Supporting teams to optimize function and independence in Veterans: a multi-study program and mixed methods protocol

Abstract

BackgroundSuccessful implementation of new clinical programs depends on effectively establishing, reorganizing, or enhancing team structures and processes to coordinate the work of individuals who are interdependent in their tasks, manage relationships, and share responsibility for outcomes. However, a one-size-fits-all approach is rarely effective. In partnership with VA national clinical leaders and local clinical champions, the Optimizing Function and Independence VA Quality Enhancement Research Initiative program (Function QUERI) will evaluate efforts to implement team-based clinical programs for Veterans at risk for functional decline and disability.MethodsFunction QUERI will implement and evaluate three innovative, evidence-based clinical programs in VA medical centers: (1) a group physical therapy program for knee osteoarthritis (Group PT); (2) assisted early mobility for hospitalized older veterans (STRIDE), a supervised walking program for hospitalized older veterans; and (3) implementation of helping invested family members improve veteran experiences study (iHI-FIVES), a skills training program for caregivers of disabled Veterans. A common reason for clinical care gaps in these populations is poor communication and coordination among the many interdisciplinary providers involved in their care. To facilitate the implementation of the clinical programs, Function QUERI will evaluate the impact of complexity science-based implementation intervention to promote team readiness (CONNECT), an implementation intervention designed as a bundle of interaction-oriented activities to promote team function and readiness for change, on the implementation of clinical programs across multiple sites. The evaluation will use a mixed methods design. Group PT is a local, single-site quality improvement project where a modified CONNECT intervention will be tested to inform the remaining program implementation projects. For STRIDE and iHI-FIVES projects, we will randomize participating sites to implement the clinical program, with the CONNECT intervention or not, and will use a stepped-wedge cluster randomized trial design.DiscussionFunction QUERI will translate its findings across its projects to identify the contextual factors and components from CONNECT that improve team processes and function to optimize effective implementation for future rollout of VA clinical programs. Synthesizing findings within and across projects, we will specify dimensions of team characteristics and function that enhance capacity for clinical innovation and uptake of evidence-based programs.Trial registrationNCT03300336 Registered September 28, 2017, NCT03474380 Registered March 15, 2018.Electronic supplementary materialThe online version of this article (10.1186/s13012-018-0748-3) contains supplementary material, which is available to authorized users.

Employment, health outcomes, and life satisfaction after spinal cord injury: comparison of veterans and nonveterans

“…There are potentially some factors that support enhanced Veterans outcomes. There are some unique programs to optimize function and increase mobility for Veterans with disabilities that are provided by the VA SCI System of Care and associated programs to support community dwelling Veterans [35]. Veterans with SCI that enrolled in NSCID could have access to more services that focus on physical independence and mobility than Non-Veterans with SCI.…”

Implementation of a stepped wedge cluster randomized trial to evaluate a hospital mobility program

“…We describe a SW-CRT that is ongoing in 8 VHA hospitals as part of the Optimizing Function and Independence Quality Enhancement Research Initiative program (Function QUERI) [11]. STRIDE is an evidence-based supervised walking program for hospitalized older adults designed to reduce the negative consequences of immobility [12,13].…”

Early Mobility in the Hospital: Lessons Learned from the STRIDE Program

“…Initial positive results suggested that STRIDE had the potential to become a system-wide approach to address hospital-associated disability in the VHA; however, differences in resources, staffing, and priorities among other conditions in VHA facilities presented barriers to successful implementation at other sites. Therefore in 2016 we launched an ongoing project, Optimizing Function and Independence QUERI (known as "Function QUERI") to implement STRIDE in 8 additional VA hospitals [24]. One of the goals of Function QUERI is to study the process of starting a STRIDE program so that these lessons can be applied in broader efforts to promote hospital mobility programs.…”

“…One of the goals of Function QUERI is to study the process of starting a STRIDE program so that these lessons can be applied in broader efforts to promote hospital mobility programs. Eight VA hospitals volunteered to begin STRIDE programs at their sites and were randomized to begin at a specific time [24]. To date, 4 of 8 have initiated their programs (hereafter referred to as expansion sites).…”