RE-INSPIRE: Rich-context Evaluation of INSPIRE

描述（由申请人提供）： 拟议的RE-INSPIRE（丰富的背景评估INSPIRE）服务导向项目（SDP）将通过对背景的影响进行严格评估，调查VA内部的地方质量改进举措在成功、传播和可持续性方面差异如此之大的原因和方式。RE-INSPIRE将在美国14个VA站点现有的卒中护理改善随机对照试验中嵌入一项前瞻性、纵向和混合方法研究。它将构成VA中风质量增强研究计划（QUERI）和VA-CASE（美国四个退伍军人工程资源中心（VERCs）之一）之间的主要合作。作为QUERI-VERC合作伙伴关系的一部分，RE-INSPIRE调查人员将包括国家认可的VA实施科学和工程专家。将嵌入RE-INSPIRE的研究是最近资助的“使用重新设计工程干预卒中表现改善”（INSPIRE）SDP。使用随机分配的实验设计，INSPIRE评估了基于系统重新设计的协作加上每月质量绩效报告对改善VA住院急性缺血性卒中护理的影响，与单独的季度绩效反馈的影响相比。RE-INSPIRE将加强和扩大最初的INSPIRE评价，（1）对背景进行深入研究，（2）在INSPIRE结束后一年多的时间里，继续对14个参与的退伍军人事务部设施进行实地访问和数据收集，以便详细评估传播和可持续性问题。为期三年的RE-INSPIRE研究的具体目标包括：（a）评估环境对随机分配参加基于系统重新设计的干预措施的7个地点使用的执行机制的影响（包括合作）;（B）在参与INSPIRE随机化的14个干预和对照地点中，评估环境对有效和无效的地方举措的影响，以改善急性卒中护理，对照试验;（c）评估环境对14个INSPIRE干预和控制地点的地方举措的传播和可持续性的影响，以改善急性卒中护理。执行情况研究综合框架将作为研究的概念框架。RE-INSPIRE调查人员将通过对所有14个VA设施的年度现场访问收集背景相关数据;进行半结构化访谈（每年一次，每季度通过电话进行一次），管理9项标准化措施（包括团队发展措施）;并进行持续的文件/工件捕获。数据分析将包括试行一项新的数据整合战略，利用先进软件将来自多个来源和地点的多种数据输入一个累积项目文件。这个统一的项目文件中的数据将被系统地探索、查询和分析，最终使RE-INSPIRE调查人员能够在研究结束时用证据解释背景对实施机制、当地质量改进举措的有效性以及传播和可持续性的影响。拟议的RE-INSPIRE项目包括一项计划，将这种“背景矩阵”方法传播给退伍军人事务部研究人员、领导人和规划人员，他们认为一种新的、基于证据的方法具有潜在价值，可以跟踪退伍军人事务部内各种各样的多地点倡议的改进和进展。 公共卫生相关性： 作为其为退伍军人提供高质量医疗保健的基本承诺的一部分，VA支持全国各地VA医疗中心和设施的质量改进计划。在这些举措中，当地退伍军人事务部团队共同努力，通过开发新的、改进的方式来满足退伍军人的需求，以提高护理质量。这些地方改进小组的成员往往来自退伍军人事务部的不同服务和部门。这些团队开发和实施的解决方案经常是创新的，因为它们代表了不同群体的最佳想法，这些群体作为一个团队工作，以改善退伍军人在其设施中的医疗保健。拟议的RE-INSPIRE研究有助于退伍军人事务部支持这些地方质量改进工作。通过确定与当地环境相关的不同因素如何帮助或阻碍14个VA设施改善中风护理的举措，RE-INSPIRE研究将发现参与当地质量改善工作的人最需要什么，以便成功地提高退伍军人的护理质量。

DESCRIPTION (provided by applicant): The proposed RE-INSPIRE (Rich-context Evaluation of INSPIRE) Service-Directed Project (SDP) will investigate how and why local quality improvement initiatives within VA differ so widely in terms of success, spread, and sustainability by conducting a rigorous evaluation of the impact of context. RE-INSPIRE will embed a prospective, longitudinal, and mixed-methods study of context in an existing randomized-controlled trial of stroke care improvement at 14 VA sites across the United States. It will constitute a major collaboration between the VA Stroke Quality Enhancement Research Initiative (QUERI) and VA-CASE, one of four Veterans Engineering Resource Centers (VERCs) in the United States. As part of this QUERI-VERC partnership, RE-INSPIRE investigators will include nationally-recognized VA experts in implementation science and engineering. The study in which RE-INSPIRE will be embedded is the recently-funded "Intervention for Stroke Performance Improvement Using Redesign Engineering" (INSPIRE) SDP. Using an experimental design with random assignment, INSPIRE evaluates the effect of a Systems Redesign-based Collaborative plus monthly quality performance reporting on improving VA inpatient acute ischemic stroke care, as compared to the effect of quarterly performance feedback alone. RE-INSPIRE will enhance and extend the original INSPIRE evaluation (1) with an in-depth study of context and (2) continuing site visits and data collection at the 14 participating VA facilities more than a full year after the end of INSPIRE in order to assess in detail issues of spread and sustainability. The specific aims of the three- year RE-INSPIRE study include: (a) evaluating the impact of context on implementation mechanisms used at 7 sites randomly assigned to participate in a Systems Redesign-based intervention (including a Collaborative); (b) evaluating the impact of context on effective and ineffective local initiatives to improve acute stroke care across 14 intervention and control sites participating in the INSPIRE randomized-controlled trial; (c) evaluating the impact of context on the spread and sustainability of local initiatives to improve acute stroke care across the 14 INSPIRE intervention and control sites. The Consolidated Framework for Implementation Research will serve as the study's conceptual framework. RE-INSPIRE investigators will collect context-related data through annual site visits at all 14 VA facilities; conducting semi-structured interviews (annually in person and quarterly by phone), administering nine standardized measures (including the Team Development Measure); and performing ongoing document/artifact capture. Data analysis will include the pilot administration of a new data integration strategy in which multiple types of data from multiple sources and sites will be imported into a single cumulative project file using advanced software. The data in this unified project file will then be systematically explored, queried, and analyzed, culminating in the ability of RE-INSPIRE investigators at study's end to explain with evidence the impact of context on implementation mechanisms, on the effectiveness of local quality improvement initiatives, and on spread and sustainability. The proposed RE-INSPIRE project includes a plan to disseminate this "context matrix" approach to VA researchers, leaders and planners who see potential value in a new, evidence-based method to track improvement and progress across a wide variety of multi-site initiatives within the VA. PUBLIC HEALTH RELEVANCE: As part of its fundamental commitment to provide high-quality healthcare to veterans, the VA supports quality-improvement initiatives at VA medical centers and facilities across the country. In these initiatives, local VA teams work together to improve quality of care by developing new, improved ways to meet veterans' needs. The members of these local improvement teams often come from different services and departments within the VA. The solutions these teams develop and implement are frequently innovative because they represent the best thinking of a diverse group of individuals who work as a team to improve healthcare for veterans at their facility. The proposed RE-INSPIRE study helps the VA support these local quality improvement efforts. By identifying how different factors related to local context help or hinder initiatives to improve stroke care at 14 VA facilities, the RE-INSPIRE study will discover what people involved in local quality improvement efforts most need in order to succeed in their efforts to enhance quality of care for veterans.