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Current Projects
Evaluation of
Parkinson’s Disease Research, Education and Clinical Centers
The two primary objectives of this project are 1) to determine whether Parkinson's Disease Research, Education, and Clinical Centers (PADRECCs) affect the utilization of VA healthcare services, improve the quality of care for patients with Parkinson's Disease (PD), increase the volume and impact of research on PD, affect the spread and implementation of research findings related to PD and expand the education for clinicians providing care to patients with PD; and 2) to assess whether the different ways of organizing PADRECCs have differential effects on these outcomes. PADRECCs are comprehensive focused organizations designed to provide specialized services across VISNs and facilities. Six PADRECCs have been established in VHA nationally. Findings from this study will have implications not only for the PADRECCs but more generally for the concept of providing highly specialized care in a few, specialized sites.
Co-PIs: Charns, Cramer
The goals of this project are to develop a pilot database of
nurse staffing and nursing-sensitive patient outcome measures at the patient
care unit level in 12 VAMCs, with a national rollout planned for 2006. The project is developing and testing a
standardized methodology to collect data related to nurse-sensitive indicators
of quality and staffing. The purpose of this effort is for benchmarking and
comparing local, VISN, and national patient quality outcomes. A database of
clinically relevant, comparable quality indicators will support strategic
decision support through timely internal and external benchmarking (to VA),
expedite testing and evaluation of interventions to define evidence-based
nursing practices, and to impact health care policy decisions.
Co-PIs: Sales (Seattle),
Charns
Strengthening
Organization to Implement Evidence-Based Clinical Practice
The aim of this project is to work
with three VISNs and their medical centers to create organizations that facilitate
the use of evidence-based clinical practices. The model for creating such
organizations is built on findings from the national evaluation of the Robert
Wood Johnson Foundation (RWJF) - funded Pursuing Perfection initiative, supported
by published evidence on organizational design and change. The model posits the
need for a balance between 1) direction and support from leadership and 2)
staff involvement in concrete improvement efforts at the front line, with 3)
strong management links to integrate the two. The feasibility and effectiveness of the
organizational model will be tested by implementing it in one VISN and
comparing it with a strategy of feedback of performance data in two VISNs. The clinical focus, and primary measure
of effectiveness, in all three VISNs will be compliance with national
hand-hygiene guidelines. The study
is also designed to identify and analyze organizational factors that affect
model implementation.
Co-PIs: VanDeusen Lukas, Chirico-Post
All Employee Survey
This continuing project, led by the VA National Center for Organization Development (NCOD), has developed and implemented the national VHA all-employee survey (AES) for the purpose of measuring employee satisfaction, workgroup factors affecting productivity and satisfaction, and organizational culture. COLMR investigators have made substantial contributions to the development and refinement of the survey instrument, its analysis and feedback to VISNs and medical centers. Based upon initial success of the survey and relationships found between survey measures and facility performance, the VHA National Leadership Board has implemented VISN and facility director performance measures based on their use of AES data feedback, and decided that the AES should be administered on an annual basis. COLMR investigators continue to collaborate with researchers at NCOD to utilize this growing longitudinal database to understand the influence of employee satisfaction, workgroup functioning and overall organization culture on performance.
PIs: Dyrenforth (NCOD), Charns, Meterko
Improving the Quality of Care through Routine, Successful Implementation of Evidence-based Practice at the Bedside
This project is using qualitative and quantitative methods to review two, contrasting case studies of hospitals at different stages of normalizing evidence-based practice in nursing. The core theoretical framework for this multi-method, multi-source explanatory case study is Pettigrew and Whipp's Content, Context, and Process model of strategic change (1992), along with Pettigrew et al's related signs and symptoms of contextual receptivity to change (1992). The study has an international team, although both cases are in the US. Data collection was completed in May, 2007. A combined 221 surveys were received; and overall, there were 14 staff nurse focus groups; 8 observations of group meetings; 59 leadership interviews; and multiple documents collected. The study is in its final stages of analysis and triangulation of data. Results will focus on the key contextual elements and related strategic processes that differentiate the two cases and thus the relevance of the Pettigrew model to institutionalization of EBP within an organization. Challenges confronting each case and additional insights regarding institutionalization of EBP will also be assessed.
PI: Stetler, Co-PI: Charns
This grant extends the project to evaluate the success of
the Pursuing Perfection program as it is implemented in seven demonstration
sites throughout the United
States. The project has its origins in the Institute of Medicine’s
work on health care quality.
The project is evaluating the extent to which participating
organizations attain their goals of perfect health care, addressing the
IOM’s six aims: effectiveness, efficiency, timeliness, patient centeredness,
equity, and safety; and examining changes in organizational culture to support
perfect care.
The project is funded by the
Robert Wood Johnson Foundation to Boston University.
PI: Charns
Improving the Quality
of Care through Routine, Successful Implementation of Evidence-based Practice
at the Bedside
This project is using
qualitative methods to develop two case studies of hospitals at different
stages of implementing evidence-based practice in nursing. The case studies are part of an
international project involving sites in the U.S.,
Canada, England and Australia focusing on how
organizations implement evidence-based practice, the barriers and the
facilitating factors.
PI: Stetler, Co-PI:
Charns
Transition
Supplement: Dissemination of the Conceptual Model of Organizational
Transformation
This project is developing
both web-based and print material for dissemination of the he conceptual model
of organizational transformation, developed by the Pursuing Perfection
Evaluation Team. The web-based model
will depict the dynamics of organizational transformation and the interaction
over time of the key factors in the model. It will also provide convenient access to an annotated bibliography of
materials on organizational change and transformation.
