Evaluating the Implementation of Patient Safety Practices to Ensure Timely, High-Quality Community Care for Veterans

背景： 通过使命法案扩大社区护理(CC)，以及退伍军人数量的增加 使用CC，使VHA在改善获得护理的需求之间取得平衡至关重要，同时确保 VHA在社区购买的服务是高质量的。由于人们对此知之甚少 退伍军人在社区接受的护理的质量和安全，这项及时的研究将开始结束这些 知识鸿沟。 具体目标： 我们的具体目标是：1)评估VISN和设施在实施指南时的差异 用于患者安全报告调查和改进的流程；2)确定组织 影响对指南安全保真度高或低的站点实施的环境因素 流程；3)描述VISN和站点之间的服务结果差异：安全事件、及时性和 退伍军人对CC质量和安全的看法；以及4)确定具体的实施配置 战略和组织背景因素，区分高绩效网站和低绩效网站 实施和服务成果。 项目的独特功能/创新： 这项及时、创新的研究将评估国家强制实施的安全流程，这些流程 在VHA社区护理办公室(OCC)“患者安全指南”中描述。《指南》是 由OCC和VHA国家患者安全中心(NCPS)开发，以应对发现的安全漏洞 在CC中。通过与我们的运营合作伙伴(OCC和NCPS)合作，我们将为VHA提供关键的 关于使用《指南》作为实施战略是否能有效地提高 CC，以及报告和调查VHA安全事件的安全流程是否可转让和 适用于社区环境。 研究方法： 对于目标1，我们将对大约3名关键线人(VHA)进行半结构化电话采访 患者安全人员、当地CC工作人员)在18个VISN的18个设施中。我们将向他们询问有关网站保真度的问题 关于指南的安全流程、指南实施的可行性以及哪些实施 策略奏效了，但哪种策略效果不佳。对于目标2，我们将从员工面谈中获得关于他们的信息 对影响实施的组织背景因素的看法，区分不同地点 高保真度和低保真度，符合指南推荐的流程。对于目标3，我们将审查税率和 VHA和CC安全事件的趋势、及时性结果以及对CC质量和安全的看法 退伍军人。我们将在目标4中整合目标1-3的结果，以确定特定的配置 区分高绩效网站与低绩效网站的实施策略和组织背景因素。 预期结果： 这种合作评估将通过生成特定于环境的评估来为退伍军人和我们的合作伙伴带来好处 促进持续实施改善医疗质量和安全的进程的调查结果 VHA和CC的退伍军人。

Background: The expansion of Community Care (CC) through the MISSION Act, and the increasing numbers of Veterans using CC, make it critical for VHA to balance the need to improve access to care, and at the same time, ensure that the services that VHA purchases in the community are of high quality. As there is little known about the quality and safety of care that Veterans receive in the community, this timely study will begin to close these knowledge gaps. Specific Aims: Our specific aims are to: 1) Assess variation across VISNs and facilities in the implementation of Guidebook processes used for patient safety reporting investigation, and improvement; 2) Identify the organizational contextual factors that influence implementation for sites with high vs. low fidelity to Guidebook safety processes; 3) Describe variation across VISNs and sites in service outcomes: safety events, timeliness, and Veterans' perceptions of CC quality and safety; and 4) Identify specific configurations of implementation strategies and organizational contextual factors that distinguish high- vs. low-performing sites on their implementation and service outcomes. Unique Features/Innovations of Project: This timely, innovative study will evaluate a national, mandated implementation of safety processes that are described in the VHA Office of Community Care (OCC) “Patient Safety Guidebook.” The Guidebook was developed by OCC and VHA National Center for Patient Safety (NCPS) in response to gaps in safety identified in CC. Through collaboration with our operational partners (OCC and NCPS), we will provide VHA with critical information on whether use of the Guidebook as an implementation strategy is effective in improving safety of CC, and whether safety processes to report and investigate safety events in VHA are transferrable and applicable to the community setting. Methodology: For Aim 1, we will conduct semi-structured telephone interviews with approximately 3 key informants (VHA patient safety staff, local CC staff) at 18 facilities across 18 VISNs. We will ask them questions on sites' fidelity to Guidebook's safety processes, feasibility of Guidebook implementation, and which implementation strategies worked well and which did not. For Aim 2, we will obtain information from the staff interviews on their perceptions of the organizational contextual factors that influence implementation, differentiating between sites with high and low fidelity to the Guidebook's recommended processes. For Aim 3, we will examine rates and trends in VHA and CC safety events, timeliness outcomes, and perceptions of CC quality and safety by Veterans. We will integrate the results from Aims 1-3 in Aim 4 to identify specific configurations of implementation strategies and organizational contextual factors that distinguish high- vs. low-performing sites. Expected Results: This partnered evaluation will be of benefit to both Veterans and our partners by generating context-specific findings that promote ongoing implementation of processes that improve quality and safety of care provided to Veterans in both VHA and CC.