Measuring Veterans' Safe Patient Handling and Mobility Experiences

背景：安全患者处理和移动(SPHM)由人体工程学技术和设备组成，以 转移不能独立行动的病人。SPHM有助于将不良事件(压疮、跌倒)降至最低， 和员工受伤。尽管有好处，但我们对患者如何体验辅助活动知之甚少。有效的 和可靠的量表，我们可以衡量患者的体验，从而促进改善护理，更定制 评估，以及更有针对性的临床教职员工教育。康复期患者是研究的理想群体。 具体目标：我们将根据患者的经验制定有效和可靠的自我报告调查 辅助活动：(PEAM)。我们有三个目标。首先，对定性访谈数据的分析将确定 并描述了患者体验的重要概念。刻度和项目将从 采访。这些项目将由患者和学科专家审查，以确保内容有效性。第二， PEAM将被实地考察并对数据进行分析，以提供信度和结构效度支持。第三，我们将 检查PEAM和相关结果之间的统计关系以建立标准效度。 意义：患者的护理体验是医疗质量的支柱之一。然而，没有任何措施 评估患者对辅助活动的看法。退伍军人事务部关于SPHM任务计划的国家指令 然而，老兵的声音不是评估的一部分。康复单位的绝对数量 退伍军人呼吁他们提供意见。和平行动计划将提供一种有效和可靠的措施来解决这一差距。Peam 将允许确定最佳实践、需要改进的领域和临床工作人员的教育优先事项。 优先领域：我们的研究解决了以患者为中心的护理和护理管理的HSR&D优先事项。我们 检查护理提供方法如何影响退伍军人的经历和相关结果。 创新：PEAM将是第一个可靠且经过验证的辅助移动体验患者报告调查。 方法：对于目标1，我们将对60名出院的退伍军人进行电话采访 康复单元包括：脊髓损伤、急性康复、短期疗养院和多发伤。我们会 采访两个医疗中心的30名工作人员，了解他们使用SPHM的经验。我们的概念模型和 面试问题包括患者、提供者、设备、环境和任务概念。我们会申请 对数据进行主题分析，以开发和改进结构。一个专家小组将评估物品是否适合构造。 我们将采访最多15名退伍军人，以确保对项目的理解符合预期。对于目标2，我们将测试 仪器与退伍军人样本(n=800)。项目反应理论和验证性因素分析将 找出表现最好的项目。我们将评估PEAM和其他验证者之间的结构效度 措施。对于目标3，我们将通过实地观察评估和 对20多个设施的退伍军人(n=3500)进行调查。我们将对患者和单位之间的关系进行建模 Peam的特点。我们还将检查患者和单位水平的结果，以建立标准有效性。 预期结果：我们的合成仪器将提供一种独特的辅助行动能力的测量方法。 对未得到充分研究的人口进行评估，评估护理恢复过程中一个重要但未得到充分研究的方面。 下一步：将向退伍军人事务部业务伙伴--包括SCI/D和SPHM--提供调查结果、见解、 以及能够支持其指令中的评估的建议。PEAM在评估方案中的使用 可以在全国范围内规划。方案办公室使用PEAM进行丰富的评估可能会导致 政策、员工教育、设备和改善的护理。通过对目标3中的设施的个人反馈， 绩效改进工作可以根据具体的调查结果进行量身定制。我们将与项目办公室合作， 开发和实施基于平板电脑的数据收集方法。使用经过验证的仪器，我们还可以包括 在退伍军人管理局定期管理的调查中，评估患者的康复护理体验。工作 还可以将该仪器改装成适用于减肥患者处理和长期护理的优先领域。

Background: Safe Patient Handling and Mobility (SPHM) consists of ergonomic techniques and equipment to move patients who cannot move independently. SPHM helps minimize adverse events (pressure ulcers, falls), and staff injuries. Despite benefits, we know little about how patients experience assisted mobility. With valid and reliable scales, we can measure patient experiences, thus facilitating improved care, more tailored evaluation, and more targeted clinical staff education. Patients in rehabilitation are an ideal group to study. Specific aims: We will develop a valid and reliable self-report survey based upon patients' experiences of assisted mobility: the (PEAM). We have three aims. First, the analysis of qualitative interview data will identify and describe important concepts of patients' experiences. Scales and items will be generated from the interviews. The items will be reviewed by patients and subject experts, assuring content validity. Second, the PEAM will be fielded and the data analyzed to provide support for reliability and construct validity. Third, we will examine the statistical relation between PEAM and associated outcomes to establish criterion validity. Significance: Patient experiences of care are one of the pillars of health care quality. Yet, no measures assess patients' perceptions of assisted mobility. The VA national directive for SPHM mandates program evaluation, yet the Voice of the Veteran is not part of the assessment. The sheer number of rehabilitation unit Veterans calls for their input. The PEAM will provide a valid and reliable measure to address this gap. PEAM will allow identification of best practices, areas in need of improvement, and clinical staff educational priorities. Priority domain: Our study addresses the HSR&D priority of patient-centered care and care management. We examine how methods of care delivery can influence Veterans' experiences and relevant outcomes. Innovation: PEAM will be the first reliable and validated patient-report survey of assisted mobility experiences. Methodology: For Aim 1, we will conduct telephone interviews with 60 Veterans discharged from inpatient rehabilitation units including: SCI, acute rehabilitation, short-stay nursing homes, and polytrauma. We will interview 30 staff at two medical centers about their experiences with SPHM. Our conceptual model and interview questions consist of patient, provider, equipment, environment, and task concepts. We will apply thematic analysis to data to develop and refine constructs. An expert panel will evaluate item fit to constructs. We will interview up to 15 Veterans to ensure items are understood as intended. For Aim 2, we will test the instrument with a sample of Veterans (n=800). Item response theory and confirmatory factor analysis will identify the best performing items. We will assess construct validity between the PEAM and other validated measures. For Aim 3, we will assess criterion validity through field-based observational assessments and surveys of Veterans (n=3500) at more than 20 facilities. We will model the relation between patient and unit characteristics with PEAM. We will also examine patient and unit-level outcomes to establish criterion validity. Expected results: Our resultant instrument will provide a unique measure of assisted mobility for this understudied population and assess an important, yet understudied, aspect of the care recovery process. Next steps: VA operational partners – including SCI/D and SPHM – will be provided with findings, insights, and recommendations that can support evaluation from their directives. PEAM use in evaluation programs nation-wide can be planned. Enriched evaluation using the PEAM by program offices could lead to changes in policies, staff education, equipment, and improved care. Through individual feedback to facilities in Aim 3, performance improvement efforts can be tailored around specific findings. We will work with program offices to develop and implement tablet-based data collection methods. With a validated instrument, we can also include the PEAM in surveys that VA regularly administers to assess patient experiences of rehabilitation care. Work can also adapt the instrument for bariatric patient handling and long-term care priority areas.