scholarly journals The “State of Implementation” Progress Report (SIPREP):A Pilot Demonstration of a Navigation System for Implementation

2020 ◽  
Author(s):  
Edward J Miech ◽  
Angela Larkin ◽  
Julie C Lowery ◽  
Andrew J Butler ◽  
Kristin M Pettey ◽  
...  
Keyword(s):  
Navigation System ◽  
Organizational Context ◽  
Medical Center ◽  
Veterans Health ◽  
Health Administration ◽  
Novel Approach ◽  
Wide Range ◽  
The Individual ◽  
Implementation Progress ◽  
Specific Implementation

Abstract Background: Implementation of new clinical programs across diverse facilities in national healthcare systems like the Veterans Health Administration (VHA) can be extraordinarily complex. Implementation is a dynamic process, influenced heavily by local organizational context and the individual staff at each medical center. It is not always clear in the midst of implementation what issues are most important to whom or how to address them. In recognition of these challenges, implementation researchers within VHA developed a new systemic approach to map the implementation work required at different stages and provide ongoing, detailed and nuanced feedback about implementation progress.Methods: This observational pilot demonstration project details how a novel approach to monitoring implementation progress was applied across two different national VHA initiatives. Stage-specific grids organized the implementation work into columns, rows and cells, identifying specific implementation activities at the site level to be completed along with who was responsible for completing each implementation activity. As implementation advanced, item-level checkboxes were crossed off and cells changed colors, offering a visual representation of implementation progress within and across sites across the various stages of implementation. Results: Applied across two different national initiatives, the SIPREP provided a novel navigation system to guide and inform ongoing implementation within and across facilities. The SIPREP addressed different needs of different audiences, both described and explained how to implement the program, made ample use of visualizations, and revealed both what was happening and not happening within and across sites. The final SIPREP product spanned distinct stages of implementation. Conclusions: The SIPREP made the work of implementation explicit at the facility level (i.e., who does what, and when) and provided a new common way for all stakeholders to monitor implementation progress and to help keep implementation moving forward. This approach could be adapted to a wide range of settings and interventions, and is planned to be integrated into the national deployment of two additional VHA initiatives within the next 12 months.

scholarly journals The "State of Implementation" Progress Report (SIPREP): A Pilot Demonstration of a Navigation System for Implementation

2020 ◽  
Author(s):  
Edward J Miech ◽  
Angela Larkin ◽  
Julie C Lowery ◽  
Andrew J Butler ◽  
Kristin M Pettey ◽  
...  
Keyword(s):  
Navigation System ◽  
Organizational Context ◽  
Medical Center ◽  
Veterans Health ◽  
Health Administration ◽  
Novel Approach ◽  
Wide Range ◽  
The Individual ◽  
Implementation Progress ◽  
Specific Implementation

Abstract Background: Implementation of new clinical programs across diverse facilities in national healthcare systems like the Veterans Health Administration (VHA) can be extraordinarily complex. Implementation is a dynamic process, influenced heavily by local organizational context and the individual staff at each medical center. It is not always clear in the midst of implementation what issues are most important to whom or how to address them. In recognition of these challenges, implementation researchers within VHA developed a new systemic approach to map the implementation work required at different stages and provide ongoing, detailed and nuanced feedback about implementation progress.Methods: This observational pilot demonstration project details how a novel approach to monitoring implementation progress was applied across two different national VHA initiatives. Stage-specific grids organized the implementation work into columns, rows and cells, identifying specific implementation activities at the site level to be completed along with who was responsible for completing each implementation activity. As implementation advanced, item-level checkboxes were crossed off and cells changed colors, offering a visual representation of implementation progress within and across sites across the various stages of implementation. Results: Applied across two different national initiatives, the SIPREP provided a novel navigation system to guide and inform ongoing implementation within and across facilities. The SIPREP addressed different needs of different audiences, both described and explained how to implement the program, made ample use of visualizations, and revealed both what was happening and not happening within and across sites. The final SIPREP product spanned distinct stages of implementation. Conclusions: The SIPREP made the work of implementation explicit at the facility level (i.e., who does what, and when) and provided a new common way for all stakeholders to monitor implementation progress and to help keep implementation moving forward. This approach could be adapted to a wide range of settings and interventions, and is planned to be integrated into the national deployment of two additional VHA initiatives within the next 12 months.

scholarly journals The “State of Implementation” Progress Report (SIPREP): a pilot demonstration of a navigation system for implementation

