Developing and Implementing a Toolkit for Measuring CLC Cultural Transformation

开发和实施衡量 CLC 文化转型的工具包

• 批准号: 8477986
• 负责人: CHRISTINE W HARTMANN
• 金额: --
• 依托单位: EDITH NOURSE ROGERS MEMORIAL VETERANS HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-01-01 至 2016-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8477986
• 关键词: Address; Adopted; Area; Behavior; Caring; Collaborations; Data; Development; Elements; Environment; Funding; Geriatrics; Individual; Institute of Medicine (U.S.); Knowledge; Long-Term Care; Measurable; Measurement; Measures; Medical; Methods; Mission; Modeling; Modification; Neighborhoods; Outcome; Patient-Centered Care; Patients; Performance; Persons; Phase; Physical Function; Physical environment; Procedures; Process; Program Development; Protocols documentation; Quality of Care; Recruitment Activity; Rehabilitation therapy; Research; Research Personnel; Resources; Sampling; Services; Site; Social Environment; Telephone Interviews; Testing; Training; Veterans; Visit; Work; base; checkup examination; community living; design; experience; health administration; hospice environment; improved; in vivo; innovation; member; primary outcome; programs; routine practice; satisfaction; success; symposium; tool

DESCRIPTION (provided by applicant): Background: The Veterans Health Administration (VHA) is in the process of transforming from a culture based on the medical-model to one that embraces a patient- (resident-) centered perspective. Community Living Centers (CLCs), which provide care to a substantial spectrum of veterans who need long-term care, rehabilitation, or hospice services, are undertaking this "cultural transformation" as well. This transformation involves alterations in the physical environment of CLCs and in staff care and work practices, although changes implemented to date are highly variable nationally and have generally focused on modifications to the physical environment. Arguably, two of the most substantial barriers to implementing resident-centered care in CLCs are (1) established practices that support the medical model and (2) lack of evidence to guide the selection of potential innovations. The Developing and Implementing Resident-centered Efforts in Cultural Transformation (DIRECT) study addresses these barriers. Objectives: The DIRECT study builds upon extensive developmental work on cultural transformation at three CLCs. Out of the developmental work emerged a standardized, observation-based tool to measure staff behaviors related to staff-resident interactions and staff members' engagement of residents: the Resident- centered Assessment of Interactions with Staff and Engagement tool (RAISE). This is a tool for use primarily by researchers. A preliminary version of an action-oriented protocol to help busy frontline staff adopt resident- centered care improvements, the Advancing Cultural Transformation in Our Neighborhoods! Plan (ACTION! Plan), was also developed. The DIRECT study expands on this previous work and has the following objectives. The first objective is to collaborate with staff at 2 CLCs in the development of a draft program implementation guide (i.e., a comprehensive set of resources for implementing a program to improve resident-centeredness of care) for the RAISE and the ACTION! Plan. This objective has 3 secondary objectives: (a) refine the RAISE and ACTION! Plan, (b) adapt the RAISE into a shortened, staff-friendly version (RAISE-sf), then test the RAISE-sf, and (c) develop and test a staff training video for the RAISE-sf and ACTION! Plan. The second objective is to evaluate two types of implementation strategies for the draft guide at 6 sites. The third objective is to finalize a practical and effective program implementation guide to enable sustainable implementation of the RAISE-sf and ACTION! Plan. Methods: The study will take place in 3 phases using mixed-methods and a purposive sample of CLCs. The CLCs recruited for participation in the DIRECT study are all strongly committed to and have already made significant strides in cultural transformation. In Phase I, at 2 CLCs researchers will (a) conduct telephone interviews with CLC staff about tool implementation and development of the RAISE-sf and (b) will test the RAISE and ACTION! Plan for user comprehensibility with CLC staff and CLC inspectors. They will then create and test the RAISE-sf and a training video and develop the implementation program guide. In Phase II, 6 sites will implement the guide, each over a 6-month period. For this, three sites will have on-site training and check- in for the implementation, while 3 will have remote training and check-in. Phase III will be dedicated to finalizing the guide and its contents based on the input received from and data collected at the 6 Phase II sites. Anticipated Impacts: The proposed research will provide systematic information about (1) how best to measure resident-centeredness of care and how best to implement changes in staff members' routine workflow to improve the resident-centeredness of care and (2) how best to implement a guide to facilitate CLCs' progress on improving resident-centeredness of care. The knowledge gained and the refined tools and protocols developed will be of immediate applicability to CLCs nationwide and will be helpful for guiding further improvements in resident-centered care in the VHA.

描述（由申请人提供）： 背景资料：退伍军人健康管理局（VHA）正在从基于医学模式的文化转变为以患者（居民）为中心的文化。社区生活中心（CLC）为需要长期护理、康复或临终关怀服务的大量退伍军人提供护理，也在进行这种“文化转型”。这一转变涉及社区学习中心的物质环境以及工作人员的照料和工作做法的改变，尽管迄今为止实施的变革因国家而异，而且一般侧重于物质环境的改变。可以说，在CLC中实施以居民为中心的护理的两个最大障碍是（1）支持医学模式的既定实践和（2）缺乏证据来指导潜在创新的选择。发展和实施以居民为中心的文化转型努力（直接）研究解决了这些障碍。目标：DIRECT研究建立在三个CLC文化转型的广泛发展工作的基础上。在开发工作中出现了一个标准化的、基于观察的工具，用于衡量工作人员与居民互动以及工作人员参与居民的行为：以居民为中心的与工作人员互动和参与评估工具（RAISE）。这是一个主要供研究人员使用的工具。一个以行动为导向的协议的初步版本，以帮助忙碌的一线工作人员采取以居民为中心的护理改进，推进文化转型，在我们的社区！计划（行动！计划），也制定了。DIRECT研究扩展了以前的工作，并有以下目标。第一个目标是与两个社区联络中心的工作人员合作， 制定方案实施指南草案（即，一套全面的资源，用于实施一项计划，以提高居民为中心的照顾）的提高和行动！计划这个目标有3个次要目标：（a）完善RAISE和ACTION！计划，（B）将RAISE改编成一个缩短的、员工友好的版本（RAISE-sf），然后测试RAISE-sf，（c）为RAISE-sf和ACTION开发和测试员工培训视频！计划第二个目标是在6个地点评价指南草案的两种执行战略。第三个目标是最后确定一个切实有效的计划实施指南，以确保可持续地实施RAISE-sf和ACTION！计划方法：本研究将分三个阶段进行，采用混合方法和有目的的CLC样本。被招募参加DIRECT研究的CLC都坚定地致力于文化转型，并已在文化转型方面取得重大进展。在第一阶段，在2个CLC研究人员将（a）进行电话采访CLC工作人员有关工具的实施和发展的RAISE-sf和（B）将测试上升和行动！与CLC工作人员和CLC检查员一起制定用户可理解性计划。然后，他们将创建和测试RAISE-sf和培训视频，并制定实施计划指南。在第二阶段，6个研究中心将在6个月内实施该指南。为此，三个研究中心将进行现场培训和实施登记，三个研究中心将进行远程培训和登记。第三阶段将致力于根据从6个第二阶段研究中心收到的意见和收集的数据最终确定指南及其内容。预期影响：拟议的研究将提供有关以下方面的系统信息：（1）如何最好地衡量以居民为中心的护理，以及如何最好地改变工作人员的日常工作流程，以改善以居民为中心的护理，以及（2）如何最好地实施指南，以促进CLC在改善以居民为中心的护理方面取得进展。所获得的知识和完善的工具和协议将立即适用于全国范围内的CLC，并将有助于指导VHA以居民为中心的护理的进一步改进。