Virtual Breakthrough Series, Part 2: Improving Fall Prevention Practices in the Veterans Health Administration

Zubkoff, Lisa; Neily, Julia; Quigley, Patricia; Soncrant, Christina; Young‐Xu, Yinong; Boar, Shoshana; Mills, Peter D.

doi:10.1016/s1553-7250(16)42092-1

Cited by 15 publications

(21 citation statements)

References 16 publications

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“…[40][41][42][43] Virtual (internet-and/or phone-enabled) adaptations of collaboratives are increasingly used to mitigate participation barriers but often still require dedicated learning sessions and often last a year or more. [44][45][46][47][48][49][50] One large-scale quality collaborative in VHA provided virtual monthly coaching but only after teams started executing their planned PDSA cycle. 47,48 LEAP coaches, in contrast, walked teams through every step, week by week, tailoring guidance to the needs of teams and providing feedback on interim progress.…”

Section: Discussionmentioning

confidence: 99%

“…[44][45][46][47][48][49][50] One large-scale quality collaborative in VHA provided virtual monthly coaching but only after teams started executing their planned PDSA cycle. 47,48 LEAP coaches, in contrast, walked teams through every step, week by week, tailoring guidance to the needs of teams and providing feedback on interim progress. LEAP curriculum was paced; though team leaders might spend up to four hours per week on learning and activities, team members usually spent much less time.…”

Section: Discussionmentioning

confidence: 99%

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The LEAP Program: Quality Improvement Training to Address Team Readiness Gaps Identified by Implementation Science Findings

et al. 2020

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Background Integrating evidence-based innovations (EBIs) into sustained use is challenging; most implementations in health systems fail. Increasing frontline teams’ quality improvement (QI) capability may increase the implementation readiness and success of EBI implementation. Objectives Develop a QI training program (“Learn. Engage. Act. Process.” (LEAP)) and evaluate its impact on frontline obesity treatment teams to improve treatment delivered within the Veterans Health Administration (VHA). Design This was a pre-post evaluation of the LEAP program. MOVE! coordinators (N = 68) were invited to participate in LEAP; 24 were randomly assigned to four starting times. MOVE! coordinators formed teams to work on improvement aims. Pre-post surveys assessed team organizational readiness for implementing change and self-rated QI skills. Program satisfaction, assignment completion, and aim achievement were also evaluated. Participants VHA facility-based MOVE! teams. Interventions LEAP is a 21-week QI training program. Core components include audit and feedback reports, structured curriculum, coaching and learning community, and online platform. Main Measures Organizational readiness for implementing change (ORIC); self-rated QI skills before and after LEAP; assignment completion and aim achievement; program satisfaction. Key Results Seventeen of 24 randomized teams participated in LEAP. Participants' self-ratings across six categories of QI skills increased after completing LEAP (p< 0.0001). The ORIC measure showed no statistically significant change overall; the change efficacy subscale marginally improved (p < 0.08), and the change commitment subscale remained the same (p = 0.66). Depending on the assignment, 35 to 100% of teams completed the assignment. Nine teams achieved their aim. Most team members were satisfied or very satisfied (81–89%) with the LEAP components, 74% intended to continue using QI methods, and 81% planned to continue improvement work. Conclusions LEAP is scalable and does not require travel or time away from clinical responsibilities. While QI skills improved among participating teams and most completed the work, they struggled to do so amid competing clinical priorities.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The LEAP Program: Quality Improvement Training to Address Team Readiness Gaps Identified by Implementation Science Findings

et al. 2020

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“…We identified 37 relevant studies which met the inclusion criteria ( Figure S1 ) [ 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 ]. Thirty-five studies were conducted in secondary care (hospital care).…”

