Center for Chronic Disease Outcomes Research, VA Medical Center, One Veterans Drive, Minneapolis, MN 55417, USA.
J Gen Intern Med. 2010 Jan;25 Suppl 1(Suppl 1):18-26. doi: 10.1007/s11606-009-1125-3.
The Department of Veterans Affairs (VA) provides rehabilitation for veterans with moderate to severe war injuries through four regional Polytrauma Rehabilitation Centers (PRCs). To standardize and improve care provided to these veterans' family members, health services researchers partnered with program leaders and rehabilitation specialists to implement a family care quality improvement collaborative.
To describe practice changes associated with the Family Care Collaborative's intervention.
Cross-site, mixed-method evaluation.
Rehabilitation interdisciplinary team members (n = 226) working at the four participating sites.
The collaborative developed and implemented in a 6-month pilot a web-based tool to standardize and promote family-centered care.
Provider survey of family care, satisfaction with family care, and perceived competence in working with families; specific practice changes at each site; provider and facilitator perceptions of the collaborative work; and a validated measure to predict likelihood of success of the selected intervention.
Family-centered practices and satisfaction improved at sites with lower baseline scores (P < 0.05) and was equivalent across sites after the pilot. Providers initiated specific family-centered practices that often began at one site and spread to the others through the collaborative. Sites standardized family education and collaboration. Providers believed that the collaborative produced a "culture change" from patient-centered to family-centered care and viewed program leadership and health services researchers' involvement as crucial for success. Scores on the measure to predict successful implementation of the intervention beyond the pilot were promising.
Collaboratives that bring together clinicians, program leaders, and researchers may be useful for fostering complex change involving interdisciplinary teams.
美国退伍军人事务部（VA）通过四个地区性的创伤后康复中心（PRC）为中度至重度战伤退伍军人提供康复治疗。为了规范并改善这些退伍军人家庭成员所接受的护理，卫生服务研究人员与项目领导和康复专家合作，实施了一项家庭护理质量改进合作。
描述与家庭护理合作相关的实践变化。
跨站点、混合方法评估。
在四个参与站点工作的康复跨学科团队成员（n=226）。
合作在 6 个月的试点中开发并实施了一个基于网络的工具，以规范和促进以家庭为中心的护理。
对家庭护理的提供者调查、对家庭护理的满意度、以及与家庭合作的感知能力；每个站点的具体实践变化；提供者和协调员对合作工作的看法；以及一个预测选定干预措施成功可能性的有效衡量标准。
家庭为中心的实践和满意度在基线得分较低的站点（P<0.05）有所提高，并且在试点后在所有站点都达到了同等水平。提供者开始实施特定的以家庭为中心的实践，这些实践通常始于一个站点，并通过合作传播到其他站点。站点对家庭教育和协作进行了标准化。提供者认为合作从以患者为中心的护理转变为以家庭为中心的护理产生了“文化变革”，并认为项目领导和卫生服务研究人员的参与对成功至关重要。预测干预措施在试点后成功实施的衡量标准得分很有希望。
将临床医生、项目领导和研究人员聚集在一起的合作可能有助于促进涉及跨学科团队的复杂变革。
