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 大流行的爆发，VA 初级保健 (PC) 经历了巨大的 然而，全国范围内基于视频的就诊数量的增加。 鉴于 VA 致力于继续扩展 VA Video Connect (VVC)，这是主要内容。 VA 的视频会议平台，需要更多的研究来全面检验 VVC 的原因和方式 在一些站点成功采用，并了解为什么 VVC 扩展在其他站点受到限制。] 意义/影响：[基于视频的护理的障碍和促进因素很多且是多方面的。 检查 PC 中高 VVC 站点和低 VVC 站点的 VVC 使用的患者、提供者和站点级别特征，并识别 以患者为中心、提供者推荐、领导层支持的 VVC 指南，这些指南针对具体情况 PC 诊所将有助于我们更广泛地了解实现目标所需的条件。 接受视频技术将有助于 VA 以及医疗保健的提供。 总体而言，深入了解 VVC 使用的挑战和成功将为未来的改进提供信息。 适用于所有 VA 设施中所有退伍军人的 VVC 政策、流程和程序。] 创新：本研究将探讨退伍军人对如何改进 PC 中的 VVC 的看法 此外，通过了解基于视频的护理来满足他们的需求。 提供商和领导层对如何更有效地实施 VVC 的看法，我们将更好 [这项为期 18 个月的试点研究将创建针对具体情况的 VVC 策略] 针对高和低 VVC，使用以患者为中心、提供者推荐和领导力的网站 这将有助于改善 VA 的基于视频的初级护理和患者治疗效果。] 具体目标：这项试点研究的总体目标是确定改善所有退伍军人 VVC 使用的策略。 1) 通过检查患者、提供者、 自 COVID-19 爆发以来（2020 年 3 月至 2024 年 3 月，又名研究期），VVC 使用的地点水平变化。 2) 描述在全国范围内 PC 中与 VVC 使用相关的患者、提供者、地点特定因素 学习期间。 3) 评估患者、提供者和领导层在 PC 中使用 VVC 的障碍和促进因素 (VISN/VAMC/CBOC) 使用 PC 中的站点对 3 个高和 3 个低 VVC 进行视角（在目标 1 和 2 中确定）。 方法论：[不采用、放弃、扩大规模、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、定量和定性的综合） 将使用两种连续的混合方法，其中将进行定量分析（目标 1 和 2）。 首先告知定性访谈（目标 3，n=60）的抽样和数据收集，高 3 低 3 VVC 网站与患者、提供者和领导层使用解释性混合方法、定性数据。 除了深入访谈之外，定性研究将有助于解释定量研究结果。 包括所有 6 个研究中心基于视频的护理和 VVC 使用的文件审查 完成所有分析后， 定量和定性研究结果将被映射到 NASSS 框架中，这将有助于提供信息 发展以患者为中心、提供者推荐、领导支持和针对具体情况的 VVC PC 诊所的手册 该手册将包括有关如何改进高 VVC 和低 VVC 站点的 VVC 的策略。 与所有研究运营合作伙伴（OCC、OPC、VEO）、研究联合研究者和退伍军人密切合作 参与小组（VEG），将评估该手册的可行性和可用性。] 后续步骤/实施：[为了评估 VVC 手册的有效性，未来的研究可以试点测试 多个 VA 站点的 PC 诊所的手册将提供接收该手册的机会。 来自不同站点的关于如何最好地使该手册适合全国退伍军人事务部所有站点的反馈。]