通过远程医疗向美国农村退伍军人提供骨折预防服务：过程评估。
Delivering fracture prevention services to rural US veterans through telemedicine: a process evaluation.
机构信息
VA Office of Rural Health, Veterans Rural Health Resource Center-Salt Lake City (VRHRC-SLC), Salt Lake City, UT, USA.
Department of Internal Medicine, Rheumatology Section, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA.
出版信息
Arch Osteoporos. 2021 Feb 10;16(1):27. doi: 10.1007/s11657-021-00882-0.
UNLABELLED
An informatics-driven population bone health clinic was implemented to identify, screen, and treat rural US Veterans at risk for osteoporosis. We report the results of our implementation process evaluation which demonstrated BHT to be a feasible telehealth model for delivering preventative osteoporosis services in this setting.
PURPOSE
An established and growing quality gap in osteoporosis evaluation and treatment of at-risk patients has yet to be met with corresponding clinical care models addressing osteoporosis primary prevention. The rural bone health tea m (BHT) was implemented to identify, screen, and treat rural Veterans lacking evidence of bone health care and we conducted a process evaluation to understand BHT implementation feasibility.
METHODS
For this evaluation, we defined the primary outcome as the number of Veterans evaluated with DXA and a secondary outcome as the number of Veterans who initiated prescription therapy to reduce fracture risk. Outcomes were measured over a 15-month period and analyzed descriptively. Qualitative data to understand successful implementation were collected concurrently by conducting interviews with clinical personnel interacting with BHT and BHT staff and observations of BHT implementation processes at three site visits using the Promoting Action on Research Implementation in Health Services (PARIHS) framework.
RESULTS
Of 4500 at-risk, rural Veterans offered osteoporosis screening, 1081 (24%) completed screening, and of these, 37% had normal bone density, 48% osteopenia, and 15% osteoporosis. Among Veterans with pharmacotherapy indications, 90% initiated therapy. Qualitative analyses identified barriers of rural geography, rural population characteristics, and the infrastructural resource requirement. Data infrastructure, evidence base for care delivery, stakeholder buy-in, formal and informal facilitator engagement, and focus on teamwork were identified as facilitators of implementation success.
CONCLUSION
The BHT is a feasible population telehealth model for delivering preventative osteoporosis care to rural Veterans.
未加标签
为了识别、筛查和治疗有骨质疏松症风险的美国农村退伍军人，实施了一个以信息学为驱动的人群骨骼健康诊所。我们报告了实施过程评估的结果，该评估表明 BHT 是在这种环境下提供预防骨质疏松症服务的可行远程医疗模式。
目的
在评估和治疗有风险的患者方面，骨质疏松症的质量差距日益扩大，但尚未找到相应的临床护理模式来解决骨质疏松症的一级预防问题。农村骨骼健康团队（BHT）的成立是为了识别、筛查和治疗缺乏骨骼健康护理证据的农村退伍军人，我们进行了过程评估，以了解 BHT 的实施可行性。
方法
对于本次评估，我们将评估退伍军人接受 DXA 检查的人数定义为主要结果，将开始使用处方疗法降低骨折风险的退伍军人人数定义为次要结果。在 15 个月的时间内测量这些结果，并进行描述性分析。为了了解成功实施的情况，我们同时收集了定性数据，包括与 BHT 互动的临床人员的访谈以及在三次实地考察中对 BHT 实施过程的观察，使用了促进健康服务研究实施行动（PARIHS）框架。
结果
在接受骨质疏松症筛查的 4500 名有风险的农村退伍军人中，有 1081 人（24%）完成了筛查，其中 37%的人骨密度正常，48%的人骨质疏松，15%的人骨质疏松。在有药物治疗指征的退伍军人中，有 90%的人开始接受治疗。定性分析确定了农村地理环境、农村人口特征和基础设施资源需求等障碍。数据基础设施、护理交付的证据基础、利益相关者的认可、正式和非正式促进者的参与以及对团队合作的关注，被确定为实施成功的促进因素。
结论
BHT 是为农村退伍军人提供预防骨质疏松症护理的可行人群远程医疗模式。
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