Learning from national implementation of the Veterans Affairs Clinical Resource Hub (CRH) program for improving access to care: protocol for a six year evaluation

BMC Health Services Research

Study Protocol

Peter J. Kaboli¹  Lisa V. Rubenstein²  Jean Yoon³  Bradford L. Felker⁴  Idamay Curtis⁵  Chelle L. Wheat⁵  Karin M. Nelson⁶  Ashok S. Reddy⁶  David E. Grembowski⁷  Susan E. Stockdale⁸ 

[1] Center for Access and Delivery Research and Evaluation (CADRE), Iowa City VA Healthcare System, Iowa City, IA, USA;Evidence-Based Practice Center, RAND Corporation, Santa Monica, CA, USA;Geffen School of Medicine and Fielding School of Public Health at UCLA, Los Angeles, CA, USA;Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, CA, USA;Department of General Internal Medicine, UCSF School of Medicine, San Francisco, CA, USA;Mental Health Service Line, VA Puget Sound Healthcare System, Seattle, WA, USA;Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA;Primary Care Analytics Team, VA Puget Sound Healthcare System, Seattle, WA, USA;Primary Care Analytics Team, VA Puget Sound Healthcare System, Seattle, WA, USA;Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA;The Department of Health Systems and Population Health in the School of Public Health, University of Washington, Seattle, USA;VA HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, USA;Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, USA;

关键词: Access to Care;    Staffing;    Learning Organizations;    Telehealth;    Primary Care;    Mental Health Care;    Implementation Science;   

DOI  :  10.1186/s12913-023-09799-5

 received in 2022-12-26, accepted in 2023-07-10,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundThe Veterans Affairs (VA) Clinical Resource Hub (CRH) program aims to improve patient access to care by implementing time-limited, regionally based primary or mental health staffing support to cover local staffing vacancies. VA’s Office of Primary Care (OPC) designed CRH to support more than 1000 geographically disparate VA outpatient sites, many of which are in rural areas, by providing virtual contingency clinical staffing for sites experiencing primary care and mental health staffing deficits. The subsequently funded CRH evaluation, carried out by the VA Primary Care Analytics Team (PCAT), partnered with CRH program leaders and evaluation stakeholders to develop a protocol for a six-year CRH evaluation.The objectives for developing the CRH evaluation protocol were to prospectively: 1) identify the outcomes CRH aimed to achieve, and the key program elements designed to achieve them; 2) specify evaluation designs and data collection approaches for assessing CRH progress and success; and 3) guide the activities of five geographically dispersed evaluation teams.MethodsThe protocol documents a multi-method CRH program evaluation design with qualitative and quantitative elements. The evaluation’s overall goal is to assess CRH’s return on investment to the VA and Veterans at six years through synthesis of findings on program effectiveness. The evaluation includes both observational and quasi-experimental elements reflecting impacts at the national, regional, outpatient site, and patient levels. The protocol is based on program evaluation theory, implementation science frameworks, literature on contingency staffing, and iterative review and revision by both research and clinical operations partners.DiscussionHealth systems increasingly seek to use data to guide management and decision-making for newly implemented clinical programs and policies. Approaches for planning evaluations to accomplish this goal, however, are not well-established. By publishing the protocol, we aim to increase the validity and usefulness of subsequent evaluation findings. We also aim to provide an example of a program evaluation protocol developed within a learning health systems partnership.

【 授权许可】

CC BY   
© The Author(s) 2023

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