Measuring Veterans' Safe Patient Handling and Mobility Experiences

衡量退伍军人的安全患者处理和移动体验

• 批准号: 9716970
• 负责人: David C Mohr
• 金额: --
• 依托单位: VA BOSTON HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-10-01 至 2022-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9716970
• 关键词: Acute; Address; Adverse event; Affect; Area; Bariatrics; Benchmarking; Caregivers; Caring; Characteristics; Clinical; Communication; Computerized Medical Record; Data; Data Analyses; Data Collection; Decision Making; Development; Devices; Dimensions; Disease; Education; Effectiveness; Elements; Ensure; Environment; Equipment; Evaluation; Factor Analysis; Fall prevention; Feedback; Fright; Future; Goals; Guidelines; Health; Hospitals; Human; Impairment; Individual; Infrastructure; Injury; Inpatients; Intervention; Interview; Lead; Learning; Link; Long-Term Care; Measures; Medical center; Methodology; Methods; Modeling; Nurses; Outcome; Pain; Patient Monitoring; Patient Self-Report; Patient Transfer; Patient-Centered Care; Patient-Focused Outcomes; Patients; Perception; Performance; Personal Satisfaction; Physical activity; Policies; Population; Privacy; Procedures; Process; Program Evaluation; Property; Provider; Quality of Care; RQ2; Recommendation; Recovery; Rehabilitation therapy; Reporting; Research Personnel; Resources; Risk; Role; Safety; Sampling; Site; Spinal cord injury; Surveys; System; Tablets; Techniques; Technology; Telephone Interviews; Testing; Training; Training Programs; Variant; Veterans; Voice; Work; base; care delivery; clinical practice; decubitus ulcer; empowered; equipment training; ergonomics; experience; falls; field study; functional independence; health care quality; improved; innovation; insight; instrument; nursing home length of stay; patient oriented; patient population; pressure ulcer prevention; programs; rehabilitative care; response; safe patient; theories; tool

Background: Safe Patient Handling and Mobility (SPHM) consists of ergonomic techniques and equipment to move patients who cannot move independently. SPHM helps minimize adverse events (pressure ulcers, falls), and staff injuries. Despite benefits, we know little about how patients experience assisted mobility. With valid and reliable scales, we can measure patient experiences, thus facilitating improved care, more tailored evaluation, and more targeted clinical staff education. Patients in rehabilitation are an ideal group to study. Specific aims: We will develop a valid and reliable self-report survey based upon patients' experiences of assisted mobility: the (PEAM). We have three aims. First, the analysis of qualitative interview data will identify and describe important concepts of patients' experiences. Scales and items will be generated from the interviews. The items will be reviewed by patients and subject experts, assuring content validity. Second, the PEAM will be fielded and the data analyzed to provide support for reliability and construct validity. Third, we will examine the statistical relation between PEAM and associated outcomes to establish criterion validity. Significance: Patient experiences of care are one of the pillars of health care quality. Yet, no measures assess patients' perceptions of assisted mobility. The VA national directive for SPHM mandates program evaluation, yet the Voice of the Veteran is not part of the assessment. The sheer number of rehabilitation unit Veterans calls for their input. The PEAM will provide a valid and reliable measure to address this gap. PEAM will allow identification of best practices, areas in need of improvement, and clinical staff educational priorities. Priority domain: Our study addresses the HSR&D priority of patient-centered care and care management. We examine how methods of care delivery can influence Veterans' experiences and relevant outcomes. Innovation: PEAM will be the first reliable and validated patient-report survey of assisted mobility experiences. Methodology: For Aim 1, we will conduct telephone interviews with 60 Veterans discharged from inpatient rehabilitation units including: SCI, acute rehabilitation, short-stay nursing homes, and polytrauma. We will interview 30 staff at two medical centers about their experiences with SPHM. Our conceptual model and interview questions consist of patient, provider, equipment, environment, and task concepts. We will apply thematic analysis to data to develop and refine constructs. An expert panel will evaluate item fit to constructs. We will interview up to 15 Veterans to ensure items are understood as intended. For Aim 2, we will test the instrument with a sample of Veterans (n=800). Item response theory and confirmatory factor analysis will identify the best performing items. We will assess construct validity between the PEAM and other validated measures. For Aim 3, we will assess criterion validity through field-based observational assessments and surveys of Veterans (n=3500) at more than 20 facilities. We will model the relation between patient and unit characteristics with PEAM. We will also examine patient and unit-level outcomes to establish criterion validity. Expected results: Our resultant instrument will provide a unique measure of assisted mobility for this understudied population and assess an important, yet understudied, aspect of the care recovery process. Next steps: VA operational partners – including SCI/D and SPHM – will be provided with findings, insights, and recommendations that can support evaluation from their directives. PEAM use in evaluation programs nation-wide can be planned. Enriched evaluation using the PEAM by program offices could lead to changes in policies, staff education, equipment, and improved care. Through individual feedback to facilities in Aim 3, performance improvement efforts can be tailored around specific findings. We will work with program offices to develop and implement tablet-based data collection methods. With a validated instrument, we can also include the PEAM in surveys that VA regularly administers to assess patient experiences of rehabilitation care. Work can also adapt the instrument for bariatric patient handling and long-term care priority areas.

