Smith Shawna N, Lai Zongshan, Almirall Daniel, Goodrich David E, Abraham Kristen M, Nord Kristina M, Kilbourne Amy M
*Department of Internal Medicine, Division of General Medicine; †Institute for Social Research, University of Michigan, Ann Arbor; ‡Department of Pathology, Beaumont Health System, Royal Oak; §VA Center for Clinical Management Research, VA Ann Arbor Healthcare System; ∥Department of Psychiatry, University of Michigan Medical School, Ann Arbor; ¶Department of Psychology, University of Detroit Mercy, Detroit, MI; and #Office of Research and Development, Veterans Health Administration, U.S. Department of Veterans, Washington DC.
J Nerv Ment Dis. 2017 Feb;205(2):161-170. doi: 10.1097/NMD.0000000000000592.
Policy is a powerful motivator of clinical change, but implementation success can depend on organizational characteristics. This article used validated measures of organizational resources, culture, and climate to predict uptake of a nationwide Veteran's Health Administration (VA) policy aimed at implementing Re-Engage, a brief care management program that reestablishes contact with veterans with serious mental illness lost to care. Patient care databases were used to identify 2738 veterans lost to care. Local recovery coordinators (LRCs) were to update disposition for 2738 veterans at 158 VA facilities and, as appropriate, facilitate a return to care. Multivariable regression was used to assess organizational culture and climate as predictors of early policy compliance (via LRC presence) and uptake at 6 months. Higher composite climate and culture scores were associated with higher odds of having a designated LRC but were not predictive of higher uptake. Sites with LRCs had significantly higher rates of updated documentation than sites without LRCs.
政策是临床变革的强大推动力，但实施的成功与否可能取决于组织特征。本文使用经过验证的组织资源、文化和氛围测量方法，来预测一项针对全国退伍军人健康管理局（VA）的政策的采用情况，该政策旨在实施“重新参与”计划，这是一个简短的护理管理项目，旨在重新与失去护理的重度精神疾病退伍军人建立联系。利用患者护理数据库识别出2738名失去护理的退伍军人。当地康复协调员（LRC）要更新158个VA设施中2738名退伍军人的处置情况，并在适当时促使他们恢复护理。多变量回归用于评估组织文化和氛围，作为早期政策合规性（通过LRC的存在）和6个月时采用情况的预测指标。综合氛围和文化得分较高与有指定LRC的几率较高相关，但不能预测较高的采用率。有LRC的地点更新文档的比率显著高于没有LRC的地点。
