Understanding and Improving Video-Based Primary Care Delivery to Veterans

了解和改善向退伍军人提供的基于视频的初级保健服务

• 批准号: 10636185
• 负责人: Claudia Der-Martirosian
• 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: 2023-09-01 至 2025-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10636185
• 关键词: Adopted; Ambulatory Care; COVID-19; COVID-19 pandemic; Caregivers; Caring; Characteristics; Clinical; Collaborations; Data; Data Collection; Development; Effectiveness; Equipment; Familiarity; Feedback; Future; Guidelines; Health; Health Personnel; Health Services Accessibility; Home; Individual; Interruption; Intervention; Interview; Knowledge; Leadership; Learning; Literature; Logistics; Maps; Methodology; Methods; Modality; Patient-Focused Outcomes; Patients; Persons; Pilot Projects; Policies; Primary Care; Procedures; Process; Provider; Qualitative Research; Recommendation; Regression Analysis; Research; Research Personnel; Schedule; Site; Structure; Technology; Telephone; Time; Time Series Analysis; Training and Education; Update; Variant; Veterans; Videoconferencing; Visit; Work; care delivery; care outcomes; effectiveness evaluation; experience; health care delivery; improved; innovation; operation; pandemic disease; patient oriented; pilot test; preference; primary care clinic; primary care patient; sample collection; scale up; success; sustainability framework; telehealth; uptake; usability; video delivery; virtual; willingness

Background: [With the onset of the COVID-19 pandemic, VA primary care (PC) experienced a substantial increase in video-based encounters, nationwide. This rapid uptake of video-based care in PC clinics, however, varied by site. Given that the VA is committed to continue expanding VA Video Connect (VVC), which is the main videoconferencing platform at the VA, more research is needed to comprehensively examine why and how VVC was successfully adopted at some sites and understand why VVC expansion was limited at other sites.] Significance/Impact: [Barriers and facilitators to video-based care are many and multifaceted. This study will examine patient, provider, and site-level characteristics of VVC use in PC at high and low VVC sites, and identify patient-centered, provider-recommended, and leadership supported VVC guidelines that are context-specific for PC clinics. This study will contribute more generally to our understanding of what is needed to achieve acceptance of video technology. Such knowledge will be helpful for VA, as well as the delivery of healthcare in general. In-depth understanding about challenges and successes of VVC use will inform future improvements of VVC policies, processes, and procedures for all Veterans, across all VA facilities.] Innovation: This study will examine Veterans’ perspectives about how VVC in PC can be improved to better meet their needs when using video-based care. This is an understudied topic. Furthermore, by learning about the providers’ and leadership’s perspectives on how VVC can be implemented more effectively, we will better understand the full context of VA video care. [This 18-month pilot study will create context-specific VVC playbook for high and low VVC using sites that will be patient-centered, provider-recommended, and leadership supported. This will help improve delivery of video-based primary care and patient outcomes at the VA.] Specific Aims: This pilot study’s overall objective is to identify strategies to improve VVC use for all Veterans. 1) Identify PC clinic sites in the top 5% and bottom 5% of VVC use nationally by examining patient, provider, and site-level variations in VVC use since the onset of COVID-19 (March 2020-March 2024, aka study period). 2) Characterize patient-, provider-, site-specific factors associated with VVC use in PC, nationwide, during the study period. 3) Evaluate barriers and facilitators to using VVC in PC from patients, providers, and leadership (VISN/VAMC/CBOC) perspectives at 3 high and 3 low VVC using sites in PC (identified in Aims 1 & 2). Methodology: [The non-adoption, abandonment, scale-up, spread, and sustainability (NASSS) framework will be used for all aspects of the proposed study (data collection, analyses, synthesis of quantitative and qualitative findings). Two sequential, mixed methods approaches will be used, where quantitative analyses (Aims 1 & 2) will first inform the sampling and data collection for the qualitative interviews (Aim 3, n=60) at 3 high and 3 low VVC sites with patients, providers, and leadership. Using the explanatory mixed methods, the qualitative data will then help explain quantitative findings. In addition to in-depth interviews, the qualitative research will include document reviews on video-based care and VVC use for all 6 study sites After completing all analyses, quantitative and qualitative study findings will be mapped into the NASSS framework, which will help inform the development of patient-centered, provider-recommended, leadership-supported, and context-specific VVC playbook for PC clinics. The playbook will include strategies on how to improve VVC for high and low VVC sites. In close collaboration with all study operation partners (OCC, OPC, VEO), study Co-Investigators, and Veteran Engagement Groups (VEG), the playbook will be assessed for feasibility and usability.] Next Steps/Implementation: [To assess the effectiveness of the VVC playbook, future studies can pilot test the playbook at PC clinics at multiple VA sites. Pilot testing the playbook will provide the opportunity to receive feedback from different sites on how best to make the playbook suitable for all sites at the VA, nationally.]