PI: Charns
Transition
Supplement: Validation of the Conceptual Model of Organizational Transformation
This project is validating
the conceptual model of organizational transformation, developed by the
Pursuing Perfection Evaluation Team. It is developing data collection instruments that can be used for
organizations self-evaluation of the key factors needed for
organizational transformation to improve quality of care. Data will be collected in twelve sites to
validate the model.
PI: Charns
Dissemination and
Implementation of Supported Employment in VHA
This
QUERI-linked project will study the implementation of supported employment
(SE), an evidence based practice for people for people with serious mental
illness. This project will seek to identify factors that influence successful
implementation of SE defined by fidelity of the SE program to the
evidence-based SE model as measured on a standardized instrument and
effectiveness as measured by the proportion of veterans who enter competitive
employment. Quantitative and qualitative methodologies will be used to address
the objectives.
PI:
Resnick (West Haven),
Cramer
Improving Safety
Culture and Outcomes in VA Hospitals
The primary objective of this study is to assess the
strength and uniformity of safety climate in a national sample of 30 VA
hospitals, and to relate that variation to various structural and functional
characteristics of those hospitals, and to their clinical processes and
outcomes. Variability in safety climate will be assessed within hospitals (e.g., by job type and unit type) as
well as across facilities, VISNs, and geographical regions. Structural characteristics to be studied
include size, level of sub-specialty care, and academic affiliation; functional
characteristics include general organization culture (teamwork,
entrepreneurial, rational and bureaucratic tendencies) and the extent of
implementation of quality and safety practices.Clinical process and outcomes will be
represented by selected patient safety indicators (PSIs), based on the
algorithms developed by AHRQ/UC-Stanford, and by outcome measures from the VA
National Surgical Quality Improvement Program (NSQIP).
A critical goal of the study is the psychometric assessment
and refinement of the Patient Safety Culture in Hospital Organizations (PSCHO)
instrument. Based on the framework of High Reliability Organization (HRO) theory, the PSCHO was developed and
tested in previous AHRQ-funded research and is currently being used to assess safety climate in 120 non-VA hospitals as part of another AHRQ-supported
study. From these two studies it will be possible to compare safety climate and outcomes in VA facilities with
those in the private sector.
A follow-up HSR&D IIR proposal has been submitted (December 2007) to implement and evaluate interventions designed to improve organization's level of safety culture.
PI: Gaba (Palo Alto), Co-PI: Rosen (Bedford), Co-Investigator: Meterko
Evaluation of
Demonstration: Rewarding Results
The major goal of this project is to evaluate the success of
the Rewarding Results program as it is implemented in demonstration sites
throughout the United States. The project is in part a response to the
findings of the Institute of Medicinethat a major barrier to improving the
quality of care in the U.S. is the lack of alignment between payment systems and quality goals for
providers.
This long term objective of this evaluation of the Rewarding
Results program is to expand what is known about the relationship between
payment/incentive systems for providers and the achievement of quality
goals.
PI: Young
Safety Net ACTION Partnership
COLMR and the Boston University School of Public Health collaborated to lead coalition of researchers and healthcare service delivery systems that qualified competitively to participate in the Agency for Healthcare Research and Quality's (AHRQ's) initiative, Accelerating Change and Transformation in Organizations and Networks (ACTION). ACTION's objective is to develop strategies to translate research into practice quickly to improve health care quality and efficiency by contracting with partnerships of research organizations and healthcare delivery systems with demonstrated capacity to turn research into practice for proven interventions.
The BU/COLMR partnership, called the Safety Net ACTION Partnership or SNAP, includes four VISNs in the Department of Veterans Affairs and three private-sector health care systems. All partners are systems with multiple hospitals and community-based health centers and thus offer rich environments for addressing a wide range of questions that may be posed by AHRQ.
The ACTION initiative is a mechanism for funding future projects awarded by AHRQ. Our designation as an ACTION network makes us eligible to respond to task orders over the next 3-5 years. In the first two years, SNAP has been awarded four ACTION contracts focused on pay for quality programs, health literacy, ambulatory adverse event trigger tools, and Hepatitis C screening and testing uptake.
PI: VanDeusen Lukas, Co-PI: Young
Team Process and Performance in Primary Care
The study will examine ambulatory care divisions within hospitals and CBOCs for variation in levels of care delivered and on team characteristics. We hypothesize that primary care team characteristics of goal orientation, learning, communication and civility will be positively associated with measures of patient care including patient satisfaction; quality of care delivered; appointment wait times; and continuity of care. Site visits will be made to facilities scoring well on patient outcomes and we will investigate and identify the best practices of teams at those facilities.
PI: Mohr
Identifying and Characterizing High Performing VHA Nursing Homes
This study will explore the development and validation of MDS-based risk-adjustment models for more quality indicators to gather a better understanding of how to most usefully aggregate risk-adjusted quality indicators; this will allow the VA to better measure nursing home performance. To measure the performance of NHCUs two composite measures of performance will be used: one based just on quality indicators and one also considering costs. Likewise, two approaches of determining the composite measures will be used along with an assessment of the advantages and disadvantages of the approaches for creating composite measures. This project looks to establish a better understanding of organizational and managerial characteristics associated with high performance and to identify managerial changes that could lead to improvements in quality of care.
PI: Shwartz
Mental Health QI-Fit Study
The study has been funded by the NIMH to learn about quality improvement (QI) activities conducted by 32 hospital psychiatry departments in Massachusetts and California. This research focuses on QI activities that employ measurement as a tool for identifying quality problems and guiding efforts to understand and address them. Investigators include COLMR researchers at Tufts University School of Medicine and researchers at the Health Services Research Center at the UCLA School of Medicine.
PI: Hermann
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