Sustaining STAR-VA: Partnered Evaluation of Veteran, Implementation and Facility Factors Contributing to Positive Sustained Outcomes to Inform Ongoing Program Implementation

STAR-VA，一种以退伍军人为中心的跨学科行为方法，用于管理行为症状 退伍军人健康管理局社区生活中心(CLC)居民痴呆症(BSD)的发病率 2013至2016年间，在66个受过培训的CLC站点实施了该方案。协作评估是必要的，以 展示STAR-VA对CLC退伍军人和现场级别结果的纵向影响，并确定 与持续执行和积极成果相关的因素，以支持方案 可持续性和扩张性。该项目旨在确定用于监控行为变化的质量指标 在患有痴呆症的CLC居民中，确定退伍军人、干预和设施/地点因素可预测 持续的积极行为和系统结果，并确定持续STAR- VA实施。项目成果将为发展和实施建议提供信息 以结果为导向的量身定做干预的评估战略，以支持CLC团队维持 明星-弗吉尼亚州。具体目标是： 1.使用最低数据集3.0开发和验证用于监测BSD患病率的质量指标 行为测量，通过STAR-VA结果测量进行验证； 2.通过比较现场和驻地结果，评估STAR-VA的纵向影响 2013-2016年在BSD、精神药物使用以及现场工作人员受伤和识别方面未经培训的CLC 高性能和低性能的CLC站点。 3.使用定性方法解释持续实施STAR-VA的变化情况 有目的地抽取经过培训的CLC站点样本，检查存在哪些知识库(KR)域 CLC地点和这些KR的影响以及其他因素对维持的影响。 目标1：从强制性居民评估工具最低要求创建BSD质量指标 数据集(MDS)3.0行为变量，由STAR-VA行为、抑郁和 在2013至2016年间，收集了280名退伍军人参加STAR-VA的焦虑。明星-退伍军人事务部参与 退伍军人被诊断为痴呆症，并反复表现出令居民或 其他，与精神错乱、其他急性疾病、精神病症状或最近的脑损伤没有直接关系。客观化 #2：通过比较受过培训和未受过培训的CLC站点和多年的居民来评估STAR-VA的影响 2013-2016年的选定成果，并确定与以下方面相关的驻地、实施和设施因素 BSD。居民水平的结果将包括使用MDS 3.0的CLC居民的BSD和精神药物使用率 行为质量指标和精神药物安全倡议(PDSI)数据。《中图法》站点级成果将是 依据：a)《中图法》的BSD总体比率(使用MDS 3.0行为质量指标和工作场所 行为风险评估、破坏性行为报告系统)、b)抗精神病药物和抗焦虑药物 使用PDSI计划数据，以及c)护理人员受伤，使用职业健康自动化安全 事件监视和跟踪系统(ASSIS)数据。目标3：解释 在有目的的样本中使用前瞻性定性方法持续实施STAR-VA 培训《中图法》网站。混合方式，包括高和低表现的采访和高和低的采访 遵守站点，将用于确定哪些KR域包括人员、例程、人工制品、 关系、信息空间、文化和结构以及其他因素存在于训练有素的《中图法》中 地点和这些KR的影响以及其他因素对STAR-VA计划的维持。数量和 将整合与持续执行和积极成果有关的定性因素，并指导 制定并建议实施和评价以成果为导向、量身定做的战略 可持续发展干预旨在改善表现不佳的人并保持高表现的结果。

STAR-VA, a Veteran-centered, interdisciplinary, behavioral approach for managing behavioral symptoms of dementia (BSD) among Veterans Health Administration Community Living Center (CLC) residents, has been implemented in 66 trained CLC sites between 2013 and 2016. Collaborative evaluation is necessary to demonstrate the longitudinal impact of STAR-VA on CLC Veteran and site level outcomes, and determine factors associated with sustained implementation and positive outcomes, in order to support program sustainability and expansion. This project intends to identify a quality indicator for monitoring behavior change among CLC residents with dementia, determine Veteran, intervention, and facility/site factors that predict sustained positive behavioral and systemic outcomes, and identify facilitators and barriers to sustained STAR- VA implementation. Project outcomes will inform development and recommendations for an implementation and evaluation strategy for an outcome-driven, tailored intervention to support CLC teams in sustaining STAR-VA. Specific aims are to: 1. Develop and validate a quality indicator for monitoring the prevalence of BSD, using Minimum Data Set 3.0 behavior measures, validated by STAR-VA outcome measures; 2. Evaluate the longitudinal impact of STAR-VA by comparing site and resident outcomes at trained and untrained CLCs in years 2013-2016 on BSD, psychotropic use, and, for sites, staff injuries, and identify high and low performing CLC sites. 3. Explain variations in the sustained implementation of STAR-VA using qualitative methods with a purposeful sample of trained CLC sites, examine what Knowledge Reservoir (KR) domains are present in CLC sites and the impact of these KRs and additional factors on sustainment. Objective #1: Create a BSD quality indicator from mandatory Resident Assessment Instrument Minimum Data Set (MDS) 3.0 behavior variables, validated by STAR-VA outcome measures of behavior, depression and anxiety collected for 280 Veterans enrolled in STAR-VA between 2013 and 2016. STAR-VA participating Veterans have a dementia diagnosis and display repeated behaviors that are distressing to the resident or others, not directly related to delirium, other acute illness, psychotic symptoms, or recent brain injury. Objective #2: Evaluate the impact of STAR-VA by comparing trained and untrained CLC sites and residents in years 2013-2016 on selected outcomes, and identify resident, implementation, and facility factors associated with BSD. Resident level outcomes will include rates of BSD and psychotropic use in CLC residents using MDS 3.0 behavior quality indicator and Psychotropic Drug Safety Initiative (PDSI) data. CLC site level outcomes will be based on: a) Overall rates of BSD in the CLC (using MDS 3.0 behavior quality indicator and Workplace Behavioral Risk Assessment disruptive behavior reporting system), b) Antipsychotic and antianxiety medication use from PDSI program data, and c) Nursing staff injuries, using Occupational Health Automated Safety Incident Surveillance and Tracking Systems (ASSISTS) data. Objective #3: Explain variations in the sustained implementation of STAR-VA using prospective qualitative methods in a purposeful sample of trained CLC sites. Mixed methods, including interviews of high and low performing and high and low adherence sites, will be used to determine what KR domains including People, Routines, Artifacts, Relationships, Information space, Culture, and Structure and additional factors are present in trained CLC sites and the impact of these KRs and additional factors on STAR-VA program sustainment. Quantitative and qualitative factors related to sustained implementation and positive outcomes will be integrated and guide the development and recommended implementation and evaluation strategy for an outcome-driven, tailored sustainability intervention designed to improve poor-performer and maintain high-performer outcomes..