Van Houtven Courtney Harold, Decosimo Kasey, Drake Connor, Bruening Rebecca, Sperber Nina R, Dadolf Joshua, Tucker Matthew, Coffman Cynthia J, Grubber Janet M, Stechuchak Karen M, Kota Swetha, Christensen Leah, Colón-Emeric Cathleen, Jackson George L, Franzosa Emily, Zullig Leah L, Allen Kelli D, Hastings Susan N, Wang Virginia
Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA.
Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA.
Health Serv Res. 2024 Dec;59(6):e14361. doi: 10.1111/1475-6773.14361. Epub 2024 Aug 8.
To assess whether a team collaboration strategy (CONNECT) improves implementation outcomes of a family caregiver skills training program (iHI-FIVES).
iHI-FIVES was delivered to caregivers at eight Veterans Affairs (VA) medical centers. Data sources were electronic health records, staff surveys, and interviews.
In a stepped wedge cluster randomized trial, sites were randomized to a 6-month time interval start date for iHI-FIVES launch. Sites were then randomized 1:1 to either (i) CONNECT, a team collaboration training strategy plus Replicating Effective Programs (REP), brief technical support training for staff, or (ii) REP only (non-CONNECT arm). Implementation outcomes included reach (proportion of eligible caregivers enrolled) and fidelity (proportion of expected trainings delivered). Staff interviews and surveys assessed team function including communication, implementation experience, and their relation to CONNECT and iHI-FIVES implementation outcomes.
DATA COLLECTION/EXTRACTION METHODS: The sample for assessing implementation outcomes included 571 Veterans referred to VA home- and community-based services and their family caregivers eligible for iHI-FIVES. Prior to iHI-FIVES launch, staff completed 65 surveys and 62 interviews. After the start of iHI-FIVES, staff completed 52 surveys and 38 interviews. Mixed methods evaluated reach and fidelity by arm.
Fidelity was high overall with 88% of expected iHI-FIVES trainings delivered, and higher among REP only (non-CONNECT) compared with CONNECT sites (95% vs. 80%). Reach was 18% (average proportion of reach across eight sites) and higher among non-CONNECT compared with CONNECT sites (22% vs. 14%). Qualitative interviews revealed strong leadership support at high-reach sites. CONNECT did not influence self-reported team function.
A team collaboration strategy (CONNECT), added to REP, required more resources to implement iHI-FIVES than REP only and did not substantially enhance reach or fidelity. Leadership support was a key condition of implementation success and may be an important factor for improving iHI-FIVES reach with national expansion.
评估团队协作策略（CONNECT）是否能改善家庭照顾者技能培训项目（iHI - FIVES）的实施效果。
iHI - FIVES在八个退伍军人事务（VA）医疗中心向照顾者提供。数据来源为电子健康记录、员工调查和访谈。
在一项阶梯楔形整群随机试验中，各站点被随机分配到iHI - FIVES启动的6个月时间间隔起始日期。然后各站点以1:1的比例随机分为两组：（i）CONNECT组，即团队协作培训策略加复制有效项目（REP），为员工提供简短的技术支持培训；（ii）仅REP组（非CONNECT组）。实施效果包括覆盖范围（符合条件的照顾者入组比例）和保真度（实际开展的预期培训比例）。员工访谈和调查评估了团队功能，包括沟通、实施经验以及它们与CONNECT和iHI - FIVES实施效果的关系。
数据收集/提取方法：用于评估实施效果的样本包括571名转介至VA家庭和社区服务的退伍军人及其符合iHI - FIVES条件的家庭照顾者。在iHI - FIVES启动前，员工完成了65份调查和62次访谈。iHI - FIVES启动后，员工完成了52份调查和38次访谈。混合方法按组评估覆盖范围和保真度。
总体保真度较高，实际开展了88%的预期iHI - FIVES培训，仅REP组（非CONNECT组）的保真度高于CONNECT组（95%对80%）。覆盖范围为18%（八个站点的平均覆盖比例），非CONNECT组的覆盖范围高于CONNECT组（22%对14%）。定性访谈显示高覆盖站点有强有力的领导支持。CONNECT对自我报告的团队功能没有影响。
在REP基础上增加的团队协作策略（CONNECT），与仅采用REP相比，实施iHI - FIVES需要更多资源，且并未显著提高覆盖范围或保真度。领导支持是实施成功的关键条件，可能是在全国推广时提高iHI - FIVES覆盖范围所需的重要因素。
