Sustaining STAR-VA: Partnered Evaluation of Veteran, Implementation and Facility Factors Contributing to Positive Sustained Outcomes to Inform Ongoing Program Implementation

维持 STAR-VA：对有助于积极持续成果的退伍军人、实施和设施因素进行合作评估，为正在进行的计划实施提供信息

• 批准号: 10021439
• 负责人: Kimberly J. Curyto
• 金额: --
• 依托单位: VA WESTERN NEW YORK HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-01-01 至 2019-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10021439
• 关键词: Acute; Address; Adherence; Advisory Committees; Aging; Agitation; Antipsychotic Agents; Anxiety; Assessment tool; Assisted Living Facilities; Behavior; Behavior Therapy; Behavior assessment; Behavior monitoring; Behavioral; Behavioral Symptoms; Brain Injuries; Caring; Cognitive; Collaborations; Competence; Complex; Consultations; Data; Data Set; Delirium; Dementia; Development; Diagnosis; Distress; Employee Engagement; Enrollment; Evaluation; Family; Frequencies; Geriatrics; Improve Access; Injury; Intervention; Interview; Joints; Knowledge; Long-Term Care; Measures; Medical; Mental Depression; Mental Health; Mental Health Services; Methods; Monitor; Morphologic artifacts; Nursing Services; Nursing Staff; Occupational Health; Office Nursing; Outcome; Outcome Measure; Pharmaceutical Preparations; Practice Guidelines; Predictive Factor; Prevalence; Professional Practice; Program Sustainability; Psychotropic Drugs; Qualitative Methods; Quality Indicator; Recommendation; Reporting; Risk Assessment; Role; Safety; Sampling; Severities; Site; Structure; System; Time; Time Factors; Training; Training Programs; Trust; Variant; Veterans; Workplace; base; behavior change; care systems; community living; dementia care; depressive symptoms; empowered; health administration; improved; inpatient service; medication safety; memory care; operation; post intervention; programs; prospective; psychotic symptoms; residence; therapy design

STAR-VA, a Veteran-centered, interdisciplinary, behavioral approach for managing behavioral symptoms of dementia (BSD) among Veterans Health Administration Community Living Center (CLC) residents, has been implemented in 66 trained CLC sites between 2013 and 2016. Collaborative evaluation is necessary to demonstrate the longitudinal impact of STAR-VA on CLC Veteran and site level outcomes, and determine factors associated with sustained implementation and positive outcomes, in order to support program sustainability and expansion. This project intends to identify a quality indicator for monitoring behavior change among CLC residents with dementia, determine Veteran, intervention, and facility/site factors that predict sustained positive behavioral and systemic outcomes, and identify facilitators and barriers to sustained STAR- VA implementation. Project outcomes will inform development and recommendations for an implementation and evaluation strategy for an outcome-driven, tailored intervention to support CLC teams in sustaining STAR-VA. Specific aims are to: 1. Develop and validate a quality indicator for monitoring the prevalence of BSD, using Minimum Data Set 3.0 behavior measures, validated by STAR-VA outcome measures; 2. Evaluate the longitudinal impact of STAR-VA by comparing site and resident outcomes at trained and untrained CLCs in years 2013-2016 on BSD, psychotropic use, and, for sites, staff injuries, and identify high and low performing CLC sites. 3. Explain variations in the sustained implementation of STAR-VA using qualitative methods with a purposeful sample of trained CLC sites, examine what Knowledge Reservoir (KR) domains are present in CLC sites and the impact of these KRs and additional factors on sustainment. Objective #1: Create a BSD quality indicator from mandatory Resident Assessment Instrument Minimum Data Set (MDS) 3.0 behavior variables, validated by STAR-VA outcome measures of behavior, depression and anxiety collected for 280 Veterans enrolled in STAR-VA between 2013 and 2016. STAR-VA participating Veterans have a dementia diagnosis and display repeated behaviors that are distressing to the resident or others, not directly related to delirium, other acute illness, psychotic symptoms, or recent brain injury. Objective #2: Evaluate the impact of STAR-VA by comparing trained and untrained CLC sites and residents in years 2013-2016 on selected outcomes, and identify resident, implementation, and facility factors associated with BSD. Resident level outcomes will include rates of BSD and psychotropic use in CLC residents using MDS 3.0 behavior quality indicator and Psychotropic Drug Safety Initiative (PDSI) data. CLC site level outcomes will be based on: a) Overall rates of BSD in the CLC (using MDS 3.0 behavior quality indicator and Workplace Behavioral Risk Assessment disruptive behavior reporting system), b) Antipsychotic and antianxiety medication use from PDSI program data, and c) Nursing staff injuries, using Occupational Health Automated Safety Incident Surveillance and Tracking Systems (ASSISTS) data. Objective #3: Explain variations in the sustained implementation of STAR-VA using prospective qualitative methods in a purposeful sample of trained CLC sites. Mixed methods, including interviews of high and low performing and high and low adherence sites, will be used to determine what KR domains including People, Routines, Artifacts, Relationships, Information space, Culture, and Structure and additional factors are present in trained CLC sites and the impact of these KRs and additional factors on STAR-VA program sustainment. Quantitative and qualitative factors related to sustained implementation and positive outcomes will be integrated and guide the development and recommended implementation and evaluation strategy for an outcome-driven, tailored sustainability intervention designed to improve poor-performer and maintain high-performer outcomes..

