Evaluating the Implementation of Patient Safety Practices to Ensure Timely, High-Quality Community Care for Veterans

评估患者安全实践的实施情况，确保为退伍军人提供及时、高质量的社区护理

• 批准号: 10181058
• 负责人: AMY K ROSEN
• 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: 2019-04-01 至 2022-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10181058
• 关键词: Accountability; Address; Adoption; Adverse event; Affect; Caring; Clinical; Collaborations; Communication; Communities; Consolidated Framework for Implementation Research; Contractor; Ensure; Equilibrium; Evaluation; Event; Feedback; Fostering; Goals; Growth; Health; Health Services Accessibility; Healthcare; Impact evaluation; Improve Access; Interview; Investigation; Knowledge; Lead; Measures; Methodology; Outcome; Patient Care; Perception; Phase; Policies; Process; Provider; Quality of Care; Reporting; Risk; Safety; Services; Site; Standardization; Strategic Planning; Structure; Telephone Interviews; Time; Training; Variant; Veterans; Veterans Health Administration; Work; care fragmentation; care providers; care systems; community involvement; community setting; contextual factors; design; evidence base; guidebooks; health care quality; implementation outcomes; implementation strategy; improved; informant; innovation; neighborhood safety; operation; patient oriented; patient safety; response; safety outcomes; safety practice; scale up; success; trend; uptake

Background: The expansion of Community Care (CC) through the MISSION Act, and the increasing numbers of Veterans using CC, make it critical for VHA to balance the need to improve access to care, and at the same time, ensure that the services that VHA purchases in the community are of high quality. As there is little known about the quality and safety of care that Veterans receive in the community, this timely study will begin to close these knowledge gaps. Specific Aims: Our specific aims are to: 1) Assess variation across VISNs and facilities in the implementation of Guidebook processes used for patient safety reporting investigation, and improvement; 2) Identify the organizational contextual factors that influence implementation for sites with high vs. low fidelity to Guidebook safety processes; 3) Describe variation across VISNs and sites in service outcomes: safety events, timeliness, and Veterans' perceptions of CC quality and safety; and 4) Identify specific configurations of implementation strategies and organizational contextual factors that distinguish high- vs. low-performing sites on their implementation and service outcomes. Unique Features/Innovations of Project: This timely, innovative study will evaluate a national, mandated implementation of safety processes that are described in the VHA Office of Community Care (OCC) “Patient Safety Guidebook.” The Guidebook was developed by OCC and VHA National Center for Patient Safety (NCPS) in response to gaps in safety identified in CC. Through collaboration with our operational partners (OCC and NCPS), we will provide VHA with critical information on whether use of the Guidebook as an implementation strategy is effective in improving safety of CC, and whether safety processes to report and investigate safety events in VHA are transferrable and applicable to the community setting. Methodology: For Aim 1, we will conduct semi-structured telephone interviews with approximately 3 key informants (VHA patient safety staff, local CC staff) at 18 facilities across 18 VISNs. We will ask them questions on sites' fidelity to Guidebook's safety processes, feasibility of Guidebook implementation, and which implementation strategies worked well and which did not. For Aim 2, we will obtain information from the staff interviews on their perceptions of the organizational contextual factors that influence implementation, differentiating between sites with high and low fidelity to the Guidebook's recommended processes. For Aim 3, we will examine rates and trends in VHA and CC safety events, timeliness outcomes, and perceptions of CC quality and safety by Veterans. We will integrate the results from Aims 1-3 in Aim 4 to identify specific configurations of implementation strategies and organizational contextual factors that distinguish high- vs. low-performing sites. Expected Results: This partnered evaluation will be of benefit to both Veterans and our partners by generating context-specific findings that promote ongoing implementation of processes that improve quality and safety of care provided to Veterans in both VHA and CC.

背景资料： 通过《使命法案》扩大社区护理（CC），以及越来越多的退伍军人 使用CC，使VHA平衡改善护理可及性的需求至关重要，同时确保 VHA在社区购买的服务是高质量的。由于对这一点知之甚少， 退伍军人在社区接受的护理质量和安全，这项及时的研究将开始关闭这些 知识差距。 具体目标： 我们的具体目标是：1）在实施指南时评估VISN和设施之间的差异 用于患者安全报告调查和改进的流程; 2）确定组织 影响指南安全性高与低保真度网站实施的背景因素 流程; 3）描述VISN和站点之间服务结果的差异：安全事件、及时性和 退伍军人对CC质量和安全的看法;以及4）确定实施的具体配置 战略和组织环境因素，区分高与低性能网站， 实施和服务成果。 项目特色/创新： 这项及时的创新研究将评估国家强制执行的安全流程， VHA社区护理办公室（OCC）“患者安全指南”中描述。该指南是 由OCC和VHA国家患者安全中心（NCPS）制定，以应对已确定的安全性差距 在CC中。通过与我们的运营合作伙伴（OCC和NCPS）合作，我们将为VHA提供关键的 关于使用《指南》作为实施战略是否能有效提高安全性的信息 CC，以及VHA中报告和调查安全事件的安全流程是否可转移， 适用于社区设置。 方法学： 对于目标1，我们将对大约3名关键线人（VHA）进行半结构化电话访谈 患者安全工作人员、当地CC工作人员）。我们会问他们关于网站忠诚度的问题 指导手册的安全流程，指导手册实施的可行性，以及实施 战略运作良好，哪些没有。就目的2而言，我们会透过与员工会面， 对影响实施的组织环境因素的看法，区分不同地点 对指南中推荐的过程有高有低的忠实度。对于目标3，我们将研究利率， VHA和CC安全事件的趋势、及时性结果以及对CC质量和安全性的看法， 老兵我们将在目标4中整合目标1-3的结果，以确定 实施战略和组织环境因素，区分高与低性能的网站。 预期结果： 这种合作评估将有利于退伍军人和我们的合作伙伴， 促进持续实施提高护理质量和安全的过程的调查结果， VHA和CC的退伍军人。