Assessing Organizational Variations in VA Pressure Ulcer Prevention Initiatives

O ？对数据分析的描述非常粗略，没有提到检查关键变量之间关系的具体统计测试。卡内洛女士大概是一名新的研究团队成员，她将使用Stata 11进行数据分析，但这一点没有明确说明。 ？调查将只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，预防需要几个学科的协同预防努力。正如一位最初的评价者所提到的那样，仅从护士那里获取信息，只能为设施中的PU预防提供一个潜在的、有偏见的视角 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项目组织管理(含调查组资质)： 高素质的调查员团队，在研究中的作用根据专门知识进行划分，尽管卡内洛女士的作用有些含糊。 6.预算(不评分--对任何问题发表评论)： 预算主要用于共同绩效指标之一的PI和研究小组成员的工资。 7.对可持续发展可能产生的影响和潜力： 在答复审查员关于如何使用本研究的最终产品的意见时，重新提交的提案提供了一些一般性的例子，说明如何利用调查数据为政策和业务决策提供信息。此外，该提案还在调查结果的基础上提供了一些未来可能的研究。 总体印象。 在这份重新提交的赠款中，PI为审查与《压疮手册》执行有关的组织特征提供了更清晰、更令人信服的理由。如果了解组织背景--流程和结构--对于了解PU手册实施中的变化至关重要，那么只对伤口护理专家进行调查可能不仅是有限的，而且可能存在偏见，而且还否定了手册中倡导的跨专业方法来预防压疮。使用护士伤口护理专家作为关键信息者的理由是基于研究小组之前的工作，在这些工作中，他们“发现伤口护理专家领导报告的结构信息与最高领导层提供的信息一致。” O然而，PI之前的工作只对6个地点进行了研究，不清楚这6个地点的伤口护理护士是否代表整个退伍军人管理局的伤口护理护士。 O伤口护理专家在以下方面的角色期望因机构而异：1)该职位是主要的工作分配还是附带职责，2)伤口护理专家在退伍军人管理局的职位上工作了多长时间，以及伤口护理专家在跨专业团队中扮演的角色。 O建议将伤口护理团队的其他成员包括在调查中。 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》的实施范围和特点。 3.护理服务办公室的大力支持 主要弱点。 1.只向伤口护理专家进行调查。 2.调查数据分析缺乏细节

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