Pimentel Camilla B, Clark Valerie, Baughman Amy W, Berlowitz Dan R, Davila Heather, Mills Whitney L, Mohr David C, Sullivan Jennifer L, Hartmann Christine W
Center for Healthcare Organization and Implementation Research, United States Department of Veterans Affairs Bedford Healthcare System, Bedford, MA, United States.
New England Geriatric Research Education and Clinical Center, United States Department of Veterans Affairs Bedford Healthcare System, Bedford, MA, United States.
JMIR Res Protoc. 2021 Jul 21;10(7):e23516. doi: 10.2196/23516.
In June 2018, the United States Department of Veterans Affairs (VA) began the public reporting of its 134 Community Living Centers' (CLCs) overall quality by using a 5-star rating system based on data from the national quality measures captured in CLC Compare. Given the private sector's positive experience with report cards, this is a seminal moment for stimulating measurable quality improvements in CLCs. However, the public reporting of CLC Compare data raises substantial and immediate implications for CLCs. The report cards, for example, facilitate comparisons between CLCs and community nursing homes in which CLCs generally fare worse. This may lead to staff anxiety and potentially unintended consequences. Additionally, CLC Compare is designed to spur improvement, yet the motivating aspects of the report cards are unknown. Understanding staff attitudes and early responses is a critical first step in building the capacity for public reporting to spur quality.
We will adapt an existing community nursing home public reporting survey to reveal important leverage points and support CLCs' quality improvement efforts. Our work will be grounded in a conceptual framework of strategic orientation. We have 2 aims. First, we will qualitatively examine CLC staff reactions to CLC Compare. Second, we will adapt and expand upon an extant community nursing home survey to capture a broad range of responses and then pilot the adapted survey in CLCs.
We will conduct interviews with staff at 3 CLCs (1 1-star CLC, 1 3-star CLC, and 1 5-star CLC) to identify staff actions taken in response to their CLCs' public data; staff's commitment to or difficulties with using CLC Compare; and factors that motivate staff to improve CLC quality. We will integrate these findings with our conceptual framework to adapt and expand a community nursing home survey to the current CLC environment. We will conduct cognitive interviews with staff in 1 CLC to refine survey items. We will then pilot the survey in 6 CLCs (2 1-star CLCs, 2 3-star CLCs, and 2 5-star CLCs) to assess the survey's feasibility, acceptability, and preliminary psychometric properties.
We will develop a brief survey for use in a future national administration to identify system-wide responses to CLC Compare; evaluate the impact of CLC Compare on veterans' clinical outcomes and satisfaction; and develop, test, and disseminate interventions to support the meaningful use of CLC Compare for quality improvement.
The knowledge gained from this pilot study and from future work will help VA refine how CLC Compare is used, ensure that CLC staff understand and are motivated to use its quality data, and implement concrete actions to improve clinical quality. The products from this pilot study will also facilitate studies on the effects of public reporting in other critical VA clinical areas.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/23516.
2018年6月，美国退伍军人事务部（VA）开始使用基于社区生活中心（CLC）比较中获取的国家质量指标数据的五星级评级系统，公开报告其134个社区生活中心的整体质量。鉴于私营部门在使用成绩单方面有积极经验，这是刺激社区生活中心实现可衡量质量改进的一个重要时刻。然而，公开报告社区生活中心比较数据对社区生活中心产生了重大且直接的影响。例如，成绩单便于对社区生活中心与社区养老院进行比较，而社区生活中心通常表现较差。这可能导致员工焦虑并可能产生意想不到的后果。此外，社区生活中心比较旨在促进改进，但成绩单的激励作用尚不清楚。了解员工态度和早期反应是建立公共报告促进质量提升能力的关键第一步。
我们将改编现有的社区养老院公共报告调查，以揭示重要的杠杆点并支持社区生活中心的质量改进工作。我们的工作将基于战略导向的概念框架。我们有两个目标。首先，我们将定性研究社区生活中心工作人员对社区生活中心比较的反应。其次，我们将改编并扩展现有的社区养老院调查，以获取广泛的反馈，然后在社区生活中心试点改编后的调查。
我们将对3个社区生活中心（1个一星级社区生活中心、1个三星级社区生活中心和1个五星级社区生活中心）的工作人员进行访谈，以确定工作人员针对其社区生活中心的公开数据采取的行动；工作人员使用社区生活中心比较的承诺或困难；以及激励工作人员提高社区生活中心质量的因素。我们将把这些结果与我们的概念框架相结合，以将社区养老院调查改编并扩展到当前的社区生活中心环境。我们将对1个社区生活中心的工作人员进行认知访谈，以完善调查项目。然后，我们将在6个社区生活中心（2个一星级社区生活中心、2个三星级社区生活中心和2个五星级社区生活中心）试点该调查，以评估调查的可行性、可接受性和初步心理测量特性。
我们将开发一份简短的调查问卷，供未来全国范围使用，以确定全系统对社区生活中心比较的反应；评估社区生活中心比较对退伍军人临床结果和满意度的影响；并开发、测试和传播干预措施，以支持有意义地使用社区生活中心比较来改进质量。
从这项试点研究和未来工作中获得的知识将有助于退伍军人事务部完善社区生活中心比较的使用方式，确保社区生活中心工作人员理解并积极使用其质量数据，并采取具体行动提高临床质量。这项试点研究的成果还将促进对退伍军人事务部其他关键临床领域公共报告效果的研究。
国际注册报告识别号（IRRID）：DERR1-10.2196/23516