STAR-VA，以退伍军人为中心的跨学科行为方法，用于管理行为症状 老年痴呆症（BSD）的退伍军人健康管理局社区生活中心（CLC）的居民， 在2013年至2016年期间在66个经过培训的CLC站点实施。合作评价是必要的， 证明STAR-VA对CLC退伍军人和研究中心水平结局的纵向影响，并确定 与持续实施和积极成果相关的因素，以支持计划 可持续性和扩张。本项目旨在确定监测行为变化的质量指标 在CLC痴呆症患者中，确定退伍军人、干预措施和设施/地点因素， 持续的积极行为和系统性结果，并确定持续星星的促进因素和障碍- VA实现。项目成果将为发展和实施建议提供信息 和评价战略，以结果为导向，量身定制的干预措施，以支持CLC团队维持 星-弗吉尼亚州。具体目标是： 1.使用最小数据集3.0开发和验证用于监测BSD流行情况的质量指标 行为测量，通过STAR-VA结局测量进行验证; 2.通过比较接受培训的临床试验机构和住院医师的结局， 2013-2016年关于BSD、精神药物使用以及研究中心工作人员伤害的未经培训的CLCs，并确定 高性能和低性能CLC站点。 3.使用定性方法解释STAR-VA持续实施中的变化， 经过训练的CLC网站的有目的的样本，检查哪些知识库（KR）域存在于 CLC场地以及这些KRs和其他因素对维持的影响。 目标#1：从强制性居民评估工具最低限度创建BSD质量指标 数据集（MDS）3.0行为变量，通过STAR-VA行为、抑郁和 收集了2013年至2016年期间参加STAR-VA的280名退伍军人的焦虑。STAR-VA参与 退伍军人有痴呆症的诊断和显示重复的行为是痛苦的居民或 其他，与谵妄、其他急性疾病、精神病症状或近期脑损伤无直接关系。目的 #2：通过比较几年来经过培训和未经培训的CLC站点和居民来评估STAR-VA的影响 2013-2016年期间，根据选定成果， BSD。居民水平的结果将包括使用MDS 3.0的CLC居民的BSD和精神药物使用率 行为质量指标和精神药物安全倡议（PDSI）数据。CLC站点级别的结果将是 基于：a）CLC中BSD的总体比率（使用MDS 3.0行为质量指标和Workplace 行为风险评估破坏性行为报告系统），B）抗精神病和抗焦虑药物 使用PDSI程序数据，以及c）护理人员受伤，使用职业健康自动安全 事件监视和跟踪系统（ASSISTS）数据。目标#3：解释 在一个有目的的样本中使用前瞻性定性方法持续实施STAR-VA， 经过培训的CLC站点。混合方法，包括高绩效和低绩效以及高绩效和低绩效的访谈 坚持的网站，将用于确定什么KR域，包括人，企业，文物， 关系，信息空间，文化，结构和其他因素都存在于训练有素的CLC 地点以及这些KRs和其他因素对STAR-VA计划维持的影响。定量和 将纳入与持续执行和积极成果有关的质量因素， 制定并建议执行和评价战略，以实现以成果为导向、量身定制的 可持续性干预，旨在改善表现不佳者并保持高表现者的成果。

项目成果

An MDS 3.0 Distressed Behavior in Dementia Indicator (DBDI): A Clinical Tool to Capture Change.

• DOI: 10.1111/jgs.16957
• 发表时间: 2021-03
• 期刊: Journal of the American Geriatrics Society
• 影响因子: 6.3
• 作者: Curyto KJ;Jedele JM;Mohr DC;Eaker A;Intrator O;Karel M
• 通讯作者: Karel M

Preference Consistency: Veteran and Non-Veteran Nursing Home Resident Self-Reported Preferences for Everyday Living.

• DOI: 10.3928/00989134-20200129-06
• 发表时间: 2020-03-01
• 期刊: Journal of gerontological nursing
• 影响因子: 1.3
• 作者: Curyto K;Dockler LM;Van Haitsma KS
• 通讯作者: Van Haitsma KS