Parkinson's disease (PD) affects motor function as well as cognition, mood, sleep, and autonomic function. There are not enough subspecialists to manage every veteran with PD. While management of some aspects of PD may require subspecialist involvement, many aspects of PD can be handled by other types of clinicians through telephone, web-based, and group formats. These aspects of care can be addressed through the design and implementation of a nurse-led care intervention.
This pilot study project's objectives were to (1) assemble a Task Force of PD champions from VISN 22 and local PD advocacy/resource groups, including a health services nurse scientist and a PD nurse specialist; (2) achieve consensus on a set of PD care quality goals; (3) develop patient-centered PD care assessment tools and protocols; (4) develop procedures for incorporating clinical information into the VA Computerized Patient Record System; (5) pilot test and refine these tools in a small sample of veterans with PD, and (6) plan how to measure intervention costs, in preparation for a subsequent randomized controlled trial of a care management intervention.
Using a modified Delphi method, the research team moderated Task Force meetings to identify high-ranking PD care goals, used to guide the design of the PD care management quality improvement (QI) tools: structured phone assessment, referral forms, summary report templates, and care protocols. These tools were pilot tested with 26 veterans with PD, recruited from VA Greater Los Angeles (GLA), VA Long Beach, and VA Loma Linda. These tools were iteratively revised with subject and staff feedback. Care management activities were recorded to identify intervention cost elements.
A Task Force of PD champions evaluated 106 PD QI indicators, rating 38 of them as having sufficiently high validity and room for improvement. Indicator domains encompass communication/education, motor symptoms, medication management, safety, and non-motor issues including speech/swallowing, gastro-intestinal problems, and neuropsychiatric disturbances. Formative evaluation feedback improved the assessment's wording and organizational flow. Veteran study participants overwhelmingly reported that the comprehensive assessment uncovered relevant problems and concerns. Detailed protocols for each indicator were created in an excel spreadsheet and developed into care management tools.
Implementation of these PDQI tools may improve veterans' health outcomes, but the care management intervention needs now to be implemented and its impact evaluated before dissemination. In December 2010, pilot study results were used in an HSR&D-NRI proposal for a multi-center randomized controlled trial of a PD care management intervention.
- Connor K, Janovsky V, Cheng E, Brown A, Farag E, Schreiber S, Cole D, Fujikawa D, Parveen M, Ganz D, Mittman BS, Taylor JL, Vickrey BG. Pilot Study Preparing for a Parkinson’s Disease Care Management QI Trial. Paper presented at: VA National Parkinson's Disease Consortium Annual Conference; 2010 Sep 9; San Francisco, CA.
- Connor K, Janovsky V, Cheng E, Brown A, Farag E, Schreiber S, Cole D, Fujikawa D, Parveen M, Mittman BS, Taylor JL, Vickrey BG. Pilot Study Preparing for a Parkinson’s Disease Care Management QI Trial. Paper presented at: VA Greater Los Angeles Healthcare System Nursing Research and Outcomes Annual Conference; 2010 Apr 5; Los Angeles, CA.
Aging, Older Veterans' Health and Care, Health Systems, Neurodegenerative Diseases
Treatment - Observational, Treatment - Comparative Effectiveness
Access, Outcomes, Outcomes - Patient, Parkinson's disease, Personal Health Record