Modica Cheryl, Lewis Joy H, Bay R Curtis
National Association of Community Health Centers, Bethesda, MD, USA.
Department of Medicine and Public Health, A.T. Still University, School of Osteopathic Medicine, Mesa, AZ, USA.
J Multidiscip Healthc. 2024 Feb 2;17:521-531. doi: 10.2147/JMDH.S443973. eCollection 2024.
Health centers are community-based, patient directed primary care providers that offer accessible, high-quality primary care within medically underserved communities. Screening for cancer and managing complex chronic conditions such as diabetes, hypertension, obesity, and depression are vital services for the vulnerable populations seen by community health centers. Delivering care for complex chronic conditions and preventive services using virtual models that integrate self-care tools and technology is an important approach to increasing access for hard-to-reach patients served by health centers.
This study aimed to explore the use of a virtual care model, applied using a systems approach and patient-driven tools and technology, on the performance of clinical and patient experience measures.
A virtual care model, applied using a systems approach offered by the Value Transformation Framework (VTF), was combined with self-care tools and technology in twenty health centers across 17 states to drive improvement efforts. Changes in clinical measures and patient experience were compared.
A total of 385 patients were enrolled and 270 (70.1%) completed a baseline visit and at least four virtual visits during the six-month intervention period. Statistically significant improvements were seen in measures for HbA1c, systolic and diastolic blood pressure, and bodyweight. Among the 270 who completed the baseline and at least 4 virtual visits, the percentage up-to-date for colorectal cancer screening increased from 113/270 (41.9%) to 169/270 (62.6%) after six months, p<0.001, a 20.7% increase. Patients completing the baseline visit and at least 4 virtual visits reported a 10.7% decrease in depression and increased satisfaction with virtual care visits compared to in-person visits (p<0.001).
Health centers applying the Value Transformation Framework's organizing framework to the use of virtual care models together with patient self-care tools, technology, and education, had improvements in measures for chronic and preventive conditions and patient experience.
健康中心是以社区为基础、以患者为导向的初级医疗服务提供者，在医疗服务不足的社区提供可及的、高质量的初级医疗服务。癌症筛查以及管理糖尿病、高血压、肥胖症和抑郁症等复杂慢性病，对于社区健康中心所服务的弱势群体而言是至关重要的服务。利用整合了自我护理工具和技术的虚拟模式来提供复杂慢性病护理和预防服务，是增加健康中心难以接触到的患者获得医疗服务机会的重要途径。
本研究旨在探讨采用系统方法以及患者驱动的工具和技术应用虚拟护理模式，对临床和患者体验指标的影响。
将价值转型框架（VTF）提供的系统方法应用的虚拟护理模式，与自我护理工具和技术相结合，在17个州的20个健康中心推动改进工作。比较临床指标和患者体验的变化。
共有385名患者入组，270名（70.1%）在六个月的干预期内完成了基线访视和至少四次虚拟访视。糖化血红蛋白、收缩压和舒张压以及体重指标有统计学意义的改善。在完成基线访视和至少4次虚拟访视的270名患者中，六个月后结直肠癌筛查最新率从113/270（41.9%）增至169/270（62.6%），p<0.001，增长20.7%。完成基线访视和至少4次虚拟访视的患者报告抑郁程度降低10.7%，与面对面访视相比，对虚拟护理访视的满意度提高（p<0.001）。
健康中心将价值转型框架的组织框架应用于虚拟护理模式，并结合患者自我护理工具、技术和教育，在慢性病和预防疾病指标以及患者体验方面有所改善。
