|
BACKGROUND/RATIONALE:
Service members from Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) with severe polytrauma and blast related injuries receive inpatient rehabilitation treatment through four newly designated Polytrauma Rehabilitation Centers (PRCs; Minneapolis, Tampa, Palo Alto, Richmond VAMCs). The complexity and severity of these patients’ injuries is presenting new challenges to these rehabilitation units and their providers. In order to promote the successful rehabilitation, psychological adjustment and community re-integration of individuals who have experienced polytrauma and blast-related injuries, the Polytrauma and Blast Related Injuries QUERI requires having an understanding of the PRCs and their needs.
OBJECTIVE(S):
The aim of this study is to determine the needs of the PRCs.
• To characterize the structures for and processes of care currently in place in the four PRCs.
• To describe the variations in structures for and processes of care across sites.
• To identify innovations in care processes that providers believe promote better outcomes.
• To identify providers’ perceptions of barriers and facilitators to patient care.
• To identify gaps and needs in both structures and processes to improve patient outcomes.
METHODS:
1. Study Design: The study will use a Rapid Assessment Process (RAP), defined by the use of triangulation (convergence of themes from multiple sources and analysis) and iterative analysis (10-12).
2. Major Characteristics: study combines nine qualitative methods: 1) collecting organizational informational prior to conducting fieldwork, 2) conducting fieldwork in each PRC, 3) key informant semi-structured in-depth and in-person interviews, 4) joint interviewing by team members and intensive team debriefings following each interview 4) listening in on PRC team meetings, 6) iterative cycles of data collection and analysis, and 7) the inclusion in the study team at each site of a PRC provider who helps navigate the site, 8) intensive data collection during the first half of fieldwork to allow for flexibility in the second half for unanticipated interviews and observations, and 9) PRC providers review of preliminary results for final data collection point.
3. Sample: The sample will comprise PRC providers and VHA point of contact personnel for patients. Including all PRCs allows identification of similarities and differences across the sites, as well as the identification of site-specific needs. Because the PRCs are multidisciplinary treatment teams, we will interview one purposefully selected individual from each discipline at each site as well as one point of contact individual.
4. Analysis: In qualitative research analysis is iterative (4-6). Initial analysis will occur on-site. Each investigator will write detailed interview field note logs. Investigators will debrief, compare, discuss logs, and reach consensus over differences. To verify preliminary findings, we will present and discuss results with providers who participated in the research. During post-fieldwork analysis, field notes and transcripts will be imported into Altas.ti software and coded. The core codes (structures of care, processes of care, facilitators to care, barriers to care, usual care, innovations to care), will expand according to the emergent themes using grounded theory analysis (5,6). Data will be analyzed within each site and across sites.
FINDINGS/RESULTS:
No results at this time.
IMPACT:
Study findings will allow the PT/BRI QUERI to move ahead with its mission, as the study will yield the in-depth understanding of the PRCs and their needs. This study will provide the PT/BRI QUERI solid information to: 1) guide the direction of the research agenda, 2) move the research agenda forward, 3) guide implementation activities.
PUBLICATIONS:
None at this time.
DRA:
Acute and Traumatic Injury, Health Services and Systems
DRE:
Rehabilitation, Quality of Care
Keywords:
Operation Enduring Freedom, Operation Iraqi Freedom
MeSH Terms:
none
|
