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: 10021439
• 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/10021439
• 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; 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; memory care; 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，以资深人士为中心的，跨学科的行为方法来管理行为症状 退伍军人卫生管理社区生活中心（CLC）居民中的痴呆症（BSD） 在2013年至2016年之间，在66个训练有素的CLC站点中实施。合作评估对于 证明Star-VA对CLC退伍军人和现场水平结果的纵向影响，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。该项目旨在确定监视行为改变的质量指标 在患有痴呆症的CLC居民中，确定预测的老兵，干预和设施/现场因素 持续积极的行为和系统性结果，并确定促进者和障碍 VA实施。项目成果将为实施的开发和建议提供信息 和评估策略，以结果为型，量身定制的干预措施，以支持CLC团队维持 星空。具体目的是： 1。使用最小数据集开发和验证用于监视BSD患病率的质量指标3.0 行为度量，通过Star-VA结果指标验证； 2。通过比较训练有素的现场和居民结果，评估星VA的纵向影响 2013 - 2016年未经训练的CLC在BSD，精神上使用以及针对站点，员工受伤的情况下，并确定 高性能的CLC站点。 3.使用具有定性方法的定性方法来解释持续实施Star-VA的变化 有目的的训练有素的CLC站点样本，检查中存在哪些知识库（KR）域 CLC站点及这些KRS的影响以及其他因素对维持。 目标＃1：通过强制性居民评估工具创建一个BSD质量指标 数据集（MDS）3.0行为变量，通过行为，抑郁和抑郁和 2013年至2016年期间，有280名退伍军人收集了280名退伍军人。 退伍军人有痴呆症诊断，并显示出对居民或 其他人，与ir妄，其他急性疾病，精神病症状或最近的脑损伤无直接关系。客观的 ＃2：通过比较多年来训练和未经训练的CLC站点和居民来评估Star-VA的影响 2013-2016关于选定的结果，并确定与居民，实施和设施因素有关 BSD。使用MDS 3.0 行为质量指标和精神药物安全计划（PDSI）数据。 CLC站点级别的结果将是 基于：a）CLC中BSD的总体速率（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）使用职业健康自动安全的护理人员受伤 事件监视和跟踪系统（协助）数据。目标＃3：解释变化 在有目的的样本中使用前瞻性定性方法持续实施Star-VA 训练有素的CLC站点。混合方法，包括高表现高和低和低和低的访谈 依从性站点将用于确定哪些KR领域在内 训练有素的CLC中存在关系，信息空间，文化和结构以及其他因素 这些KRS和其他因素对Star-VA计划维持的影响。定量和 与持续实施和积极结果有关的定性因素将集成并指导 开发和推荐实施和评估策略，以量身定制的结果驱动 可持续性干预措施旨在改善表现不佳并保持高效结果。

项目成果

An MDS 3.0 Distressed Behavior in Dementia Indicator (DBDI): A Clinical Tool to Capture Change.

• DOI: 10.1111/jgs.16957
• 发表时间: 2021-03
• 期刊: Journal of the American Geriatrics Society
• 影响因子: 6.3
• 作者: Curyto KJ;Jedele JM;Mohr DC;Eaker A;Intrator O;Karel M
• 通讯作者: Karel M

Preference Consistency: Veteran and Non-Veteran Nursing Home Resident Self-Reported Preferences for Everyday Living.

• DOI: 10.3928/00989134-20200129-06
• 发表时间: 2020-03-01
• 期刊: Journal of gerontological nursing
• 影响因子: 1.3
• 作者: Curyto K;Dockler LM;Van Haitsma KS
• 通讯作者: Van Haitsma KS