Understanding the Effects of the MISSION Act on VA's Specialty Care Referral Networks

了解 MISSION 法案对 VA 专业护理转诊网络的影响

• 批准号: 10620107
• 负责人: Megan Adkins Adams
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-01 至 2025-10-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10620107
• 关键词: Acceleration; Address; Affect; Ambulatory Care; COVID-19 pandemic; Caring; Case Study; Characteristics; Cirrhosis; Community Healthcare; Complex; Enrollment; Event; Face; Future; Geography; Goals; Grant; Health; Health Services Accessibility; Health system; Healthcare Systems; Individual; Interview; Knowledge; Leadership; Measurable; Measures; Methodological Studies; Methodology; Methods; Modernization; Natural experiment; Nephrology; Outcome; Patients; Performance; Phase; Policies; Policy Making; Population; Process; Ramp; Recommendation; Recovery; Research; Resources; Sampling; Services; Site; Specialist; Structure; System; Telephone; Time; Variant; Veterans; care coordination; care delivery; comorbidity; coronavirus disease; economic impact; environmental change; experience; financial incentive; health care service organization; health management; improved; innovation; insight; medical specialties; post-COVID-19; response; time use; virtual healthcare

Background: Recently, VA underwent two unprecedented disruptive changes that fundamentally altered how care is delivered to Veterans. First, the VA MISSION Act was implemented in June 2019. Arguably the biggest policy change in VA care delivery since the "Kizer revolution,” MISSION’s purpose is to improve Veteran access to care, especially for services that have traditionally been resource-limited in VA due to geographic/ temporal barriers (e.g., specialty care). While VA healthcare systems were still in the early phases of adapting to MISSION, the COVID pandemic spread rapidly across the world, resulting in a sudden and prolonged ramp- down of elective outpatient care across the entire US healthcare system. VAMCs nationwide are independently adapting to these disruptive changes in ways that directly impact Veterans’ health and experience. Significance/Impact: Currently, we know little about MISSION’s early effects on where and how Veterans access specialty care (as moderated by COVID-related disruptions), or factors influencing community care referral. We also lack a clear understanding of how individual VAMCs are responding to these disruptive forces in realigning organizational strategy/structure to optimize performance. Addressing these knowledge gaps is critical to assessing the long-term impacts of MISSION and COVID on VA specialty care delivery and helping VAMCs to tailor adaptation approaches to their local setting to optimize the health and experience of Veterans. Innovation: Expansion of VA community care under the MISSION Act represents one of the largest natural experiments in delivery transformation in any U.S. healthcare system in modern times. Thus, VA community care expansion under MISSION offers an unparalleled opportunity to study the relationship between rapid environmental change, organizational adaptation, and long-term performance. The unanticipated system "reset" caused by COVID will only amplify and accelerate the adaptation process already underway. Specific Aims: Aim 1: Examine the relationship between VAMC organizational/environmental characteristics and longitudinal performance under MISSION/post-COVID, and the extent to which facility-level organizational adaptation measurably impacts performance. Aim 2: Characterize variation in organizational adaptation by high-performing tertiary VAMCs with different organizational/environmental characteristics. Aim 3: Explore how the experience of Veterans with specialty care needs differs at high-performing VAMCs with distinct organizational adaptation approaches. Methodology: In Aim 1a, using a longitudinal pre-/post- comparison analysis, we will examine the relationship between VAMC organizational/environmental characteristics and longitudinal performance under MISSION/post-COVID, including measures of access, care coordination, and community care referral. In Aim 1b, using a difference-in-differences approach, we will leverage differences in financial incentives between VAMCs to empirically assess the effect of VAMC organizational adaptation on longitudinal rates of VA community care referral and other outcomes. In Aim 2, we will interview leadership at 12 high-performing Level 1 VAMCs with varying organizational/environmental attributes to characterize variation in adaptation approaches under MISSION/post-COVID. In Aim 3, we will explore how VAMC organizational adaptation impacts Veterans’ specialty care experience through qualitative interviews of 48 Veterans at select Aim 2 sites. Implementation/Next Steps: This study will provide critical information about where and how Veterans access specialty care under MISSION/post-COVID, how high-performing tertiary VAMCs with different organizational/ environmental characteristics are adapting to enhance specialty care delivery under MISSION/post-COVID, and how variation in these adaptation approaches affects the Veteran experience of care. Grant products will provide vital information to VHA leaders about how tertiary VAMCs with unique facility-level characteristics can best adapt their organizational approaches to optimize performance and enhance the Veteran care experience.

背景：最近，VA进行了两个前所未有的破坏性变化，从根本上改变了 护理已交付给退伍军人。首先，《 VA任务法》于2019年6月实施。可以说是最大的 自“ Kizer Revoluts”以来，VA护理交付的政策变化，任务的目的是改善退伍军人 获得护理的访问，特别是对于传统上由于地理/ 临时障碍（例如，专业护理）。而VA医疗保健系统仍处于适应的早期阶段 为了传教，共同流行迅速在世界各地传播，导致突然而延长的坡道 - 整个美国医疗保健系统的选修课门诊护理。全国VAMC是独立的 通过直接影响退伍军人的健康和经验的方式适应这些破坏性的变化。 意义/影响力：目前，我们对任务对退伍军人的早期影响知之甚少 访问专业护理（受共同相关的干扰调节）或因素影响社区护理 推荐。我们也缺乏对个别VAMC如何应对这些破坏性力量的明确了解 在重新调整组织策略/结构以优化绩效。解决这些知识差距是 对于评估任务和共证对VA专业护理交付和帮助的长期影响至关重要 VAMC量身定制适应性的方法，以优化退伍军人的健康和经验。 创新：根据《任务法》的扩大VA社区护理是最大的自然之一 现代任何美国医疗保健系统中交付转型的实验。那是VA社区 任务下的护理扩张提供了一个无与伦比的机会来研究快速之间的关系 环境变化，组织适应和长期绩效。意外的系统 由COVID引起的“重置”只会扩大和加速已经进行的适应过程。 具体目的：目标1：检查VAMC组织/环境特征之间的关系 以及在任务/杂货后的纵向表现，以及设施级的组织的程度 适应会影响性能。目标2：通过组织适应的变化来表征 具有不同组织/环境特征的高绩效第三级VAMC。目标3：探索如何 具有专业护理需求的退伍军人的经验在高绩效的VAMC上有所不同 组织适应方法。 方法论：在AIM 1A中，使用纵向前/后比较分析，我们将研究这种关系 在VAMC组织/环境特征和纵向表现之间 任务/后载体，包括访问，护理协调和社区护理转诊的措施。目标 1B，使用差异差异方法，我们将利用经济激励措施的差异 VAMC以经验评估VAMC组织适应对VA纵向率的影响 社区护理转诊和其他结果。在AIM 2中，我们将在12个高绩效水平上采访领导力 1个具有不同组织/环境属性以表征适应性变化的VAMC 在任务/后载后的方法下。在AIM 3中，我们将探讨如何适应VAMC 通过对AIM 2个网站的48名退伍军人进行定性访谈，影响退伍军人的专业护理经验。 实施/下一步：本研究将提供有关退伍军人在何处和如何访问的关键信息 特殊护理在任务/杂乱之后，具有不同组织的高效三级VAMC/ 环境特征正在适应以增强任务/杂货后的专业护理交付， 以及这些适应方法中的变化如何影响退伍军人的护理经验。授予产品将 向VHA领导人提供有关具有独特设施级特征的第三纪VAMC的重要信息 最佳改编他们的组织方法来优化绩效并增强退伍军人护理体验。