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Edward J. Miech ◽  
Angela Larkin ◽  
Julie C. Lowery ◽  
Andrew J. Butler ◽  
Kristin M. Pettey ◽  
...  
Keyword(s):  
Navigation System ◽  
Organizational Context ◽  
Medical Center ◽  
Veterans Health ◽  
Health Administration ◽  
Novel Approach ◽  
Wide Range ◽  
The Individual ◽  
Implementation Progress ◽  
Specific Implementation

Abstract Background Implementation of new clinical programs across diverse facilities in national healthcare systems like the Veterans Health Administration (VHA) can be extraordinarily complex. Implementation is a dynamic process, influenced heavily by local organizational context and the individual staff at each medical center. It is not always clear in the midst of implementation what issues are most important to whom or how to address them. In recognition of these challenges, implementation researchers within VHA developed a new systemic approach to map the implementation work required at different stages and provide ongoing, detailed, and nuanced feedback about implementation progress. Methods This observational pilot demonstration project details how a novel approach to monitoring implementation progress was applied across two different national VHA initiatives. Stage-specific grids organized the implementation work into columns, rows, and cells, identifying specific implementation activities at the site level to be completed along with who was responsible for completing each implementation activity. As implementation advanced, item-level checkboxes were crossed off and cells changed colors, offering a visual representation of implementation progress within and across sites across the various stages of implementation. Results Applied across two different national initiatives, the SIPREP provided a novel navigation system to guide and inform ongoing implementation within and across facilities. The SIPREP addressed different needs of different audiences, both described and explained how to implement the program, made ample use of visualizations, and revealed both what was happening and not happening within and across sites. The final SIPREP product spanned distinct stages of implementation. Conclusions The SIPREP made the work of implementation explicit at the facility level (i.e., who does what, and when) and provided a new common way for all stakeholders to monitor implementation progress and to help keep implementation moving forward. This approach could be adapted to a wide range of settings and interventions and is planned to be integrated into the national deployment of two additional VHA initiatives within the next 12 months.

Abstract 244: Real World Evaluation of Implementing a Mock Cardiac Arrest Program

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Brad Trumpower ◽  
Lee A Kamphuis ◽  
Joseph McEvoy ◽  
Pamela J Weber ◽  
Sarah Krein ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Training Program ◽  
Program Implementation ◽  
Medical Center ◽  
Veterans Health ◽  
Health Administration ◽  
Response Team ◽  
Study Team ◽  
National Initiative ◽  
Data Elements

Introduction: In 2019, the Veterans Health Administration (VHA) began rolling out a national initiative to create a standardized mock code training program through the Resuscitation Education Initiative (REdI). We partnered with REdI and the local REdI Mock Code Program team at a Midwestern VA medical center to evaluate the launch of this mock cardiac arrest training program using a mixed methods approach. Methods: The REdI mock cardiac arrest program provided training to VA medical center clinical and non-clinical staff using didactic, small group, and hands-on simulation activities over a 2-day site visit in January 2019 where all facets of the resuscitation team were reviewed. Following this training visit at one VA medical center, 10 mock cardiac arrests were conducted between March 2019 and December 2019. One mock cardiac arrest included a hospital-wide activation and nine were conducted on individual units without activation of the cardiac arrest response team. The research team was composed of clinical and methodological experts who observed 8 of the mock cardiac arrests. We used an observation template to record structured data elements and take field notes during the mock code (e.g., how participants made decisions, assigned roles and quality of communication between the participants). At the end of the mock code, facilitators and the study team collected oral and written feedback from the participants. Results: In the 8 mock cardiac arrests observed, we identified 54 participants. Participants overwhelmingly rated the mock cardiac arrests as positive (83.3%, 45/54). Debriefing-feedback after the mock cardiac arrest was identified as the most helpful aspect (42.6%, 23/54). Areas for improving implementation of the mock cardiac arrest training program focused primarily on the need for a better introduction to the exercise. This included understanding the manikin’s functionality (9.3%, 5/54) and the expectation that participants should perform CPR just as they would in an actual cardiac arrest event (7.4%, 4/54). Two critical takeaways frequently cited by participants related to performance during the mock cardiac arrest were a need for better communication (20.4%, 11/54) and defined roles (18.5%, 10/54). Conclusions: Implementation of a mock cardiac arrest program was positively received by participants at a VA medical center. Moreover, participants identified both opportunities for improving resuscitation performance and optimizing learning experiences as part of program implementation.