背景：[随着Covid-19大流行的发作，VA初级保健（PC）经历了实质性的 在全国范围内增加基于视频的相遇。但是，这种在PC诊所的基于视频护理的迅速吸收 随着站点而变化。鉴于VA致力于继续扩展VA视频连接（VVC），这是主要的 VA的视频会议平台需要更多的研究来全面研究为什么和如何VVC 在某些地点成功采用，并理解为什么VVC扩展在其他站点受到限制。] 意义/影响力：[基于视频的护理的障碍和促进者是许多多方面的。这项研究会 检查VVC在高和低VVC站点中VVC使用的患者，提供商和站点级别的特征，并识别 以患者为中心的，提供者推荐和领导力支持的VVC指南，这些准则特定于上下文 PC诊所。这项研究将为我们对实现所需的目标做出更大的贡献 视频技术的接受。此类知识将对VA以及提供医疗保健的交付有所帮助 一般的。对VVC使用的挑战和成功的深入了解将为未来的改进提供信息 所有VA设施中所有退伍军人的VVC政策，过程和程序。] 创新：这项研究将研究退伍军人对如何改进PC中的VVC的观点 使用基于视频的护理时满足他们的需求。这是一个理解的话题。此外，通过学习 提供者和领导人对如何更有效地实施VVC的观点，我们将更好 了解VA视频护理的完整背景。 [这项18个月的试点研究将创建上下文特定的VVC剧本 对于使用将以患者为中心的网站，提供者推荐以及领导力的高VVC和低VVC 支持。这将有助于改善弗吉尼亚州基于视频的初级保健和患者结果的交付。] 具体目的：该试点研究的总体目标是确定改善所有退伍军人使用VVC的策略。 1）通过检查患者，提供者，在全国范围内使用VVC的前5％和最低5％的PC诊所站点 自19（2020-3月2024年3月，又名研究期）以来，VVC使用的现场级别变化。 2）表征患者，提供者，提供者，特定于现场的因素 研究期。 3）评估患者，提供者和领导者在PC中使用VVC的障碍和促进者 （VISN/VAMC/CBOC）使用PC中的位点在3个高和3低VVC处的透视图（在AIMS 1＆2中标识）。 方法论：[非补习，放弃，扩大，传播和可持续性（NASSS）框架将 用于拟议研究的各个方面（数据收集，分析，定量和定性的合成 发现）。将使用两种连续的混合方法方法，其中定量分析（AIMS 1和2）将 首先将定性访谈的采样和数据收集（目标3，n = 60）以3高和3低 VVC网站与患者，提供者和领导力。使用剥夺混合方法，定性数据 然后将有助于解释定量发现。除了深入的访谈外，定性研究还将 在完成所有分析后，包括有关所有6个研究网站的基于视频护理和VVC使用的文档评论， 定量和定性研究结果将映射到NASSS框架中，这将有助于信息 以患者为中心的，提供者推荐，支持领导和背景特定的VVC的开发 PC诊所的剧本。该剧本将包括有关如何改善高VVC站点的VVC的策略。 与所有学习操作合作伙伴（OCC，OPC，VEO）密切合作 参与小组（VEG），将评估剧本的可行性和可用性。] 下一步/实施：[为了评估VVC剧本的有效性，未来的研究可以试行测试 多个VA网站的PC诊所的剧本。试点测试剧本将提供接收的机会 来自不同网站的反馈，涉及如何最好地使剧本适合全国范围内的所有网站。]