HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Sepulveda, California, USA.
David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA.
Transl Behav Med. 2018 May 23;8(3):492-502. doi: 10.1093/tbm/ibx072.
Promising practices for the coordination of chronic care exist, but how to select and share these practices to support quality improvement within a healthcare system is uncertain. This study describes an approach for selecting high-quality tools for an online care coordination toolkit to be used in Veterans Health Administration (VA) primary care practices. We evaluated tools in three steps: (1) an initial screening to identify tools relevant to care coordination in VA primary care, (2) a two-clinician expert review process assessing tool characteristics (e.g. frequency of problem addressed, linkage to patients' experience of care, effect on practice workflow, and sustainability with existing resources) and assigning each tool a summary rating, and (3) semi-structured interviews with VA patients and frontline clinicians and staff. Of 300 potentially relevant tools identified by searching online resources, 65, 38, and 18 remained after steps one, two and three, respectively. The 18 tools cover five topics: managing referrals to specialty care, medication management, patient after-visit summary, patient activation materials, agenda setting, patient pre-visit packet, and provider contact information for patients. The final toolkit provides access to the 18 tools, as well as detailed information about tools' expected benefits, and resources required for tool implementation. Future care coordination efforts can benefit from systematically reviewing available tools to identify those that are high quality and relevant.
存在有前途的慢性病协调实践，但如何选择和分享这些实践以支持医疗保健系统内的质量改进尚不确定。本研究描述了一种选择高质量工具的方法，用于在退伍军人事务部 (VA) 初级保健实践中使用在线护理协调工具包。我们分三个步骤评估工具：(1) 初步筛选以确定与 VA 初级保健护理协调相关的工具，(2) 由两名临床医生进行的专家审查过程，评估工具特征（例如，解决问题的频率、与患者护理体验的联系、对实践工作流程的影响以及与现有资源的可持续性），并为每个工具分配一个总结评分，以及 (3) 与 VA 患者和一线临床医生和工作人员进行半结构化访谈。通过在线资源搜索，确定了 300 种可能相关的工具，分别经过步骤一、二和三后，分别有 65、38 和 18 种工具保留下来。这 18 种工具涵盖五个主题：管理向专科护理的转介、药物管理、患者就诊后总结、患者激活材料、议程设置、患者就诊前包和患者的医生联系方式。最终的工具包可访问这 18 种工具，以及有关工具预期收益和工具实施所需资源的详细信息。未来的护理协调工作可以从系统地审查现有工具中受益，以确定高质量和相关的工具。