Patient Safety Trilogy: Perspectives from Clinical Engineering

2013 ◽  
Vol 47 (2) ◽  
pp. 137-142 ◽  
Author(s):  
Izabella Gieras ◽  
Paul Sherman ◽  
Dennis Minsent
Keyword(s):  
Patient Safety ◽  
Medical Center ◽  
Academic Medical Center ◽  
Clinical Engineering ◽  
Veterans Health ◽  
Health Administration ◽  
Healthcare Technology ◽  
Academic Medical ◽  
Clinical Engineers

This article examines the role a clinical engineering or healthcare technology management (HTM) department can play in promoting patient safety from three different perspectives: a community hospital, a national government health system, and an academic medical center. After a general overview, Izabella Gieras from Huntington Hospital in Pasadena, CA, leads off by examining the growing role of human factors in healthcare technology, and describing how her facility uses clinical simulations in medical equipment evaluations. A section by Paul Sherman follows, examining patient safety initiatives from the perspective of the Veterans Health Administration with a focus on hazard alerts and recalls. Dennis Minsent from Oregon Health & Science University writes about patient safety from an academic healthcare perspective, and details how clinical engineers can engage in multidisciplinary safety opportunities.

The Individual Health Insurance Mandate and Veterans Health Coverage

2019 ◽  
pp. 0095327X1987887 ◽  
Author(s):  
Dongjin Oh ◽  
Frances Stokes Berry
Keyword(s):  
Health Insurance ◽  
Safety Net ◽  
Veterans Health ◽  
Health Coverage ◽  
Health Administration ◽  
Social Safety Net ◽  
Individual Mandate ◽  
Insurance Mandate ◽  
The Individual ◽  
Veteran Health Care

In December 2017, Congress repealed the individual insurance mandate penalty. Given the poor health status of veterans, their higher demands for health insurance, and the substantial number of uninsured veterans, the repeal of the individual mandate should have a significant impact on the veterans. This article investigates how the repeal of the individual mandate effective in January 2019 is likely to affect the number of uninsured veterans and their enrollments in Veterans Affairs (VA) insurance. By analyzing 52,692 nonelderly veterans in Florida and California from 2008 to 2017, the findings suggest that the repeal will lead to a considerable increase in the number of uninsured veterans. Veterans who are unemployed, poor, and suffering disabilities are more likely to sign up for the VA insurance than better-off veterans. Thus, one of the important functions of veteran health care is to serve as a social safety net for vulnerable veterans. Thus, the Veterans Health Administration should establish a policy to minimize the expected negative repercussions of the repeal.

scholarly journals Reduction of Methicillin-ResistantStaphylococcus aureusInfection among Veterans in Atlanta

2013 ◽  
Vol 34 (1) ◽  
pp. 62-68 ◽  
Author(s):  
Edward Stenehjem ◽  
Cortney Stafford ◽  
David Rimland
Keyword(s):  
Active Surveillance ◽  
Medical Center ◽  
Veterans Health ◽  
Health Administration ◽  
Healthcare Settings ◽  
Surveillance Cultures ◽  
Mrsa Infection ◽  
The Impact ◽  
Mrsa Colonization ◽  
Community Onset

Objective.Describe local changes in the incidence of community-onset and hospital-onset methicillin-resistantStaphylococcus aureus(MRSA) infection and evaluate the impact of MRSA active surveillance on hospital-onset infection.Design.Observational study using prospectively collected data.Setting.Atlanta Veterans Affairs Medical Center (AVAMC).Patients.All patients seen at the AVAMC over an 8-year period with clinically and microbiologically proven MRSA infection.Methods.All clinical cultures positive for MRSA were prospectively identified, and corresponding clinical data were reviewed. MRSA infections were classified into standard clinical and epidemiologic categories. The Veterans Health Administration implemented the MRSA directive in October 2007, which required active surveillance cultures in acute care settings.Results.The incidence of community-onset MRSA infection peaked in 2007 at 5.45 MRSA infections per 1,000 veterans and decreased to 3.14 infections per 1,000 veterans in 2011 (P< .001 for trend). Clinical and epidemiologic categories of MRSA infections did not change throughout the study period. The prevalence of nasal MRSA colonization among veterans admitted to AVAMC decreased from 15.8% in 2007 to 11.2% in 2011 (P<.001 for trend). The rate of intensive care unit (ICU)-related hospital-onset MRSA infection decreased from October 2005 through March 2007, before the MRSA directive. Rates of ICU-related hospital-onset MRSA infection remained stable after the implementation of active surveillance cultures. No change was observed in rates of non-ICU-related hospital-onset MRSA infection.Conclusions.Our study of the AVAMC population over an 8-year period shows a consistent trend of reduction in the incidence of MRSA infection in both the community and healthcare settings. The etiology of this reduction is most likely multifactorial.

