Assessing Organizational Variations in VA Pressure Ulcer Prevention Initiatives

评估 VA 压疮预防计划的组织差异

• 批准号: 8541555
• 负责人: Lynn M Soban
• 金额: --
• 依托单位: VA GREATER LOS ANGELES HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-10-01 至 2014-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8541555
• 关键词: Acute; Advocate; Budgets; Care given by nurses; Caring; Characteristics; Collection; Complex; Cream; Data; Data Analyses; Data Collection; Databases; Decision Making; Decubitus ulcer; Development; Dietitian; Discipline; Discipline of Nursing; Equipment; Future; Goals; Grant; Guidelines; Health Services Research; Hospitals; Intervention; Lead; Leadership; Nurses; Nursing Services; Occupations; Office Nursing; Outcome; Patients; Performance; Physicians; Policies; Policy Maker; Population; Positioning Attribute; Prevention; Preventive; Process; Published Comment; Qualifying; Quality of Care; Recommendation; Reporting; Research; Research Personnel; Resources; Risk Assessment; Role; Sampling; Site; Skin; Specialist; Structure; Surface; Surveys; System; Testing; Translating; Variant; Wages; Work; base; care delivery; clinical care; development policy; expectation; handbook; health care quality; high risk; human subject protection; impression; improved; informant; member; operation; organizational structure; patient safety; prevent; programs; tool; wound

o ? Description of data analysis very sketchy with no mention of specific statistical tests that will examine relationships between key variables. Presumably Ms. Canelo, a new study team member, will conduct the data analysis using STATA 11 but this is not clearly stated. ? Survey is to be emailed only to wound care specialists. One goal of the Handbook is to facilitate an interprofessional approach to pressure ulcer prevention. Because pressure ulcer development is multifactorial, prevention requires the collaborative preventive efforts of several disciplines. Obtaining information only from nurses, as mentioned by one of the initial reviewers, provides only one, potentially biased perspective of PU prevention at a facility 4. Human Subjects Protection (do not score - comment on any issues): No issues 5 Project Organization and Management (including qualifications of investigator team): Well qualified investigator team with roles on the study divided according to expertise although the role of Ms. Canelo is somewhat vague. 6. Budget (do not score - comment on any issues): Budget is primarily for salary for PI, one of Co-PIs, and members of the research team. 7. Likely Impact and Potential for Sustainability: In responding to the reviewers' comments as to how the end product of this study will be used, the resubmitted proposal provides some general examples of how the survey data may be used to inform policy and operational decisions. Addtitionally, the proposal offers some possible future studies building on the results of the survey. Overall Impression. In this grant resubmission, the PI provides clearer, more compelling rationale for examining organizational features associated with implementation of the Pressure Ulcer Handbook. If understanding organizational context-processes and structures-are critical to understanding variations in implementation of the PU Handbook, then administering the survey to only wound care specialists may be not only limiting and potentially biased, but also negates the interprofessional approach to pressure ulcer prevention advocated in the Handbook. The rationale for using nurse wound care specialists as the key informants is based on the study team's prior work in which they have "found that the structural information reported by the wound care specialist lead has been consistent with the information provided by top leadership." o The PI's prior work, however, has been a study of only 6 sites and it is not clear if the wound care nurses at these 6 sites are representative of wound care nurses across the VA. o The role expectations of the wound care specialist vary among facilities as to 1) whether the position is the primarily job assignment or a collateral duty, 2) how long the wound care specialist has been in the position at the VA, and the role the wound care specialist assumes on the interprofessional team. o Recommend including other members of the wound care team in the survey. Key Strengths. 1. Expertise of study team 2. Potential for VHA to better understand the extent and characteristics of the implementation of the PU Handbook. 3. Strong support from the Office of Nursing Services Key Weaknesses. 1. Administration of survey to wound care specialists only. 2. Lack of detail regarding survey data analysis

O ? 对数据分析的描述非常粗略，没有提到将检查关键变量之间关系的具体统计测试。 据推测，新研究团队成员Canelo女士将使用STATA 11进行数据分析，但未明确说明。 ? 调查仅通过电子邮件发送给伤口护理专家。 该手册的一个目标是促进跨专业的方法来预防压疮。 由于压疮的发展是多因素的，预防需要多个学科的合作预防工作。 正如一位最初的评论者所提到的，仅从护士那里获得信息，只能提供一个潜在的有偏见的预防PU的观点 4. 人类受试者保护（不评分-对任何问题发表评论）： 没有问题 5 项目组织和管理（包括研究者团队的资质）： 合格的研究者团队，根据专业知识划分研究职责，尽管Canelo女士的职责有些模糊。 6. 预算（不评分-评论任何问题）： 预算主要用于PI（Co-PI之一）和研究团队成员的工资。 7. 可能的影响和可持续性潜力： 针对审查人员关于如何使用这项研究的最终产品的意见，重新提交的提案提供了一些一般性例子，说明如何使用调查数据为政策和业务决定提供信息。 此外，该提案还提出了今后可能在调查结果基础上开展的一些研究。 整体印象。 在此补助金重新提交，PI提供了更清晰，更令人信服的理由，检查与压疮手册的实施相关的组织功能。如果了解组织背景下的流程和结构是理解PU手册的实施变化的关键，那么管理调查，只有伤口护理专家可能不仅是限制和潜在的偏见，而且还否定了跨专业的方法来预防压疮手册中提倡的。 使用护士伤口护理专家作为关键信息提供者的理由是基于研究团队的先前工作，其中他们"发现伤口护理专家领导报告的结构信息与最高领导提供的信息一致。" O 然而，PI之前的工作仅涉及6家临床试验机构，尚不清楚这6家临床试验机构的伤口护理护士是否代表VA的伤口护理护士。 O 伤口护理专家的角色期望因机构而异，包括：1）该职位是主要工作任务还是附带职责，2）伤口护理专家在VA担任该职位的时间，以及伤口护理专家在跨专业团队中承担的角色。 O 建议将伤口护理团队的其他成员纳入调查。 关键优势。 1. 研究团队的专业知识 2. VHA有可能更好地了解PU手册实施的程度和特点。 3. 护理服务办公室的大力支持 关键弱点。 1. 仅对伤口护理专家进行调查。 2. 调查数据分析缺乏细节