Healthcare providers and public reporting of Community Living Center (CLC) quality: Investigating responses and opportunities for intervention through the PROACTIVE mixed-methods study

医疗保健提供者和社区生活中心 (CLC) 质量的公开报告：通过前瞻性混合方法研究调查干预措施的反应和机会

• 批准号: 10186470
• 负责人: Camilla Benedicto Pimentel
• 金额: --
• 依托单位: EDITH NOURSE ROGERS MEMORIAL VETERANS HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-06-01 至 2020-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10186470
• 关键词: Address; Anxiety; Area; Attitude; CLC Gene; Caring; Clinical; Collaborations; Communities; Cream; Data; Development; Ensure; Environment; Foundations; Future; Geriatrics; Health; Health Personnel; Health Services Accessibility; Intervention; Interview; Investments; Knowledge; Lead; Light; Long-Term Care; Measurable; Measures; Methods; Modeling; Motivation; Nursing Homes; Outcome; Patient Admission; Perception; Performance; Private Sector; Property; Psychometrics; Publishing; Qualitative Research; Reaction; Recording of previous events; Reporting; Sampling; Seminal; Site; Staff Attitudes; Structure; Surveys; System; Testing; Time; Training; United States Centers for Medicare and Medicaid Services; Veterans; Visit; Work; acceptability and feasibility; base; cognitive interview; community center; community living; community setting; dashboard; design; experience; formative assessment; hospital performance; improved; response; satisfaction; web site; willingness

Background: In June, 2018, VHA began public reporting of its 135 Community Living Centers’ (CLCs’) overall quality using a five-star rating system based on data from the national quality measures captured in CLC Compare. In light of the private sector’s positive experience with report cards, this is a seminal moment for stimulating measurable quality improvements in CLCs. Yet public reporting of CLC Compare data raises substantial and immediate implications for CLCs. The report cards, for example, facilitate comparisons between CLCs and community nursing homes in which CLCs generally fare worse. This may lead to staff anxiety and potential unintended consequences (e.g., selective patient admissions—“cream skimming”). In addition, CLC Compare is designed to spur improvement, yet the motivating aspects of the report cards are unknown. Understanding staff attitudes and early responses is a critical first step in building the capacity for public reporting to spur quality. Specific Aims: We thus propose to adapt an existing community nursing home public reporting survey to reveal important leverage points to support CLCs’ quality improvement efforts. Our work will be grounded in a conceptual framework of strategic orientation and conducted in partnership with the VA Office of Geriatrics and Extended Care (GEC). We have 2 aims. 1. Qualitatively examine a sample of CLC staff reactions to CLC Compare. 2. Adapt and expand upon an extant community nursing home survey to capture a broad range of responses, then pilot the adapted survey in CLCs. Methods: Aim 1: We will conduct interviews with staff at 3 CLCs (one 1-star, one 3-star, and one 5-star) to identify (1) specific staff actions taken in response to their CLC’s public data, (2) staff commitment to/difficulties with using CLC Compare for quality improvement, and (3) factors that motivate staff to improve CLC quality. Aim 2: We will integrate these findings with our conceptual framework to adapt and expand a community nursing home survey to the current CLC environment. We will conduct cognitive interviews with staff in 1 CLC to refine survey items. We will then pilot the survey in 6 CLCs (two 1-star, two 3-star, and two 5-star) to assess survey feasibility, acceptability, and preliminary psychometric properties. Expected Results and Next Steps: We expect to develop a brief survey to be used in a future national administration to (1) identify system-wide responses to CLC Compare; (2) evaluate the impact of CLC Compare on Veterans’ clinical outcomes and satisfaction; and (3) develop, test, and disseminate interventions to support meaningful use of CLC Compare for quality improvement. Knowledge gained from this pilot and from future work will help GEC refine how CLC Compare is used, ensure that CLC staff understand and are motivated to use its quality data, and implement concrete actions to improve clinical quality. Products from this pilot will also facilitate studies of the effects of public reporting in other critical VHA clinical areas. Significance & Relevance to Veterans’ Health: This study responds to HSR&D’s Long-Term Care priority domain and the VHA priority of Greater Choice for Veterans. Just as public reporting of VHA hospital performance led to both positive and maladaptive responses, CLC Compare may have similar impacts on CLC staff and the 40,000 vulnerable Veterans they serve. This study seizes the opportunity to identify positive, as well as unintended and potentially maladaptive, early responses to CLC Compare to help improve VHA long-term care.