Section: Resultsmentioning

confidence: 99%

Optimising Interventions for Catheter-Associated Urinary Tract Infections (CAUTI) in Primary, Secondary and Care Home Settings

et al. 2020

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Catheter-associated urinary tract infections (CAUTI) are common yet preventable. Healthcare professional behaviours, such as reducing unnecessary catheter use, are key for preventing CAUTI. Previous research has focused on identifying gaps in the national response to CAUTI in multiple settings in England. This study aimed to identify how national interventions could be optimised. We conducted a multi-method study comprising: a rapid review of research on interventions to reduce CAUTI; a behavioural analysis of effective research interventions compared to national interventions; and a stakeholder focus group and survey to identify the most promising options for optimising interventions. We identified 37 effective research interventions, mostly conducted in United States secondary care. A behavioural analysis of these interventions identified 39 intervention components as possible ways to optimise national interventions. Seven intervention components were prioritised by stakeholders. These included: checklists for discharge/admission to wards; information for patients and relatives about the pros/cons of catheters; setting and profession specific guidelines; standardised nationwide computer-based documentation; promotion of alternatives to catheter use; CAUTI champions; and bladder scanners. By combining research evidence, behavioural analysis and stakeholder feedback, we identified how national interventions to reduce CAUTI could be improved. The seven prioritised components should be considered for future implementation.

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“…Most published studies on VLCs are descriptive and have not definitively tested its effectiveness to enhance adoption and implementation [16,[71][72][73][74][75][76][77][78][79][80][81][82]. There are also few randomized-clinical trials that evaluate traditional in-person learning collaboratives [14,15,21,22] or compare their effectiveness to other implementation approaches [16,17,71,83].…”

Section: Discussionmentioning

confidence: 99%

A cluster randomized controlled trial comparing Virtual Learning Collaborative and Technical Assistance strategies to implement an early palliative care program for patients with advanced cancer and their caregivers: a study protocol

et al. 2021

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Background Virtual Learning Collaboratives (VLC), learning communities focused on a common purpose, are used frequently in healthcare settings to implement best practices. Yet, there is limited research testing the effectiveness of this approach compared to other implementation strategies. This study evaluates the effectiveness of a VLC compared to Technical Assistance (TA) among community oncology practices implementing ENABLE (Educate, Nurture, Advise, Before Life Ends), an evidence-based, early palliative care telehealth, psycho-educational intervention for patients with newly diagnosed advanced cancer and their caregivers. Methods Using Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) and Proctor’s Implementation Outcomes Frameworks, this two-arm hybrid type-III cluster-randomized controlled trial (RCT) will compare two implementation strategies, VLC versus TA, among the 48 National Cancer Institute Community Oncology Research Program (NCORP) practice clusters that have not historically provided palliative care to all patients with advanced cancer. Three cohorts of practice clusters will be randomized to the study arms. Each practice cluster will recruit 15–27 patients and a family caregiver to participate in ENABLE. The primary study outcome is ENABLE uptake (patient level), i.e., the proportion of eligible patients who complete the ENABLE program (receive a palliative care assessment and complete the six ENABLE sessions over 12 weeks). The secondary outcome is overall program implementation (practice cluster level), as measured by the General Organizational Index at baseline, 6, and 12 months. Exploratory aims assess patient and caregiver mood and quality of life outcomes at baseline, 12, and 24 weeks. Practice cluster randomization will seek to keep the proportion of rural practices, practice sizes, and minority patients seen within each practice balanced across the two study arms. Discussion This study will advance the field of implementation science by evaluating VLC effectiveness, a commonly used but understudied, implementation strategy. The study will advance the field of palliative care by building the capacity and infrastructure to implement an early palliative care program in community oncology practices. Trial registration Clinicaltrials.gov. NCT04062552; Pre-results. Registered: August 20, 2019. https://clinicaltrials.gov/ct2/show/NCT04062552?term=NCT04062552&draw=2&rank=1

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Virtual Breakthrough Series, Part 2: Improving Fall Prevention Practices in the Veterans Health Administration

Cited by 15 publications

References 16 publications

The LEAP Program: Quality Improvement Training to Address Team Readiness Gaps Identified by Implementation Science Findings

The LEAP Program: Quality Improvement Training to Address Team Readiness Gaps Identified by Implementation Science Findings

Optimising Interventions for Catheter-Associated Urinary Tract Infections (CAUTI) in Primary, Secondary and Care Home Settings

A cluster randomized controlled trial comparing Virtual Learning Collaborative and Technical Assistance strategies to implement an early palliative care program for patients with advanced cancer and their caregivers: a study protocol

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