Improving Veteran Transitions from VA Community Living Centers to the Community

改善退伍军人从退伍军人事务部社区生活中心到社区的过渡

• 批准号: 8782758
• 负责人: Whitney L Mills
• 金额: --
• 依托单位: MICHAEL E DEBAKEY VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-01 至 2019-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8782758
• 关键词: Acute; Adoption; Area; Award; Back; CLC Gene; Caring; Communities; Competence; Cost Effectiveness Analysis; Country; Data; Data Set; Development; Elderly; Ensure; Environment; Equilibrium; Evaluation; Face; Future; Goals; Health; Home Nursing Care; Home environment; Housing; Independent Living; Individual; Inpatients; Intervention; Interview; Knowledge; Left; Length of Stay; Life; Long-Term Care; Manuals; Maps; Mental Depression; Mentors; Methodology; Mission; Modeling; Nursing Homes; Outcome; Personal Satisfaction; Persons; Phase; Phase III Clinical Trials; Problem Solving; Process; Provider; Psychometrics; Quality of life; Rehabilitation therapy; Research; Research Personnel; Resources; Risk; Services; Site; Structure; Suggestion; Techniques; Testing; Time; Training; Veterans; base; career; caregiving; community living; community planning; cost; cost effectiveness; effective intervention; effectiveness trial; experience; functional decline; implementation science; improved; information gathering; innovation; instrument; member; patient oriented; primary outcome; programs; public health relevance; rehabilitation service; success; symposium; therapy development; treatment as usual; treatment planning

DESCRIPTION: According to the model of person-environment fit (P-E fit), older adults are at risk for poor outcomes when the demands and resources available in the environment are no longer in balance with the individual's everyday competence (the ability to solve problems associated with everyday life). It has been estimated that 29% of Community Living Center (CLC; VA nursing homes) residents may not require nursing home levels of care and could safely reside in the community with appropriate rehabilitative services. In VA, a major focus is to minimize time in CLCs by providing rehabilitation and transitioning Veterans to the community. CLC staff and Veterans face barriers to facilitating these transitions (e.g., caregiving needs, housing, etc.). N standardized process exists to assure that treatment planning includes processes to maximize P-E fit. The objective of this study is to develop a toolkit the CLC interdisciplinary team can use to 1) assess the Veteran's everyday competence; 2) develop personally meaningful rehabilitation goals based on everyday competence; and 3) conduct structured treatment planning to support resident goals around transitions back into the community. Acknowledging that even the most effective intervention is worthless if no one actually uses it, we propose a three-phase research process: Understand ¿ Develop ¿ Trial. Phase 1 (Understand) focuses on gaining an understanding of the current environment, discharge planning processes, and outcomes in CLCs. In Aim 1a, we will use administrative data to examine outcomes and predictors of successful/unsuccessful transitions among CLC residents. Aim 1b employs qualitative interviews, to understand the current barriers and facilitators to transitioning CLC residents, identify everyday scenarios residents face, and collect staff suggestions for appropriate goal-setting domains. For Aim 1c, we will use field observation to understand the workflow, relationships, and interactions between members of the interdisciplinary team during transition planning. Phase 2 (Develop) will use information gathered in Phase 1 to develop the Everyday Competence Assessment and Planning for Community Transitions (ECAP-CT) toolkit components, including rehabilitation goal-setting domains and creation of a structured manual to guide the CLC interdisciplinary team through the assessment, goal-setting, and treatment planning steps. Phase 3 (Trial) will be a quasi-experimental effectiveness trial of the ECAP-CT toolkit in the Houston (n=30 residents) and Tuscaloosa (n=30 residents) VA CLCs. The toolkit will be implemented sequentially in the two sites allowing for adaptation. Our primary outcome is transition outcome (successful/not successful), which will be compared to concurrent administrative data gathered from two matched comparison sites (n=60). We will conduct an exploratory cost-effectiveness analysis of the toolkit compared to usual care within the context of this trial. The PI's overall career aim is to become an independent rehabilitation researcher with expertise in developing and testing interventions targeting the needs of CLC residents, maximizing autonomy, independence, and function. Long-term, her career goals include developing strategies for assessment of everyday competence among CLC residents, setting resident-directed goals, and developing care plans to transition Veterans back into the community. The CDA-2 mentoring team includes established VA researchers with expertise in vulnerable older adults, assessing everyday competence, intervention development and evaluation, and long- term care transitions. With the guidance of the mentoring team, areas that would benefit from additional training have been identified The training aims outlined in this CDA-2 award will provide additional experience in these areas: 1) evaluation of patient-centered interventions, including cost-effectiveness and psychometrics methodology; 2) intervention development; 3) experience and knowledge of VA rehabilitation services; and 4) submission of a RR&D Merit Review Award. These objectives will be achieved through mentoring and attending seminars, formal courses, and conferences.

