Haun Jolie, Chavez Margeaux, Hathaway Wendy, Antinori Nicole, Melillo Christine, Cotner Bridget A, McMahon-Grenz Julie, Zilka Brian, Patel-Teague Shilpa, Messina William, Nazi Kim
Health Services Research and Development Service Center of Innovation on Disability and Rehabilitation Research, James A Haley VA Medical Center, Tampa, FL, United States.
Department of Community & Family Health, College of Public Health, University of South Florida, Tampa, FL, United States.
JMIR Res Protoc. 2018 Aug 15;7(8):e11262. doi: 10.2196/11262.
The Veterans Health Administration (VHA) is making system-wide efforts to increase integrated use of health information technology (HIT), including My HealtheVet (MHV), the Veterans Affairs (VA) electronic patient portal, Vet Link kiosks, telehealth, and mobile apps. Integrated use of HIT can increase individual and system efficiency, maximize resources, and enhance patient outcomes. Prior research indicates that provider endorsement and reinforcement are key determinants of patient adoption of HIT. HIT implementation strategies need to reflect providers' perspectives to promote adoption and endorsement of these tools; however, providers often lack awareness or are unmotivated to incorporate HIT into clinical care with their patients. When these modalities are used by patients, the approach is often fragmented rather than integrated within and across care settings. Research is needed to identify effective implementation strategies for increasing patient-aligned care team (PACT) member (ie, the VHA's Patient Centered Medical Home) awareness and motivation to use HIT in a proactive and integrated approach with patients.
This paper describes the rationale, design, and methods of the PACT protocol to promote proactive integrated use of HIT.
In Aim 1, focus groups (n=21) were conducted with PACT members (n=65) along with questionnaires and follow-up individual interviews (n=16). In Aim 2, the team collaborated with VA clinicians, electronic health researchers and operational partners to conduct individual expert interviews (n=13), and an environmental scan to collect current and emerging provider-focused implementation tools and resources. Based on Aim 1 findings, a gap analysis was conducted to determine what implementation strategies and content needed to be adapted or developed. Following the adaptation or development of resources, a PACT expert panel was convened to evaluate the resultant content. In Aim 3, a local implementation of PACT-focused strategies to promote integrated use of HIT was evaluated using pre- and postquestionnaire surveys, brief structured interviews, and secondary data analysis with PACT members (n=63).
Study enrollment for Aim 1 has been completed. Aims 1 and 2 data collection and analysis are underway. Aim 3 activities are scheduled for year 3.
This work highlights the practical, technological, and participatory factors involved in facilitating implementation research designed to engage PACT clinical members in the proactive integrated use of HIT. These efforts are designed to support the integrated and proactive use of VA HIT to support clinical care coordination in ways that are directly aligned with PACT member preferences. This study evaluated integrated VA HIT use employing mixed-methods and multiple data sources. Deliverables included PACT-focused strategies to support integrated use of HIT in the ambulatory care setting that will also inform strategy development in other systems of care and support subsequent implementation efforts at regional and national levels.
RR1-10.2196/11262.
退伍军人健康管理局（VHA）正在进行全系统的努力，以增加对健康信息技术（HIT）的综合利用，包括“我的健康退伍军人”（MHV）、退伍军人事务部（VA）电子患者门户、退伍军人链接信息亭、远程医疗和移动应用程序。综合利用健康信息技术可以提高个人和系统效率，使资源最大化，并改善患者治疗效果。先前的研究表明，提供者的认可和强化是患者采用健康信息技术的关键决定因素。健康信息技术实施策略需要反映提供者的观点，以促进这些工具的采用和认可；然而，提供者往往缺乏认识或没有动力将健康信息技术纳入与患者的临床护理中。当患者使用这些方式时，其方法通常是零散的，而不是在不同护理环境中进行整合。需要开展研究，以确定有效的实施策略，提高患者协调护理团队（PACT）成员（即VHA的以患者为中心的医疗之家）的认识，并激发他们以积极主动和综合的方式与患者一起使用健康信息技术的动力。
本文描述了促进健康信息技术主动综合利用的PACT方案的基本原理、设计和方法。
在目标1中，对PACT成员（n = 65）进行了焦点小组访谈（n = 21），并发放了问卷以及进行了后续的个人访谈（n = 16）。在目标2中，该团队与VA临床医生、电子健康研究人员和运营合作伙伴合作，进行了个人专家访谈（n = 13），并进行了环境扫描，以收集当前和新出现的以提供者为重点的实施工具和资源。根据目标1的研究结果，进行了差距分析，以确定需要调整或开发哪些实施策略和内容。在资源调整或开发之后，召集了一个PACT专家小组来评估最终内容。在目标3中，使用问卷调查前和调查后的问卷、简短的结构化访谈以及对PACT成员（n = 63）的二次数据分析，对以PACT为重点的促进健康信息技术综合利用的策略在当地的实施情况进行了评估。
目标1的研究入组工作已经完成。目标1和目标2的数据收集和分析正在进行中。目标3的活动计划在第3年进行。
这项工作突出了促进实施研究中涉及的实际、技术和参与性因素，该实施研究旨在促使PACT临床成员积极主动地综合使用健康信息技术。这些努力旨在支持VA健康信息技术的综合和主动使用，以直接符合PACT成员偏好的方式支持临床护理协调。本研究采用混合方法和多个数据源对VA健康信息技术的综合使用情况进行了评估。可交付成果包括以PACT为重点的策略，以支持在门诊护理环境中综合使用健康信息技术，这也将为其他护理系统的策略制定提供参考，并支持区域和国家层面的后续实施工作。
RR1-10.2196/11262
