Evidence-Based Practice Center, RAND Corporation, Santa Monica, CA, USA.
Geffen School of Medicine and Fielding School of Public Health at UCLA, Los Angeles, CA, USA.
BMC Health Serv Res. 2023 Jul 25;23(1):790. doi: 10.1186/s12913-023-09799-5.
The Veterans Affairs (VA) Clinical Resource Hub (CRH) program aims to improve patient access to care by implementing time-limited, regionally based primary or mental health staffing support to cover local staffing vacancies. VA's Office of Primary Care (OPC) designed CRH to support more than 1000 geographically disparate VA outpatient sites, many of which are in rural areas, by providing virtual contingency clinical staffing for sites experiencing primary care and mental health staffing deficits. The subsequently funded CRH evaluation, carried out by the VA Primary Care Analytics Team (PCAT), partnered with CRH program leaders and evaluation stakeholders to develop a protocol for a six-year CRH evaluation. The objectives for developing the CRH evaluation protocol were to prospectively: 1) identify the outcomes CRH aimed to achieve, and the key program elements designed to achieve them; 2) specify evaluation designs and data collection approaches for assessing CRH progress and success; and 3) guide the activities of five geographically dispersed evaluation teams.
The protocol documents a multi-method CRH program evaluation design with qualitative and quantitative elements. The evaluation's overall goal is to assess CRH's return on investment to the VA and Veterans at six years through synthesis of findings on program effectiveness. The evaluation includes both observational and quasi-experimental elements reflecting impacts at the national, regional, outpatient site, and patient levels. The protocol is based on program evaluation theory, implementation science frameworks, literature on contingency staffing, and iterative review and revision by both research and clinical operations partners.
Health systems increasingly seek to use data to guide management and decision-making for newly implemented clinical programs and policies. Approaches for planning evaluations to accomplish this goal, however, are not well-established. By publishing the protocol, we aim to increase the validity and usefulness of subsequent evaluation findings. We also aim to provide an example of a program evaluation protocol developed within a learning health systems partnership.
退伍军人事务部 (VA) 临床资源中心 (CRH) 计划旨在通过实施限时的、基于区域的初级或心理健康人员配备支持，以填补当地人员配备空缺，从而改善患者获得护理的机会。VA 的初级保健办公室 (OPC) 设计了 CRH，以通过为经历初级保健和心理健康人员配备不足的站点提供虚拟应急临床人员配备，为 1000 多个地理位置分散的退伍军人事务部门诊站点提供支持，其中许多站点位于农村地区。随后，由退伍军人事务部初级保健分析小组 (PCAT) 进行的 CRH 评估与 CRH 计划领导人和评估利益相关者合作，制定了六年 CRH 评估计划。制定 CRH 评估计划的目标是前瞻性地：1）确定 CRH 旨在实现的结果，以及旨在实现这些结果的关键计划要素；2）指定评估设计和数据收集方法，以评估 CRH 的进展和成功；3）指导五个地理位置分散的评估小组的活动。
该方案记录了一个多方法的 CRH 计划评估设计，包括定性和定量要素。该评估的总体目标是通过综合有关计划效果的发现，在六年内评估 CRH 对退伍军人事务部和退伍军人的投资回报。该评估包括反映国家、区域、门诊站点和患者层面影响的观察性和准实验性要素。该方案基于计划评估理论、实施科学框架、应急人员配备文献以及研究和临床运营合作伙伴的迭代审查和修订。
医疗系统越来越希望使用数据来指导新实施的临床计划和政策的管理和决策。然而，用于规划评估以实现这一目标的方法尚未得到很好的确立。通过发布方案，我们旨在提高后续评估结果的有效性和有用性。我们还旨在提供一个在学习型医疗系统伙伴关系中制定的计划评估方案的示例。
