Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Denver, CO, USA.
VA Eastern Colorado Health Care System, Denver, CO, USA.
J Gen Intern Med. 2019 May;34(Suppl 1):67-74. doi: 10.1007/s11606-019-04968-x.
Transitions of care are high risk for vulnerable populations such as rural Veterans, and adequate care coordination can alleviate many risks. Single-center care coordination programs have shown promise in improving transitional care practices. However, best practices for implementing effective transitional care interventions are unknown, and a common pitfall is lack of understanding of the current process at different sites. The rural Transitions Nurse Program (TNP) is a Veterans Health Administration (VA) intervention that addresses the unique transitional care coordination needs of rural Veterans, and it is currently being implemented in five VA facilities.
We sought to employ and study process mapping as a tool for assessing site context prior to implementation of TNP, a new care coordination program.
Observational qualitative study guided by the Lean Six Sigma approach. Data were collected in January-March 2017 through interviews, direct observations, and group sessions with front-line staff, including VA providers, nurses, and administrative staff from five VA Medical Centers and nine rural Patient-Aligned Care Teams.
We integrated key informant interviews, observational data, and group sessions to create ten process maps depicting the care coordination process prior to TNP implementation at each expansion site. These maps were used to adapt implementation through informing the unique role of the Transitions Nurse at each site and will be used in evaluating the program, which is essential to understanding the program's impact.
Process mapping can be a valuable and practical approach to accurately assess site processes before implementation of care coordination programs in complex systems. The process mapping activities were useful in engaging the local staff and simultaneously guided adaptations to the TNP intervention to meet local needs. Our approach-combining multiple data sources while adapting Lean Six Sigma principles into practical use-may be generalizable to other care coordination programs.
对于农村退伍军人等弱势群体而言，医疗过渡期风险较高，而充分的医疗协调可以减轻许多风险。单中心医疗协调计划已显示出改善医疗过渡期实践的潜力。然而，实施有效的医疗过渡期干预措施的最佳实践尚不清楚，一个常见的陷阱是不了解不同地点的当前流程。农村过渡护士计划（TNP）是一项退伍军人健康管理局（VA）干预措施，旨在满足农村退伍军人独特的医疗过渡期协调需求，目前正在五家 VA 设施中实施。
我们试图在实施新的医疗协调计划 TNP 之前，使用流程映射作为评估地点背景的工具。
以精益六西格玛方法为指导的观察性定性研究。数据于 2017 年 1 月至 3 月间通过与前线工作人员（包括退伍军人服务提供商、护士和行政人员）的访谈、直接观察和小组会议收集，这些工作人员来自五家退伍军人医疗中心和九家农村患者护理团队。
我们整合了关键知情人访谈、观察数据和小组会议，为每个扩展站点创建了十个描绘 TNP 实施前医疗协调流程的流程映射。这些地图被用于通过告知每个站点过渡护士的独特角色来调整实施，这对于评估项目至关重要，这对于理解项目的影响是必要的。
流程映射可以是一种在复杂系统中实施医疗协调计划之前准确评估地点流程的有价值且实用的方法。流程映射活动对于吸引当地员工非常有用，同时也指导了 TNP 干预措施的调整，以满足当地需求。我们的方法——结合多种数据源，同时将精益六西格玛原则应用于实际使用——可能适用于其他医疗协调计划。
