Patient-Experienced Integrated Care for Veterans with Multiple Chronic Conditions

为患有多种慢性病的退伍军人提供患者体验的综合护理

• 批准号: 8590444
• 负责人: Mark Meterko
• 金额: --
• 依托单位: VA BOSTON HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-04-01 至 2017-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8590444
• 关键词: Address; Behavior; Caregivers; Caring; Characteristics; Clinical; Collaborations; Comorbidity; Complex; Consultations; Data Collection; Databases; Development; Diabetes Mellitus; Dimensions; Future; Geographic Locations; Goals; Hand; Healthcare; Healthcare Systems; Intervention; Interview; Knowledge; Lead; Location; Measures; Medical; Medical center; Mental Health; Methods; Modeling; Organizational Change; Outcome; Patient Care; Patient Self-Report; Patient-Centered Care; Patients; Phase; Policies; Positioning Attribute; Primary Health Care; Process; Property; Provider; Psyche structure; Quality of Care; RQ2; Research; Research Design; Role; Services; Severities; Site; Structure; Support System; Surveys; System; Systems Integration; Technology; Testing; Time; Training; Translating; Veterans; Visit; Work; base; collaborative care; cost; design; experience; health administration; improved; innovation; instrument; medical specialties; multiple chronic conditions; preference; programs; therapy design; tool

DESCRIPTION (provided by applicant): Integration remains a signature challenge for healthcare. Fragmentation limits healthcare systems' ability to provide the right care, at the right time, at reasonable cost. This fragmentatin is driven by several factors including the rapid expansion of medical knowledge and technology, and the related specialization among clinical professionals. These factors increase the number of hand-offs across departmental boundaries and geographic locations. In the VA, major national redesign innovations such as Primary Care-Mental Health Integration (PC-MHI) and Patient-Aligned Care Teams (PACTs) have been initiated to promote integration across the boundaries of specialty, role, and physical location where information and patient hand-offs occur. The ultimate goal of these efforts is to enhance patient-centered care. However, the degree to which these integrating innovations at the structural and process level enhance the patient's experience of integrated care remains unknown. Thus the overall goal of the proposed study is to assess the extent to which Veterans experience their care as integrated and to identify the alterable organizational characteristics and specific care processes that promote patient-experienced integrated care. Working with operational partners, this knowledge can then be used to develop interventions that enhance patient- experienced integration (PEI). We propose to target patients with diabetes and co-morbid conditions that differ on two dimensions: co-morbidity domain (physical; mental health-related) and severity (low; high). As the number of providers and locations multiply, so do the integration challenges. The most complex co-morbidities, presenting the greatest threat to integration, are those that cross physical and mental domains and require both primary and specialty care services. Studying these four groups will expose challenges in integration and identify actionable levers for organizational change. We propose to achieve the overall study goal by addressing four specific research questions: We propose to achieve the overall study goal by addressing four specific research questions: (RQ1) How integrated is the care experienced by Veterans with diabetes, and does experienced integration vary among patient groups given differences in co-morbidity domain and extent of specialty care involvement, as well as differences in other patient-level characteristics? (RQ2) In addition to patient-level characteristics, what provider and organizational characteristics are associated with higher and lower levels of PEI in the four patient groups? (RQ3) What is the relationship between the various dimensions of PEI and clinical processes and outcomes for diabetes in the four patient groups? (RQ4) What specific inter- and intra-departmental relationships, managerial practices and staff behaviors constitute the structures and processes that produce higher levels of PEI? We propose a four-year mixed-methods study. The quantitative phase will address RQs 1, 2 and 3 using multiple existing secondary databases and new survey-based variables obtained from both Veterans and VHA staff. For RQ4, we propose to qualitatively compare sites selected from the upper and lower extremes of the patient-experienced integration continuum. Working with our operational partners, relevant results from our study will be incorporated into specific national training and quality improvement programs.

描述（由申请人提供）： 整合仍然是医疗保健领域的一个标志性挑战。分散化限制了医疗保健系统在正确的时间以合理的成本提供正确护理的能力。这种碎片化是由多种因素驱动的，包括医学知识和技术的快速扩展以及临床专业人员的相关专业化。这些因素增加了跨部门边界和地理位置的交接次数。 在退伍军人管理局，初级保健-心理健康一体化 (PC-MHI) 和患者协调护理团队 (PACT) 等重大国家级重新设计创新已经启动，以促进跨专业、角色和物理位置界限的整合，其中信息和患者交接发生。这些努力的最终目标是加强以患者为中心的护理。然而，这些结构和流程层面的整合创新在多大程度上增强了患者的综合护理体验仍然未知。因此，拟议研究的总体目标是评估退伍军人体验综合护理的程度，并确定可改变的组织特征和促进患者体验综合护理的具体护理流程。与运营合作伙伴合作，这些知识可用于开发增强患者体验整合（PEI）的干预措施。 我们建议针对患有糖尿病和合并症的患者，这些患者在两个维度上有所不同：合并症领域（身体；心理健康相关）和严重程度（低；高）。随着提供商和地点数量的增加，集成挑战也随之增加。最复杂的合并症对融合构成最大的威胁，是那些跨越身体和精神领域并需要初级和专业护理服务的合并症。研究这四个群体将揭示整合方面的挑战，并确定组织变革的可行杠杆。 我们建议通过解决四个具体研究问题来实现总体研究目标： 我们建议通过解决四个具体研究问题来实现总体研究目标： (RQ1) 患有糖尿病的退伍军人所经历的护理的整合程度如何，以及经验的整合是否因人而异患者群体在共病领域和专业护理参与程度以及其他患者水平特征方面存在差异？ (RQ2) 除了患者层面的特征之外，哪些提供者和组织特征与四个患者组中较高和较低的 PEI 水平相关？ (RQ3) PEI 的各个维度与四个患者组中糖尿病的临床过程和结果之间的关系是什么？ (RQ4) 哪些具体的部门间和部门内关系、管理实践和员工行为构成了产生更高水平 PEI 的结构和流程？ 我们提出一项为期四年的混合方法研究。定量阶段将使用多个现有二级数据库以及从退伍军人和 VHA 工作人员获得的新的基于调查的变量来解决 RQ 1、2 和 3。对于 RQ4，我们建议定性比较从患者经历的整合连续体的上限和下限中选择的站点。与我们的业务合作伙伴合作，我们研究的相关结果将被纳入具体的国家培训和质量改进计划中。