According to the Institute of Medicine, improving communication and care coordination is essential to improving quality and safety, given the complexity and fragmentation of contemporary health care. To improve communication and coordination, the VA has implemented new initiatives, including a team-based model of health-care delivery, Patient Aligned Care Teams (PACT) and emphasizes innovative uses of health IT. In this next generation of our work as a Center of Innovation (COIN), we strive to meet the challenges of improving communication and coordination in the VA's evolving health-care system. Building upon our recently funded Collaborative Research to Enhance and Advance Transformation and Excellence (CREATE), we propose Improving quality, effectiveness and safety of health care through patient-centered communication and coordination as our core mission. We have identified four research focus areas to improve communication and coordination of care for Veterans in the primary care, mental health care and cancer care settings. The goal of focus area one (based on our CREATE) is to improve the quality of communication and coordination of care in the outpatient setting by developing and implementing point-of-care interventions. We define point of care within the context of PACT as any setting in which a provider evaluates clinical information and makes a health care decision. This broad definition encompasses both traditional face-to-face encounters at clinical visits, as well as nonface-to-face interactions (eg telephone calls, secure messaging, or processing information from the electronic health record [EHR]). The goal of focus area two is to improve the effectiveness and reach of Veteran-centered, evidence-based mental health care in nonmental health settings. We will develop and implement coordinated care-delivery models that target certain high-risk subgroups of Veterans, (e.g., those who have comorbid medical conditions) to achieve this goal. Our proposed COIN is a leader in mental health interventions for Veterans with comorbid conditions, and we are well positioned to lead the VHA in implementing novel models of mental health care coordination across VA. The goal of focus area three is to improve the coordination and reach of high-quality, Veteran-centered cancer care. To address the broad and multifaceted aspects of cancer care, this approach will include 1) expanded use of innovative technology-enabled interventions to improve coordination of cancer-care services; 2) strategies that enhance communication among clinicians, Veterans, and family; and 3) patient-centered, comparative-effectiveness studies in screening, surveillance and treatment of cancer. Lastly, we propose an emerging focus area to enhance safety of EHR-enabled communication using informatics and human factors engineering-based approaches. In the next five years, we will focus on developing and evaluating automated measurement and monitoring systems to track communication of abnormal test results. We will also refine and evaluate tools for improving the safety of EHR-based test-result communication systems. This work will be done in collaboration with VA system partners, including the National Center for Patient Safety. Our proposed name, Center for Innovations in Quality, Effectiveness and Safety (IQuESt) cohesively brings together our four focus areas. Our vision is to be a research pioneer in developing methods and innovative interventions for timely, effective communication and coordination of integrated health care. Our partnership, mentoring, and career- development goals encourage cultivation of appropriate relationships with VA clinical and operations partners, as well as develop research capacity to achieve our vision for improving the VA integrated health system and the care received by Veterans. Our strong track record of innovative research, scientific discovery, collaboration, career development, effective partnerships, solid infrastructure and support by our Methodology and Statistics Core, Administrative and Operations Core, and Education and Training Core, provides all the elements required to meet the goals of the new COIN program and the vision for HSR&D in the 21st century.
Given the complexity and fragmentation of contemporary health care, improving communication and care coordination is essential to improving quality and safety. To improve communication and care coordination, the VA has implemented a team-based model of health-care delivery, Patient Aligned Care Teams. As a Center of Innovation, we will build upon our recently funded CREATE. Our core mission is 'Improving quality, effectiveness and safety of health care through patient-centered communication and coordination'. Our four research focus areas will improve communication and coordination in primary care, mental health care and cancer care settings, and enhance the safety of electronic health record-enabled communication using informatics and human factors engineering-based approaches. Our partnership and career development goals will further expand our relationships with VA clinical and operations partners and develop the research capacity to achieve our vision for improving the VA integrated health system and the care received by Veterans.
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