CSI: Assessing Resident Supervision

CSI：评估驻地监督

• 批准号: 8784044
• 负责人: T. MICHAEL KASHNER
• 金额: --
• 依托单位: VA LOMA LINDA HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-08-01 至 2017-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8784044
• 关键词: Accounting; Agreement; Algorithms; Ambulatory Care; Award; Caring; Client satisfaction; Clinic; Clinical; Community Health Education; Comorbidity; Complex; Computer software; Computerized Patient Records; Data; Development; Discipline of Nursing; Education; Educational process of instructing; Effectiveness; Electronics; Enrollment; Ensure; Environment; Equation; Focus Groups; Future; Goals; Gold; Health; Health Occupations; Health Professional; Health care facility; Healthcare; Healthcare Systems; Hospitals; Inpatients; Institution; Interview; Leadership; Learning; Length; Measures; Medical Staff; Medical center; Methods; Mission; Non-Insulin-Dependent Diabetes Mellitus; Nurses; Nursing Students; Online Systems; Outcome; Outpatients; Patient Care; Patients; Performance; Pharmacy facility; Physicians; Pilot Projects; Play; Policies; Procedures; Process; Psychology; Quality of Care; Registries; Reporting; Research; Research Personnel; Resource Allocation; Role; Sampling; Services; Site; Students; Supervision; Surveys; System; Testing; Time; Training; Variant; Veterans; Work; Workload; base; care seeking; clinical care; design; experience; indexing; information gathering; innovation; instrument; meetings; member; patient oriented; patient safety; programs; response; satisfaction; theories

DESCRIPTION (provided by applicant): Background: One-third of all U.S. physician residents rotate through a VA medical center and are involved in 37% of VA's physician services while caring for 2.5 million veterans. Despite the critical role that VA professional staff plays in supervising trainees in patient care, no scientifically valid measure exists to quantify the intensity of that supervision. Thus, little is understood as to how supervision may impact patient outcomes, guide trainees' progress towards competencies to enter independent practice, or contribute to producing clinical workload to meet the health care needs of veterans. Purpose: The purpose of this study is to assess the performance of the Clinical Supervision Index (CSI), a VA conceived instrument designed and developed by the investigators through an HSR&D pilot study and VHA/OI&T Greenfield award to quantitatively measure the intensity of the supervision that trainees receive during inpatient or outpatient encounters with pre-selected "active" patients. Fully functioning at the VA Loma Linda medical center since May 2013 on class II software in CPRS, CSI's key features are: the measure is applicable across all health professions education trainees (physicians, nurses, psychology, pharmacy, etc.) and over inpatient and outpatient care settings and measures supervision for the clinical care described in trainee-signed progress notes. We maintain a registry of trainees and supervisors within the medical center. In addition, our CSI software automatically administers electronic Trainee and Supervisor Surveys through CPRS, searches across VistA for the responsible supervising practitioner, creates merged files on regional servers, and electronically transfers those files to the Allocation Resource Center for processing. Objective: We assess CSI concurrent validity (do the lengths of supervised time that trainees and supervisors report in CSI surveys agree with time computed from direct observations?); construct validity (are supervision levels predictable?); and applicability (do adjusted CSI intensity scores reflect trainee's clinical competencies and predict patient care outcomes, patient satisfaction with trainee- involved VA care, trainee education outcomes, and trainee satisfaction with their learning experiences?) Method: Data are obtained at the VA Loma Linda medical center from CSI electronic files, VistA extracts (supplemented with CDW data), face-to-face quarterly patient surveys during one-year patient follow-ups, web-based semi-annual trainee satisfaction surveys during the two-year trainee follow-ups, panel of 40 trainees, panel of 300 patients with type II diabetes enrolled in the continuity clinic, 90 supervisors, involving 1,500 encounters (indexed progress notes), with 750 encounters sampled for direct observation. The CSI has been fully operational at the study site since May 2013. Analyses include intraclass correlations, mean response biases, and effect sizes computed from Generalized Estimating Equations to account for hierarchical trainee, supervisor, and patient encounter level data.

描述（由申请人提供）： 背景资料：三分之一的美国医生居民通过VA医疗中心轮换，并参与VA 37%的医生服务，同时照顾250万退伍军人。尽管VA专业人员在监督患者护理受训人员方面发挥着关键作用，但没有科学有效的措施来量化这种监督的强度。因此，很少有人知道如何监督可能会影响病人的结果，指导学员的进步能力进入独立的做法，或有助于生产临床工作量，以满足退伍军人的医疗保健需求。目的：本研究的目的是评估临床监督指数（CSI）的性能，这是一种由研究人员通过HSR&D试点研究和VHA/OI&T格林菲尔德奖设计和开发的VA构想工具，用于定量测量受训者在住院或门诊与预先选定的“活跃”患者接触期间接受的监督强度。全面运作， VA洛马琳达医疗中心自2013年5月以来在CPRS中的II类软件，CSI的主要特点是：该措施适用于所有卫生专业教育实习生（医生，护士，心理学，药房等）。以及住院和门诊护理设置和措施监督受训者签署的进度说明中描述的临床护理。我们在医疗中心有一个实习生和主管的登记册。此外，我们的CSI软件通过CPRS自动管理电子实习生和主管调查，在VistA中搜索负责的监督从业人员，在区域服务器上创建合并文件，并将这些文件以电子方式传输到分配资源中心进行处理。目的：我们评估CSI的同时有效性（实习生和主管在CSI调查中报告的监督时间长度是否与直接观察计算的时间一致？）;结构效度（监督水平是可预测的吗？）和适用性（调整后的CSI强度评分是否反映了受训者的临床能力并预测患者护理结果、患者对受训者参与的VA护理的满意度、受训者教育结果以及受训者对其学习经历的满意度？）方法：数据来自VA Loma琳达医疗中心的CSI电子文件，VistA摘录（补充CDW数据）、一年患者随访期间面对面的季度患者调查、两年学员随访期间基于网络的半年期学员满意度调查、40名学员组成的小组、300名连续性诊所登记的II型糖尿病患者、90名主管，涉及1人、500次遭遇（编入索引的进展说明），其中750次遭遇抽样进行直接观察。自2013年5月以来，CSI已在研究中心全面运行。分析包括组内相关性，平均响应偏差，并从广义估计方程计算的效果大小，以考虑分层学员，主管和患者遇到的水平数据。