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
基本信息
- 批准号:9757612
- 负责人:
- 金额:--
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2014
- 资助国家:美国
- 起止时间:2014-09-01 至 2020-02-29
- 项目状态:已结题
- 来源:
- 关键词:AcuteAdoptionAreaAwardBackCLC GeneCaringCommunitiesCompetenceCost Effectiveness AnalysisCountryDataData SetDevelopmentDischarge PlanningsElderlyEnsureEnvironmentEquilibriumEvaluationFaceFutureGoalsHealthHome Nursing CareHome environmentHousingIndependent LivingIndividualInpatientsInterventionInterviewKnowledgeLength of StayLifeLong-Term CareManualsMental DepressionMentorsMethodologyMissionModelingNursing HomesOutcomePersonal SatisfactionPersonsPhasePhase III Clinical TrialsProblem SolvingProcessProviderPsychometricsQuality of lifeRehabilitation therapyResearchResearch PersonnelResourcesRiskServicesSiteStandardizationStructureSuggestionTechniquesTestingTimeTrainingVeteransbasecareercaregivingcommunity livingcommunity planningcostcost effectivenesseffective interventioneffectiveness trialexperienceformative assessmentfunctional declineimplementation scienceimprovedinnovationinstrumentmemberpatient orientedprimary outcomeprogramspublic health relevancerehabilitation servicesuccesssymposiumtherapy developmenttreatment as usualtreatment planning
项目摘要
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.
产品说明:
根据人与环境的匹配模型,当环境中的需求和可用资源与个人的日常能力(解决日常生活问题的能力)不再平衡时,老年人就有可能出现不良结果。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水平的护理,可以安全地居住在社区,并提供适当的康复服务。在弗吉尼亚州,一个主要的重点是通过提供康复和过渡退伍军人到社区,以尽量减少在CLC的时间。CLC工作人员和退伍军人面临着促进这些过渡的障碍(例如,生活需要、住房等)。存在N个标准化过程,以确保治疗计划包括最大化P-E拟合的过程。本研究的目的是开发一个工具包,CLC跨学科团队可以使用
1)评估退伍军人的日常能力; 2)根据日常能力制定个人有意义的康复目标; 3)进行结构化的治疗计划,以支持居民在过渡到社区时的目标。认识到即使是最有效的干预是毫无价值的,如果没有人真正使用它,我们提出了一个三阶段的研究过程:理解-发展-试验。第1阶段(了解)侧重于了解CLC的当前环境、排放规划流程和结果。在目标1a中,我们将使用行政数据来检查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,了解目前的障碍和促进者过渡CLC居民,确定居民面临的日常情景,并收集工作人员的建议,为适当的目标设定域。对于目标1c,我们将使用现场观察来了解跨学科团队成员在过渡规划期间的工作流程,关系和互动。第2阶段(开发)将利用第1阶段收集的信息开发日常能力评估和社区转型规划(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,目标设定和治疗规划步骤。第3阶段(试验)将是休斯顿(n=30名居民)和塔斯卡卢萨(n=30名居民)VA CLC的ECAP-CT工具包的准实验有效性试验。该工具包将在这两个地点依次实施,以便进行调整。我们的主要结局是过渡结局(成功/不成功),将其与从两个匹配的比较中心(n=60)收集的同期管理数据进行比较。我们将在本试验的背景下对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人员,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CLC居民日常能力评估战略,制定居民导向的目标,并制定护理计划,将退伍军人过渡到社区。CDA-2指导团队包括已建立的VA研究人员,他们具有脆弱老年人的专业知识,评估日常能力,干预开发和评估以及长期护理过渡。在指导团队的指导下,已经确定了将从额外培训中受益的领域。CDA-2奖项中概述的培训目标将在以下领域提供额外的经验:1)以患者为中心的干预措施的评估,包括成本效益和心理测量学方法; 2)干预措施的开发; 3)VA康复服务的经验和知识;以及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。
项目成果
期刊论文数量(6)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
Implementation and Feasibility of the Re-Engineered Discharge for Surgery (RED-S) Intervention: A Pilot Study.
重新设计的手术出院 (RED-S) 干预措施的实施和可行性:试点研究。
- DOI:10.1097/jhq.0000000000000266
- 发表时间:2021
- 期刊:
- 影响因子:0
- 作者:Du,RebeccaY;Shelton,George;Ledet,CeliaR;Mills,WhitneyL;Neal-Herman,Levi;Horstman,Molly;Trautner,Barbara;Awad,Samir;Berger,David;Naik,AanandD
- 通讯作者:Naik,AanandD
An Unintended Consequence of Culture Change in VA Community Living Centers.
退伍军人事务部社区生活中心文化变革的意外后果。
- DOI:10.1016/j.jamda.2016.10.006
- 发表时间:2017
- 期刊:
- 影响因子:7.6
- 作者:Harrison,Jill;Tyler,DeniseA;Shield,RenéeR;Mills,WhitneyL;Morgan,KristenE;Cutty,MaxwellE;Coté,DanielleL;Allen,SusanM
- 通讯作者:Allen,SusanM
Care Transitions to the Community from Veterans Affairs Nursing Homes: Experiences of Social Connection and Disconnection.
从退伍军人事务疗养院到社区的护理过渡:社会联系和脱节的经历。
- DOI:10.1016/j.jamda.2020.07.029
- 发表时间:2021
- 期刊:
- 影响因子:7.6
- 作者:Simons,KelseyV;Bower,EmilyS;Gillespie,SuzanneM;Mills,WhitneyL
- 通讯作者:Mills,WhitneyL
Validation of the MEDSAIL Tool to Screen for Capacity for Safe and Independent Living Among Nursing Home Residents.
- DOI:10.1016/j.jamda.2020.05.008
- 发表时间:2020-12
- 期刊:
- 影响因子:7.6
- 作者:Mills, Whitney L.;Kunik, Mark E.;Kelly, P. Adam;Wilson, Nancy L.;Starks, Steven;Asghar-Ali, Ali;Curren-Vo, Hannah;Naik, Aanand D.
- 通讯作者:Naik, Aanand D.
Assessing Social Functioning During COVID-19 and Beyond: Tools and Considerations for Nursing Home Staff.
- DOI:10.1016/j.jamda.2021.07.022
- 发表时间:2021-10
- 期刊:
- 影响因子:7.6
- 作者:Madrigal C;Bower E;Simons K;Gillespie SM;Van Orden K;Mills WL
- 通讯作者:Mills WL
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Whitney L Mills其他文献
Whitney L Mills的其他文献
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{{ truncateString('Whitney L Mills', 18)}}的其他基金
Implementing the Behavioral Activities Intervention (BE-ACTIV) to Reduce Depression among Veterans in Community Living Centers
实施行为活动干预 (BE-ACTIV) 以减少社区生活中心退伍军人的抑郁症
- 批准号:
10524009 - 财政年份:2020
- 资助金额:
-- - 项目类别:
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 - 财政年份:2014
- 资助金额:
-- - 项目类别:
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:
9360882 - 财政年份:2014
- 资助金额:
-- - 项目类别:
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:
8926245 - 财政年份:2014
- 资助金额:
-- - 项目类别:
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