描述： 根据人与环境适合度（P-E适合度）模型，当环境中可用的需求和资源与个人的日常能力（解决与日常生活相关的问题的能力）不再平衡时，老年人就有出现不良结果的风险。据估计，29% 的社区生活中心（CLC；VA 疗养院）居民可能不需要疗养院级别的护理，可以安全地居住在拥有适当康复服务的社区中。在退伍军人事务部，一个主要重点是通过提供康复服务并将退伍军人转移到社区来最大限度地减少 CLC 的时间。 CLC 工作人员和退伍军人在促进这些过渡方面面临障碍（例如护理需求、住房等）。 N 个标准化流程的存在是为了确保治疗计划包括最大化 P-E 拟合的流程。本研究的目的是开发一个 CLC 跨学科团队可以使用的工具包 1) 评估退伍军人的日常能力； 2）根据日常能力制定对个人有意义的康复目标； 3) 制定结构化治疗计划，以支持居民重返社区的目标。我们承认，如果没有人实际使用，即使是最有效的干预措施也是毫无价值的，因此我们提出了一个三阶段的研究过程：理解、开发、试验。第 1 阶段（了解）侧重于了解 CLC 中的当前环境、出院计划流程和结果。在目标 1a 中，我们将使用管理数据来检查 CLC 居民成功/不成功过渡的结果和预测因素。目标 1b 采用定性访谈，了解当前 CLC 居民转型的障碍和促进因素，确定居民面临的日常情况，并收集工作人员对适当目标设定领域的建议。对于目标 1c，我们将使用现场观察来了解过渡计划期间跨学科团队成员之间的工作流程、关系和互动。第 2 阶段（开发）将使用第 1 阶段收集的信息来开发日常能力评估和社区过渡规划 (ECAP-CT) 工具包组件，包括康复目标设定领域和创建结构化手册，以指导 CLC 跨学科团队完成评估、目标设定和治疗计划步骤。第 3 阶段（试验）将是 ECAP-CT 工具包在休斯顿（n=30 名居民）和塔斯卡卢萨（n=30 名居民）VA CLC 的准实验有效性试验。该工具包将在两个站点中依次实施，以便进行调整。我们的主要结果是过渡结果（成功/不成功），它将与从两个匹配的比较站点（n = 60）收集的并发管理数据进行比较。我们将在本试验的背景下对该工具包与常规护理进行探索性成本效益分析。 PI 的总体职业目标是成为一名独立的康复研究员，拥有开发和测试针对 CLC 居民需求的干预措施的专业知识，最大限度地提高自主性、独立性和功能。从长远来看，她的职业目标包括制定评估 CLC 居民日常能力的策略、设定居民导向的目标以及制定护理计划以帮助退伍军人重返社区。 CDA-2 指导团队包括资深 VA 研究人员，他们在弱势老年人、评估日常能力、干预措施制定和评估以及长期护理过渡方面具有专业知识。在指导团队的指导下，已经确定了可以从额外培训中受益的领域。CDA-2 奖项中概述的培训目标将提供以下领域的额外经验：1）评估以患者为中心的干预措施，包括成本效益和心理测量方法； 2）干预发展； 3）VA康复服务的经验和知识； 4) 提交 RR&D 优异评审奖。这些目标将通过指导和参加研讨会、正式课程和会议来实现。