将应用于 HSR&D 优异评审奖拨款提案 制定干预措施以改善 PC-MHI 中的虚拟护理协调。