Pre-Training Intervention for Expedited TeamSTEPPS Implementation in Critical Access Hospitals

 描述(申请人提供)：尽管经过十多年的高度关注和广泛的努力来改善患者的安全，最近的研究发现，患者伤害在美国医院仍然很常见。研究还报告说，与非危重医院相比，危重医院(CAH)的风险调整后30天死亡率更高，而且在2002至2010年间这一比率有所上升。医疗研究和质量机构(AHRQ)正在积极推广TEAMSTEPPS，这是一种基于证据的团队合作和团队培训干预措施，旨在改善医疗保健提供者之间的沟通和团队合作技能。我们之前的研究发现，许多CAH在实施和维持TEAMSTEPPS方面难以及时取得进展。最大的失误之一是他们在没有采取必要的准备步骤的情况下启动了执行工作。一旦启动，有限的资源条件限制了CAH调整其执行方法的能力，这往往导致执行工作暂停或被驳回。这项研究的目标是开发专门设计的培训前干预措施，以帮助CAH人员为 TEAMSTEPPS。我们将在四个CAH中对干预措施进行试点测试，并前瞻性地研究干预措施如何影响在这些CAH中实施TEAMSTEPPS的过程。我们将解决三个具体目标。第一个目标是设计培训前干预措施，以协助CAH为TEAMSTEPPS的实施做准备。在我们以前工作的基础上，确定了战略准备的五个关键要素：评估战略需求、评估组织背景、选择变革推动者、形成共同理解和明确实施目标，我们将制定一项干预协议，规定开展培训前准备的关键步骤和实用指导方针。第二个具体目标是在四家CAH医院进行培训前干预，并前瞻性地检查这些医院的实施过程。我们将招募四名CAH进行干预，然后他们才能参加TEAMSTEPPS高级培训师培训。培训结束后，我们将每季度访问每家医院，收集有关实施动态(实施的忠诚度和重点、变革因素的效力和参与度)和进展(实施活动的时间和范围)的数据。第三个具体目标是评价干预要素与执行力度和进展之间的关系。我们将使用传统的定性方法和定性比较分析(QCA)来确定将干预措施的特定要素与各种过程结果(如实施忠诚度、变革推动者参与和实施进度)联系起来的完整联系。我们预计，经过未来的改进和测试，拟议的干预措施可以用于促进TEAMSTEPPS在CAH中的实施，并将对AHRQ传播这一以证据为基础的计划以提高患者安全的努力做出重大贡献。

 DESCRIPTION (provided by applicant): Despite more than a decade of heightened attention and extensive efforts to improve patient safety, recent studies find that patient harms remain common in American hospitals. Studies also report that Critical Access Hospitals (CAHs) have higher risk-adjusted 30-day mortality rates compared with non-CAHs and the rates increased between 2002 and 2010. Agency for Healthcare Research and Quality (AHRQ) is actively disseminating TeamSTEPPS, an evidence-based teamwork and team training intervention for improving communication and teamwork skills among health care providers. Our previous research has found that many CAHs struggled with making timely progress with implementing and sustaining TeamSTEPPS. One of the biggest miss-steps was that they initiated the implementation without conducting necessary preparation steps. Once initiated, the limited resource conditions constrained the CAHs' ability to adjust their implementation approach, which often led to the suspension or dismissal of the implementation effort. The objective of this study is to develop a pre-training intervention specifically designed to assist CAHs to prepare for TeamSTEPPS. We will pilot test the intervention in four CAHs and prospectively examine how the intervention influences the process of implementing TeamSTEPPS in these CAHs. We will address three specific aims. The first aim is to design a pre-training intervention to assist CAHs to prepare for TeamSTEPPS implementation. Building on our previous work that identified five key elements to strategic preparation ¿ assessing strategic needs, assessing the organizational context, selecting change agents, developing a shared understanding, and specifying implementation goals, we will develop an intervention protocol that specifies key steps and practical guidelines for conducting pre-training preparation. The second specific aim is to conduct the pre-training intervention in four CAHs and prospectively examine the implementation processes in these hospitals. We will recruit and conduct the intervention in four CAHs before they participate in the TeamSTEPPS Master Trainer Training. After the Training, we will make quarterly visits to each hospital to collect data on implementation dynamics (implementation fidelity and focus, change agent efficacy and engagement) and progress (timing and scope of implementation activities). The third specific aim is to evaluate the relationship between the elements of the intervention and the implementation dynamics and progress. We will use both traditional qualitative methods and the Qualitative Comparative Analysis (QCA) to identify integral connections linking specific elements of the intervention to various process outcomes such as implementation fidelity, change agent engagement, and implementation progress. We expect that the proposed intervention, after future refinement and testing, can be used to facilitate TeamSTEPPS implementation in CAHs, and will significant contribute to AHRQ's effort to disseminate this evidence-based program to enhance patient safety.