Measuring Veterans' Safe Patient Handling and Mobility Experiences

衡量退伍军人的安全患者处理和移动体验

• 批准号: 10308445
• 负责人: Deborah Gurewich
• 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: 2019-10-01 至 2023-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10308445
• 关键词: Acute; Address; Adverse event; Affect; Area; Bariatrics; Benchmarking; Caregivers; Caring; Characteristics; Clinical; Communication; Computerized Medical Record; Data; Data Analyses; Data Collection; Decision Making; Development; Devices; Dimensions; Disease; Education; Effectiveness; Elements; Ensure; Environment; Equipment; Evaluation; Factor Analysis; Fall prevention; Feedback; Fright; Future; Goals; Guidelines; Health; Hospitals; Human; Impairment; Individual; Infrastructure; Injury; Inpatients; Intervention; Interview; Lead; Learning; Link; Long-Term Care; Measures; Medical center; Methodology; Methods; Modeling; Multiple Trauma; Nurses; Outcome; Pain; Patient Monitoring; Patient Self-Report; Patient Transfer; Patient-Centered Care; Patient-Focused Outcomes; Patients; Perception; Performance; Personal Satisfaction; Persons; Physical activity; Policies; Population; Privacy; Procedures; Process; Program Evaluation; Property; Provider; Quality of Care; RQ2; Recommendation; Recovery; Rehabilitation therapy; Reporting; Research Personnel; Resources; Risk; Role; Safety; Sampling; Site; Spinal cord injury; Surveys; System; Tablets; Techniques; Technology; Telephone Interviews; Testing; Training; Training Programs; Variant; Veterans; Voice; Work; base; care delivery; clinical practice; decubitus ulcer; empowered; equipment training; ergonomics; experience; falls; field study; functional independence; health care quality; improved; innovation; insight; instrument; military veteran; nursing home length of stay; patient oriented; patient population; pressure ulcer prevention; programs; rehabilitative care; response; safe patient; theories; tool

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.

背景：安全患者处理和移动（SPHM）由符合人体工程学的技术和设备组成， 移动不能独立移动的患者。 SPHM 有助于最大限度地减少不良事件（压疮、跌倒）、 以及工作人员受伤。尽管有好处，但我们对患者如何体验辅助行动知之甚少。具有有效的 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、更加量身定制 评估，以及更有针对性的临床人员教育。康复患者是理想的研究群体。 具体目标：我们将根据患者的经历制定有效且可靠的自我报告调查 辅助移动：（PEAM）。我们有三个目标。首先，定性访谈数据的分析将确定 并描述患者经历的重要概念。秤和物品将从 采访。这些项目将由患者和学科专家进行审查，以确保内容的有效性。其次， 将部署 PEAM 并分析数据，为可靠性和结构有效性提供支持。第三，我们将 检查 PEAM 和相关结果之间的统计关系以确定标准有效性。 意义：患者的护理体验是医疗保健质量的支柱之一。但仍无措施 评估患者对辅助移动的看法。 VA 国家 SPHM 指令强制计划 评估，但退伍军人之声不属于评估的一部分。康复单位的数量之多 退伍军人呼吁他们提供意见。 PEAM 将提供有效且可靠的措施来解决这一差距。 PEAM 将允许确定最佳实践、需要改进的领域以及临床人员教育优先事项。 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 研究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，我们将与 60 名出院退伍军人进行电话访谈 康复单位包括：SCI、急性康复、短期疗养院和多发伤。我们将 采访了两个医疗中心的 30 名工作人员，了解他们使用 SPHM 的经历。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。我们将申请 对数据进行主题分析以开发和完善结构。专家小组将评估项目是否适合结构。 我们将采访最多 15 名退伍军人，以确保项目得到理解。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 确定表现最好的项目。我们将评估 PEAM 和其他经过验证的结构之间的有效性 措施。对于目标 3，我们将通过基于现场的观察评估来评估标准的有效性 在 20 多个设施中对退伍军人 (n=3500) 进行了调查。我们将对患者和单位之间的关系进行建模 PEAM 的特性。我们还将检查患者和单位层面的结果，以确定标准的有效性。 预期结果：我们最终的仪器将为此提供一种独特的辅助移动测量方法 未充分研究的人群，并评估护理恢复过程中一个重要但尚未充分研究的方面。 后续步骤：VA 运营合作伙伴（包括 SCI/D 和 SPHM）将获得调查结果、见解、 以及可以支持根据其指令进行评估的建议。 PEAM 在评估程序中的使用 可以在全国范围内进行规划。项目办公室使用 PEAM 进行丰富的评估可能会导致以下方面的变化： 政策、员工教育、设备和改善的护理。通过对目标 3 中设施的个人反馈， 可以根据具体的发现来调整绩效改进工作。我们将与项目办公室合作 开发并实施基于平板电脑的数据收集方法。通过经过验证的仪器，我们还可以包括 PEAM 是 VA 定期进行的调查，旨在评估患者的康复护理体验。工作 还可以将该仪器应用于肥胖患者处理和长期护理优先领域。