背景：2018 年 6 月，VHA 开始公开报告其 135 个社区生活中心的情况 （CLC）整体质量采用基于国家质量数据的五星级评级系统 CLC 比较中所采取的措施是考虑到私营部门在这方面的积极经验。 报告卡，这是刺激可衡量的质量改进的开创性时刻 然而，CLC 比较数据的公开报告提出了重大且直接的影响。 例如，CLC 的报告卡有助于 CLC 和社区之间的比较。 CLC 的情况通常较差的疗养院，这可能会导致员工焦虑和潜在的风险。 意想不到的后果（例如，选择性入院——“撇脂”）。 CLC Compare 旨在促进改进，但报告卡的激励方面 了解员工的态度和早期反应是建设的关键第一步。 公共报告提高质量的能力。 具体目标：因此，我们建议调整现有的社区疗养院公共报告 调查揭示了支持 CLC 质量改进工作的重要杠杆点。 工作将以战略方向的概念框架为基础，并在 与退伍军人管理局老年病学和延伸护理办公室 (GEC) 合作我们有 2 个目标。 1. 定性检查 CLC 工作人员对 CLC Compare 的反应样本。 2. 改编并扩展现有的社区疗养院调查，以获取广泛的信息 范围的响应，然后在 CLC 中试点经过调整的调查。 方法： 目标 1：我们将对 3 个 CLC 的员工进行访谈（1 个 1 星级、1 个 3 星级、1 个 一颗 5 星）以确定 (1) 员工针对其 CLC 公共数据采取的具体行动，(2) 员工使用 CLC Compare 来提高质量的承诺/困难，以及 (3) 因素 激励员工提高 CLC 质量 目标 2：我们将把这些发现与我们的工作相结合。 适应和扩展社区疗养院调查的概念框架 CLC 环境。我们将对 1 个 CLC 的员工进行认知访谈，以完善调查。 然后，我们将在 6 个 CLC（两个 1 星级、两个 3 星级和两个 5 星级）中进行试点调查以进行评估。 调查可行性、可接受性和初步心理测量特性。 预期结果和后续步骤：我们希望制定一项简短的调查以供将来使用 国家主管部门 (1) 确定全系统对 CLC Compare 的反应；(2) 评估 CLC Compare 对退伍军人临床结果和满意度的影响；以及 (3) 开发、测试、 并传播干预措施以支持有意义地使用 CLC Compare 来提高质量 从本次试点和未来工作中获得的知识将有助于 GEC 改进改进方法。 使用 CLC Compare，确保 CLC 员工理解并有动力使用其质量 数据，并采取具体行动来提高该试点产品的临床质量。 促进公共报告在其他关键 VHA 临床领域的影响的研究。 对退伍军人健康的意义和相关性：这项研究响应了 HSR&D 的长期计划 护理优先领域和退伍军人更大选择的 VHA 优先权就像公众一样。 VHA 医院表现的报告导致了积极和适应不良的反应，CLC 比较可能会对 CLC 工作人员以及他们所服务的 40,000 名弱势退伍军人产生类似的影响 这项研究抓住了识别积极的、无意的和无意的服务的机会。 潜在适应不良，对 CLC 比较的早期反应有助于改善 VHA 长期护理。

项目成果

Health Care Providers and the Public Reporting of Nursing Home Quality in the United States Department of Veterans Affairs: Protocol for a Mixed Methods Pilot Study.

美国退伍军人事务部的医疗保健提供者和疗养院质量的公开报告：混合方法试点研究方案。

• 发表时间: 2021-07-21
• 影响因子: 1.7
• 作者: Pimentel, Camilla B;Clark, Valerie;Baughman, Amy W;Berlowitz, Dan R;Davila, Heather;Mills, Whitney L;Mohr, David C;Sullivan, Jennifer L;Hartmann, Christine W
• 通讯作者: Hartmann, Christine W