Understanding care coordination for Veterans with complex care needs: protocol of a multiple-methods study to build evidence for an effectiveness and implementation study

Frontiers in Health Services

Health Services

Kathryn M. McDonald¹  Kristina M. Cordasco²  Matthew Maciejewski³  Dylan Waller⁴  Avery Z. Laliberte⁴  Holly McCready⁴  Mazhgan Rowneki⁴  Alex Hickok⁴  Anaïs Tuepker⁵  Christopher G. Slatore⁶  Denise M. Hynes⁷  Diana J. Govier⁸  Meike Niederhausen⁸  Sara J. Singer⁹  Catherine Battaglia^1,10  Kathleen C. Thomas^1,11  Lisa Perla^1,12 

[1] Center for Diagnostic Excellence, Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Nursing, Baltimore, MD, United States;Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States;Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States;Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA, United States;Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, United States;Department of Population Health Sciences & Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC, United States;Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, United States;Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, United States;Department of Family Medicine, Oregon Health & Science University, Portland, OR, United States;Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, United States;Division of Pulmonary & Critical Care Medicine, Department of Medicine, Oregon Health & Science University, Portland, OR, United States;Section of Pulmonary & Critical Care Medicine, VA Portland Health Care System, Portland, OR, United States;Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, United States;School of Nursing, Oregon Health & Science University, Portland, OR, United States;College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, United States;Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, United States;School of Public Health, Oregon Health & Science University & Portland State University, Portland, OR, United States;Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States;Department of Veterans Affairs, Eastern Colorado Health Care System, Denver, CO, United States;Department of Health Systems, Management & Policy, University of Colorado Anschutz Medical Campus, Aurora, CO, United States;Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States;Rehabilitation Services, Veterans Affairs Central Office, Washington, DC, United States;

关键词: Veterans;    care coordination;    study protocol;    access to care;    care integration;   

DOI  :  10.3389/frhs.2023.1211577

 received in 2023-04-24, accepted in 2023-08-01,  发布年份 2023

来源: Frontiers

【 摘 要 】

BackgroundFor patients with complex health and social needs, care coordination is crucial for improving their access to care, clinical outcomes, care experiences, and controlling their healthcare costs. However, evidence is inconsistent regarding the core elements of care coordination interventions, and lack of standardized processes for assessing patients’ needs has made it challenging for providers to optimize care coordination based on patient needs and preferences. Further, ensuring providers have reliable and timely means of communicating about care plans, patients’ full spectrum of needs, and transitions in care is important for overcoming potential care fragmentation. In the Veterans Health Administration (VA), several initiatives are underway to implement care coordination processes and services. In this paper, we describe our study underway in the VA aimed at building evidence for designing and implementing care coordination practices that enhance care integration and improve health and care outcomes for Veterans with complex care needs.MethodsIn a prospective observational multiple methods study, for Aim 1 we will use existing data to identify Veterans with complex care needs who have and have not received care coordination services. We will examine the relationship between receipt of care coordination services and their health outcomes. In Aim 2, we will adapt the Patient Perceptions of Integrated Veteran Care questionnaire to survey a sample of Veterans about their experiences regarding coordination, integration, and the extent to which their care needs are being met. For Aim 3, we will interview providers and care teams about their perceptions of the innovation attributes of current care coordination needs assessment tools and processes, including their improvement over other approaches (relative advantage), fit with current practices (compatibility and innovation fit), complexity, and ability to visualize how the steps proceed to impact the right care at the right time (observability). The provider interviews will inform design and deployment of a widescale provider survey.DiscussionTaken together, our study will inform development of an enhanced care coordination intervention that seeks to improve care and outcomes for Veterans with complex care needs.

【 授权许可】

Unknown   
© 2023 Hynes, Govier, Niederhausen, Tuepker, Laliberte, McCready, Hickok, Rowneki, Waller, Cordasco, Singer, McDonlad, Slatore, Thomas, Maciejewski, Battaglia and Perla.