RE-INSPIRE: Rich-context Evaluation of INSPIRE

RE-INSPIRE：INSPIRE 的丰富上下文评估

• 批准号: 9077058
• 负责人: EDWARD J. MIECH
• 金额: --
• 依托单位: RLR VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-10-01 至 2015-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9077058
• 关键词: Acute; Address; Adopted; Behavioral; Boxing; Caring; Clinical; Collaborations; Complex; Computer software; Country; Data; Data Analyses; Data Collection; Development; Dimensions; Education; Effectiveness; Effectiveness of Interventions; Engineering; Evaluation; Evidence based practice; Experimental Designs; Face; Feedback; Funding; Goals; Health Communication; Healthcare; Impact evaluation; Individual; Inpatients; Intervention; Interview; Investments; Ischemic Stroke; Joints; Knowledge; Learning; Left; Measures; Mediating; Medical center; Methodology; Methods; Mining; Morphologic artifacts; Operations Research; Outcome; Patient Care; Patients; Performance; Persons; Play; Process; Psychology; Quality of Care; Questioning individuals; Randomized; Randomized Controlled Trials; Reporting; Research; Research Personnel; Resources; Role; Services; Site; Site Visit; Social Network; Sociology; Solutions; Source; Stroke; Structure; System; Telephone; Thinking; Time; United States; Veterans; Work; acute stroke; base; data integration; editorial; evidence base; experience; flexibility; health care quality; implementation research; implementation science; improved; innovation; meetings; member; microsystems; multidisciplinary; peer networks; prospective; psychologic; response; social; standardize measure; success; trial design

DESCRIPTION (provided by applicant): The proposed RE-INSPIRE (Rich-context Evaluation of INSPIRE) Service-Directed Project (SDP) will investigate how and why local quality improvement initiatives within VA differ so widely in terms of success, spread, and sustainability by conducting a rigorous evaluation of the impact of context. RE-INSPIRE will embed a prospective, longitudinal, and mixed-methods study of context in an existing randomized-controlled trial of stroke care improvement at 14 VA sites across the United States. It will constitute a major collaboration between the VA Stroke Quality Enhancement Research Initiative (QUERI) and VA-CASE, one of four Veterans Engineering Resource Centers (VERCs) in the United States. As part of this QUERI-VERC partnership, RE-INSPIRE investigators will include nationally-recognized VA experts in implementation science and engineering. The study in which RE-INSPIRE will be embedded is the recently-funded "Intervention for Stroke Performance Improvement Using Redesign Engineering" (INSPIRE) SDP. Using an experimental design with random assignment, INSPIRE evaluates the effect of a Systems Redesign-based Collaborative plus monthly quality performance reporting on improving VA inpatient acute ischemic stroke care, as compared to the effect of quarterly performance feedback alone. RE-INSPIRE will enhance and extend the original INSPIRE evaluation (1) with an in-depth study of context and (2) continuing site visits and data collection at the 14 participating VA facilities more than a full year after the end of INSPIRE in order to assess in detail issues of spread and sustainability. The specific aims of the three- year RE-INSPIRE study include: (a) evaluating the impact of context on implementation mechanisms used at 7 sites randomly assigned to participate in a Systems Redesign-based intervention (including a Collaborative); (b) evaluating the impact of context on effective and ineffective local initiatives to improve acute stroke care across 14 intervention and control sites participating in the INSPIRE randomized-controlled trial; (c) evaluating the impact of context on the spread and sustainability of local initiatives to improve acute stroke care across the 14 INSPIRE intervention and control sites. The Consolidated Framework for Implementation Research will serve as the study's conceptual framework. RE-INSPIRE investigators will collect context-related data through annual site visits at all 14 VA facilities; conducting semi-structured interviews (annually in person and quarterly by phone), administering nine standardized measures (including the Team Development Measure); and performing ongoing document/artifact capture. Data analysis will include the pilot administration of a new data integration strategy in which multiple types of data from multiple sources and sites will be imported into a single cumulative project file using advanced software. The data in this unified project file will then be systematically explored, queried, and analyzed, culminating in the ability of RE-INSPIRE investigators at study's end to explain with evidence the impact of context on implementation mechanisms, on the effectiveness of local quality improvement initiatives, and on spread and sustainability. The proposed RE-INSPIRE project includes a plan to disseminate this "context matrix" approach to VA researchers, leaders and planners who see potential value in a new, evidence-based method to track improvement and progress across a wide variety of multi-site initiatives within the VA.

描述（由申请人提供）： 拟议的 RE-INSPIRE（INSPIRE 的丰富情境评估）服务导向项目 (SDP) 将通过对情境影响进行严格评估，调查 VA 内的本地质量改进举措在成功、传播和可持续性方面如何以及为何存在如此巨大的差异。 RE-INSPIRE 将在美国 14 个 VA 站点现有的改善中风护理的随机对照试验中嵌入一项前瞻性、纵向和混合方法的背景研究。它将构成 VA 中风质量增强研究计划 (QUERI) 和 VA-CASE（美国四个退伍军人工程资源中心 (VERC) 之一）之间的重大合作。作为 QUERI-VERC 合作伙伴关系的一部分，RE-INSPIRE 研究人员将包括国家认可的实施科学和工程领域的 VA 专家。 RE-INSPIRE 将纳入的研究是最近资助的“利用重新设计工程改善中风表现的干预措施”(INSPIRE) SDP。 INSPIRE 使用随机分配的实验设计，评估基于系统重新设计的协作加上每月质量绩效报告对改善 VA 住院患者急性缺血性中风护理的效果，与单独季度绩效反馈的效果相比。 RE-INSPIRE 将增强和扩展最初的 INSPIRE 评估：(1) 对背景进行深入研究；(2) 在 INSPIRE 结束后一整年的时间里继续对 14 个参与的 VA 设施进行实地考察和数据收集，以便详细评估传播和可持续性问题。为期三年的 RE-INSPIRE 研究的具体目标包括： (a) 评估环境对随机分配参与基于系统重新设计的干预（包括协作）的 7 个地点所使用的实施机制的影响； (b) 评估参与 INSPIRE 随机对照试验的 14 个干预和控制点的环境对改善急性卒中护理的有效和无效当地举措的影响； (c) 评估环境对改善 14 个 INSPIRE 干预和控制点的急性卒中护理的当地举措的传播和可持续性的影响。实施研究综合框架将作为该研究的概念框架。 RE-INSPIRE 调查人员将通过对所有 14 个 VA 设施进行年度现场访问来收集背景相关数据；进行半结构化访谈（每年一次，每季度一次通过电话），实施九项标准化措施（包括团队发展措施）；并执行持续的文档/工件捕获。数据分析将包括新数据集成策略的试点管理，其中来自多个来源和站点的多种类型的数据将使用先进的软件导入到单个累积项目文件中。然后，将系统地探索、查询和分析这个统一项目文件中的数据，最终使 RE-INSPIRE 调查人员能够在研究结束时用证据解释背景对实施机制、当地质量改进举措的有效性以及传播和可持续性的影响。拟议的 RE-INSPIRE 项目包括一项向 VA 研究人员、领导者和规划者传播这种“背景矩阵”方法的计划，他们看到了一种新的、基于证据的方法的潜在价值，用于跟踪 VA 内各种多站点计划的改进和进展。