Background: VA is undergoing a major transformation to improve how care is delivered. Two aspects of this transformation are an emphasis on patient-centered care, and the use of new models of care that increase access to and choice for care delivery. To facilitate delivery of patient-centered care that may include care delivered through technology, it is important that we understand not only the patient's medical condition but also his or her contextual factors and preferences. This project involves the development and testing of a patient inventory that can complement existing information (e.g., history and physical) to identify and make available to patients and providers information to support collaborative decision making and optimal patient-centered care delivery. 1. To identify contextual factors (e.g., patient preferences, situational characteristics, resources) that influence the delivery of patient-centered care. a) Identify contextual factors that affect delivery of patient-centered care from the patient's perspective. ) Identify patient contextual factors that providers believe are important in delivery of patient- centered care. 2. To examine the role of technology in health care delivery from patient and provider perspectives. a) To assess patients' experiences, resources, awareness of and willingness, to use technology for care delivery. b) To assess providers' knowledge of and experiences with care delivered through technology. 3. To develop and test a patient inventory that facilitates collaborative decision-making between patients and providers, and supports the delivery of patient-centered care by making contextual information and preferences available during the patient/provider encounter. a) To develop a patient inventory tool that can be deployed using an iPad or other device (e.g. kiosk). b) To conduct a randomized trial of Veterans to assess whether there is greater patient- centered care and collaborative decision making when the patient inventory is used. We hypothesize that incorporating patient contextual information into the patient/provider encounter results in care that is more patient-centered and decision making that is collaborative. As an exploratory aim, we will examine workload processes and time involved in utilizing the patient inventory to assess potential workflow and cost impacts of this intervention. Methods: Three phases: focus groups and interviews with patients and providers, Delphi panel with stakeholders, randomized control trial of patient inventory tool v. usual care.
The expected product of this research is a patient inventory that facilitates patient-centered care delivery. With the help of our operations partners, the inventory can be adapted for use through a variety of options that are most convenient for patients, including through a kiosk, tablet computer, or through securing messaging The Health Informatics Initiative (hi2) and the VHA Patient-Centered Care & Cultural Transformation office are interested in prototyping patient-entered data (as part of the Aviva medical record/data platform framework in development) that would add personal information to the medical record (S. Woods, email communication 1/21/12). Future steps include integrating the patient inventory into the medical record where it can be flagged, regularly updated and easily accessible to the healthcare team to provide continuous patient-centered care.