Sustaining STAR-VA: Partnered Evaluation of Veteran, Implementation and Facility Factors Contributing to Positive Sustained Outcomes to Inform Ongoing Program Implementation

维持 STAR-VA：对有助于积极持续成果的退伍军人、实施和设施因素进行合作评估，为正在进行的计划实施提供信息

• 批准号: 9502750
• 负责人: Kimberly J. Curyto
• 金额: --
• 依托单位: VA WESTERN NEW YORK HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-01-01 至 2019-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9502750
• 关键词: Acute; Address; Adherence; Advisory Committees; Aging; Agitation; Antipsychotic Agents; Anxiety; Assessment tool; Assisted Living Facilities; Behavior; Behavior Therapy; Behavior assessment; Behavior monitoring; Behavioral; Behavioral Symptoms; Brain Injuries; Caring; Cognitive; Collaborations; Competence; Complex; Consultations; Data; Data Set; Delirium; Dementia; Development; Diagnosis; Distress; Employee Engagement; Enrollment; Evaluation; Family; Frequencies; Geriatrics; Improve Access; Injury; Intervention; Interview; Joints; Knowledge; Long-Term Care; Measures; Medical; Memory; Mental Depression; Mental Health; Mental Health Services; Methods; Monitor; Morphologic artifacts; Nursing Services; Nursing Staff; Occupational Health; Office Nursing; Outcome; Outcome Measure; Pharmaceutical Preparations; Practice Guidelines; Predictive Factor; Prevalence; Professional Practice; Program Sustainability; Psychotropic Drugs; Qualitative Methods; Quality Indicator; Recommendation; Reporting; Risk Assessment; Role; Safety; Sampling; Severities; Site; Structure; System; Time; Time Factors; Training; Training Programs; Trust; Variant; Veterans; Workplace; base; behavior change; care systems; community living; dementia care; depressive symptoms; empowered; health administration; improved; inpatient service; medication safety; operation; post intervention; programs; prospective; psychotic symptoms; residence; therapy design

STAR-VA, a Veteran-centered, interdisciplinary, behavioral approach for managing behavioral symptoms of dementia (BSD) among Veterans Health Administration Community Living Center (CLC) residents, has been implemented in 66 trained CLC sites between 2013 and 2016. Collaborative evaluation is necessary to demonstrate the longitudinal impact of STAR-VA on CLC Veteran and site level outcomes, and determine factors associated with sustained implementation and positive outcomes, in order to support program sustainability and expansion. This project intends to identify a quality indicator for monitoring behavior change among CLC residents with dementia, determine Veteran, intervention, and facility/site factors that predict sustained positive behavioral and systemic outcomes, and identify facilitators and barriers to sustained STAR- VA implementation. Project outcomes will inform development and recommendations for an implementation and evaluation strategy for an outcome-driven, tailored intervention to support CLC teams in sustaining STAR-VA. Specific aims are to: 1. Develop and validate a quality indicator for monitoring the prevalence of BSD, using Minimum Data Set 3.0 behavior measures, validated by STAR-VA outcome measures; 2. Evaluate the longitudinal impact of STAR-VA by comparing site and resident outcomes at trained and untrained CLCs in years 2013-2016 on BSD, psychotropic use, and, for sites, staff injuries, and identify high and low performing CLC sites. 3. Explain variations in the sustained implementation of STAR-VA using qualitative methods with a purposeful sample of trained CLC sites, examine what Knowledge Reservoir (KR) domains are present in CLC sites and the impact of these KRs and additional factors on sustainment. Objective #1: Create a BSD quality indicator from mandatory Resident Assessment Instrument Minimum Data Set (MDS) 3.0 behavior variables, validated by STAR-VA outcome measures of behavior, depression and anxiety collected for 280 Veterans enrolled in STAR-VA between 2013 and 2016. STAR-VA participating Veterans have a dementia diagnosis and display repeated behaviors that are distressing to the resident or others, not directly related to delirium, other acute illness, psychotic symptoms, or recent brain injury. Objective #2: Evaluate the impact of STAR-VA by comparing trained and untrained CLC sites and residents in years 2013-2016 on selected outcomes, and identify resident, implementation, and facility factors associated with BSD. Resident level outcomes will include rates of BSD and psychotropic use in CLC residents using MDS 3.0 behavior quality indicator and Psychotropic Drug Safety Initiative (PDSI) data. CLC site level outcomes will be based on: a) Overall rates of BSD in the CLC (using MDS 3.0 behavior quality indicator and Workplace Behavioral Risk Assessment disruptive behavior reporting system), b) Antipsychotic and antianxiety medication use from PDSI program data, and c) Nursing staff injuries, using Occupational Health Automated Safety Incident Surveillance and Tracking Systems (ASSISTS) data. Objective #3: Explain variations in the sustained implementation of STAR-VA using prospective qualitative methods in a purposeful sample of trained CLC sites. Mixed methods, including interviews of high and low performing and high and low adherence sites, will be used to determine what KR domains including People, Routines, Artifacts, Relationships, Information space, Culture, and Structure and additional factors are present in trained CLC sites and the impact of these KRs and additional factors on STAR-VA program sustainment. Quantitative and qualitative factors related to sustained implementation and positive outcomes will be integrated and guide the development and recommended implementation and evaluation strategy for an outcome-driven, tailored sustainability intervention designed to improve poor-performer and maintain high-performer outcomes..

