Belkora Jeffrey K, Reichert Jill, Williams Katherine, Whooley Mary A, Rezayat Talayeh, Sorensen Stacy, Chilakamarri Priyanka, Sanders Elizabeth, Maas Andrea, Gomez Alexander, Kurien Philip, Ashbrook Liza, Thomas Jacque, Sarmiento Kathleen F
Institute of Health Policy Studies and Department of Surgery, University of California, San Francisco, San Francisco, CA, United States.
San Francisco Veterans Affairs Health Care System, San Francisco, CA, United States.
Front Sleep. 2024 Sep 10;3. doi: 10.3389/frsle.2024.1444689.
Veteran access to sleep medicine is of paramount importance to the Veterans Health Administration (VA). To increase access, VA has created community referral policies and programs, as well as telehealth programs. In 2017, the Office of Rural Health (ORH) funded a TeleSleep initiative focused on reaching rural Veterans with unmet sleep needs. ORH provided 3-6 years of funding to help 19 hubs support 98 spoke sites serving rural Veterans. As ORH funding concluded, each hub identified its path to sustainment. This case study follows one TeleSleep hub in VA's western geographic region as it transitioned from ORH funding sustainment as a regional Sleep Clinical Resource Hub. This case study describes the real-world process of adaptation in care delivery strategies. One key area of adaptation revolved around whether to deliver care via the patient's home facility or the provider's home facility. In early 2021, the TeleSleep team implemented an innovative provider transfer model, where temporary reinforcements from the TeleSleep hub increased the workforce capacity of spoke sites, similar to the concept of locum tenens. In this provider transfer model, TeleSleep clinicians scheduled, documented, and billed for each encounter at the Veteran's home facility. Positioning TeleSleep clinicians as local providers facilitated communication and referrals and promoted continuity and quality of care for Veterans in their home facility. This provider transfer model reduced the administrative burden of providers and schedulers and supported patient-side-only documentation of care. While this mirrors current locum tenens practice, transferring providers did not fit VA's financial model as implemented by the western region's Sleep Clinical Resource Hub. Therefore, in December 2021, VA aligned TeleSleep with VA's preferred practice of patient rather than provider transfers. In the patient transfer model, providers schedule and document in both the provider and patient electronic health records, and bill in the provider's facility. However, reflecting on this period of innovation, TeleSleep team members concluded that the provider transfer model could improve patient safety and care coordination while reducing the administrative burden of frontline clinicians. Further research and development are needed to align the provider transfer model with VA's financial model.
退伍军人获得睡眠医学服务对退伍军人健康管理局（VA）至关重要。为了增加获得服务的机会，VA制定了社区转诊政策和项目以及远程医疗项目。2017年，农村卫生办公室（ORH）资助了一项远程睡眠倡议，重点是为有未满足睡眠需求的农村退伍军人提供服务。ORH提供了3至6年的资金，以帮助19个中心支持为农村退伍军人服务的98个分支站点。随着ORH资金的结束，每个中心都确定了其维持运营的途径。本案例研究跟踪了VA西部地理区域的一个远程睡眠中心，该中心从ORH资金支持过渡为区域睡眠临床资源中心。本案例研究描述了护理提供策略的实际适应过程。适应的一个关键领域围绕是通过患者的家庭医疗机构还是提供者的家庭医疗机构提供护理。2021年初，远程睡眠团队实施了一种创新的提供者转移模式，即远程睡眠中心的临时增援人员增加了分支站点的劳动力能力类似于临时替班的概念。在这种提供者转移模式中，远程睡眠临床医生在退伍军人的家庭医疗机构安排、记录和计费每次诊疗。将远程睡眠临床医生定位为当地提供者促进了沟通和转诊，并提高了退伍军人在其家庭医疗机构接受护理的连续性和质量。这种提供者转移模式减轻了提供者和调度员的行政负担，并支持仅在患者端记录护理情况。虽然这与当前的临时替班做法类似，但转移提供者不符合VA西部地区睡眠临床资源中心实施的财务模式。因此，2021年12月，VA将远程睡眠与VA首选的患者而非提供者转移做法保持一致。在患者转移模式中，提供者在提供者和患者的电子健康记录中安排和记录，并在提供者的机构计费。然而，回顾这一创新时期，远程睡眠团队成员得出结论，提供者转移模式可以提高患者安全和护理协调，同时减轻一线临床医生的行政负担。需要进一步的研究和开发，以使提供者转移模式与VA的财务模式保持一致。