背景：安全的患者处理和流动性（SPHM）由人体工程学技术和设备组成 移动无法独立移动的患者。 SPHM有助于最大程度地减少广告活动（压疮，瀑布）， 和员工受伤。尽管有好处，但我们对患者如何经历辅助移动性知之甚少。有效 和可靠的量表，我们可以衡量患者体验，从而发展改善的护理，更量身定制 评估和更多针对性的临床人员教育。康复患者是一个理想的研究群体。 具体目的：我们将根据患者的经验制定有效可靠的自我报告调查 辅助流动性：（PEAM）。我们有三个目标。首先，对定性访谈数据的分析将确定 并描述患者经历的重要概念。秤和项目将从 访谈。这些项目将由患者和学科专家进行审查，以确保内容有效性。第二， PEAM将被放置，并分析数据以提供支持和构造有效性的支持。第三，我们会的 检查PEAM与相关结果之间的统计关系以建立标准有效性。 意义：护理患者体验是医疗保健质量的支柱之一。但是，没有措施 评估患者对辅助活动性的看法。 VA国家SPHM授权计划 评估，但是老兵的声音并不是评估的一部分。康复单位数量庞大 退伍军人要求他们的投入。 PEAM将提供有效可靠的措施来解决此差距。 peam 将允许确定最佳实践，需要改进的领域以及临床员工的教育重点。 优先领域：我们的研究涉及以患者为中心的护理和护理管理的HSR＆D优先级。我们 检查护理方法如何影响退伍军人的经验和相关结果。 创新：PEAM将是对辅助流动性经历的首次可靠且有效的患者报告调查。 方法论：对于AIM 1，我们将对从住院而出院的60名退伍军人进行电话采访 康复单元在内，包括：SCI，急性康复，短期护士住宅和Polytrauma。我们将 在两个医疗中心采访了30名员工，以了解他们在SPHM的经历。我们的概念模型和 面试问题包括患者，提供者，设备，环境和任务概念。我们将申请 对数据的主题分析以开发和完善结构。专家小组将评估适合构造的项目。 我们将面试多达15名退伍军人，以确保将物品理解为预期。对于AIM 2，我们将测试 带有退伍军人样本的仪器（n = 800）。项目响应理论和确认因素分析将 确定最佳性能项目。我们将评估PEAM和其他经过验证的构造有效性 措施。对于AIM 3，我们将通过基于现场的观察评估来评估标准有效性和 在20多个设施中对退伍军人的调查（n = 3500）。我们将建模患者和单位之间的关系 Peam的特征。我们还将检查患者和单位级别的结果以建立标准有效性。 预期结果：我们的最终工具将为此提供独特的辅助移动性测量 研究的人口和评估是护理恢复过程的重要方面。 下一步：VA运营合作伙伴（包括SCI/D和SPHM）将提供发现，见解， 以及可以支持其指令评估的建议。在评估程序中使用PEAM 可以计划在全国范围内进行计划。使用计划办公室的PEAM进行丰富的评估可能会导致变化 政策，员工教育，设备和改进的护理。通过对AIM 3中设施的个人反馈， 绩效改进工作可以围绕特定发现量身定制。我们将与计划办公室合作 开发和实施平板电脑的数据收集方法。使用经过验证的工具，我们还可以包括 VA定期管理的调查中的PEAM来评估康复护理的患者经历。工作 还可以使该仪器适应减肥患者的处理和长期护理优先区域。