STAR-VA，一种以退伍军人为中心的跨学科行为方法，用于管理行为症状 退伍军人健康管理局社区生活中心 (CLC) 居民中痴呆症 (BSD) 的发病率 2013 年至 2016 年间，在 66 个经过培训的 CLC 站点实施。协作评估对于 证明 STAR-VA 对 CLC 退伍军人和站点级别结果的纵向影响，并确定 与持续实施和积极成果相关的因素，以支持计划 可持续性和扩张。该项目旨在确定监控行为变化的质量指标 在患有痴呆症的 CLC 居民中，确定可预测的退伍军人、干预措施和设施/地点因素 持续积极的行为和系统结果，并确定持续 STAR- 的促进因素和障碍 VA 实施。项目成果将为开发和实施建议提供信息 和评估策略，以结果为导向，量身定制干预措施，以支持 CLC 团队维持 STAR-VA。具体目标是： 1. 使用最小数据集 3.0 开发并验证用于监测 BSD 患病率的质量指标 行为测量，由 STAR-VA 结果测量验证； 2. 通过比较受过培训的地点和居民的结果来评估 STAR-VA 的纵向影响 2013-2016 年未经培训的 CLC 涉及 BSD、精神药物使用以及场所、工作人员伤害，并确定 高和低性能 CLC 站点。 3. 使用定性方法解释 STAR-VA 持续实施的变化 对经过训练的 CLC 站点进行有目的的样本，检查其中存在哪些知识库 (KR) 域 CLC 地点以及这些 KR 和其他因素对维持的影响。 目标#1：根据强制性居民评估工具最低标准创建 BSD 质量指标 数据集 (MDS) 3.0 行为变量，通过行为、抑郁和抑郁症的 STAR-VA 结果测量进行验证 收集了 2013 年至 2016 年间参加 STAR-VA 的 280 名退伍军人的焦虑情况。STAR-VA 参与 退伍军人被诊断患有痴呆症，并且反复表现出令居民或居民感到痛苦的行为 其他与谵妄、其他急性疾病、精神病症状或最近的脑损伤没有直接关系的。客观的 #2：通过比较多年来经过培训和未经培训的 CLC 站点和居民来评估 STAR-VA 的影响 2013-2016 年选定的成果，并确定与相关的居民、实施和设施因素 BSD。住院医师级别结果将包括使用 MDS 3.0 的 CLC 住院医师的 BSD 和精神药物使用率 行为质量指标和精神药物安全倡议（PDSI）数据。 CLC 站点级别的结果将是 基于： a) CLC 中 BSD 的总体比率（使用 MDS 3.0 行为质量指标和工作场所 行为风险评估破坏性行为报告系统），b）抗精神病药和抗焦虑药 使用 PDSI 计划数据，以及 c) 护理人员伤害，使用职业健康自动化安全 事件监视和跟踪系统 (ASSISTS) 数据。目标#3：解释 使用前瞻性定性方法在有目的的样本中持续实施 STAR-VA 经过培训的 CLC 站点。混合方法，包括高绩效和低绩效以及高绩效和低绩效的访谈 遵守站点，将用于确定哪些 KR 域，包括人员、例程、工件、 受过训练的 CLC 中存在关系、信息空间、文化和结构以及其他因素 地点以及这些 KR 和其他因素对 STAR-VA 计划维持的影响。定量和 将整合与持续实施和积极成果相关的定性因素并指导 制定并建议实施和评估战略，以实现成果驱动、量身定制的目标 可持续性干预措施旨在改善表现不佳者并保持表现出色的结果。