scholarly journals Analysis of a hepatitis C screening programme for US veterans

2005 ◽  
Vol 134 (2) ◽  
pp. 249-257 ◽  
Author(s):  
I. A. ZUNIGA ◽  
J. J. CHEN ◽  
D. S. LANE ◽  
J. ALLMER ◽  
V. E. JIMENEZ-LUCHO
Keyword(s):  
Risk Factors ◽  
Hepatitis C ◽  
Screening Programme ◽  
Medical Center ◽  
Liver Function Tests ◽  
Hcv Infection ◽  
Veterans Health ◽  
Health Administration ◽  
Screening Guidelines ◽  
Us Veterans

This study analyses a screening programme for hepatitis C virus (HCV) infection among US veterans in a suburban Veterans Affairs Medical Center, in New York. This is the first study examining all 11 potential risk factors listed in the 2001 National U.S. Veterans Health Administration Screening Guidelines. A retrospective study was conducted of 5400 veterans ‘at risk’ of HCV, identified through a questionnaire in this institution's primary-care outpatient departments between 1 October 2001 and 31 December 2003. Multivariate logistic regression models were built to identify independent predictors of infection. Of 2282 veterans tested for HCV, 4·6% were confirmed by HCV PCR to be HCV infected. In the multivariate model developed, injection drug use, blood transfusion before 1992, service during the Vietnam era, tattoo, and a history of abnormal liver function tests were independent predictors of HCV infection. Our data support considering a more targeted screening approach that includes five of the 11 risk factors.

scholarly journals Analysis of Barriers to Transitioning from a Linear to a Circular Economy for End of Life Materials: A Case Study for Waste Feathers

2020 ◽  
Vol 12 (5) ◽  
pp. 1725 ◽  
Author(s):  
Elena Dieckmann ◽  
Leila Sheldrick ◽  
Mike Tennant ◽  
Rupert Myers ◽  
Christopher Cheeseman
Keyword(s):  
End Of Life ◽  
Circular Economy ◽  
Public Perception ◽  
Organizational Context ◽  
Assessment Method ◽  
Basic Material ◽  
Novel Approach ◽  
Wide Range ◽  
The Uk

This research aimed to develop a simple but robust method to identify the key barriers to the transition from a linear to a circular economy (CE) for end of life products or material. Nine top-tier barrier categories have been identified that influence this transition. These relate to the basic material properties and product characteristics, the availability of suitable processing technology, the environmental impacts associated with current linear management, the organizational context, industry and supply chain issues, external drivers, public perception, the regulatory framework and the overall economic viability of the transition. The method provides a novel and rapid way to identify and quantitatively assess the barriers to the development of CE products. This allows mitigation steps to be developed in parallel with new product design. The method has been used to assess the potential barriers to developing a circular economy for waste feathers generated by the UK poultry industry. This showed that transitioning UK waste feathers to circularity faces significant barriers across numerous categories and is not currently economically viable. The assessment method developed provides a novel approach to identifying barriers to circularity and has potential to be applied to a wide range of end of life materials and products.

First-line chemotherapy (CT) versus anti-androgen therapy (AT) for patients (pts) with metastatic castration-resistant prostate cancer (mCRPC): Individual patient analysis of the Veterans Health Administration (VHA) dataset.

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 156-156 ◽  
Author(s):  
Guru Sonpavde ◽  
Ahong Huang ◽  
Li Wang ◽  
Onur Baser ◽  
Raymond Miao
Keyword(s):  
Prognostic Factors ◽  
Multivariable Analysis ◽  
Specific Antigen ◽  
Veterans Health ◽  
Health Administration ◽  
Castration Resistant Prostate Cancer ◽  
First Line ◽  
Cox Proportional Hazard Models ◽  
The Individual ◽  
The Impact

156 Background: The outcomes of pts receiving first-line CT vs AT for mCRPC are unclear. Using the VHA dataset, we compared outcomes with first-line CT vs AT in pts with mCRPC and assessed the impact of prior androgen deprivation therapy (ADT) duration and known prognostic factors. Methods: Pts with mCRPC initiating first-line AT (abiraterone, enzalutamide) or CT (taxane) from Oct 2012 to Sept 2014 were identified. The impact of AT vs CT on overall survival (OS) and time to discontinuation (TTD) was assessed using Cox proportional hazard models, adjusting for prior ADT duration, known prognostic factors (hemoglobin [Hb], albumin [alb], alkaline phosphatase [ALP], prostate-specific antigen [PSA]), Charlson Comorbidity Index (CCI) and chronic disease score (CDS). Results: Overall, 1445 pts were evaluable; 1108 received AT (abiraterone 996, enzalutamide 112) and 337 received CT (docetaxel). The overall median duration of prior ADT was 464 days. On multivariable analysis, prior ADT duration, CCI, CDS, Hb, Alb, ALP and PSA were associated with OS, but AT vs CT was not (HR: 1.041 [95% CI: 0.853–1.270], p = 0.6943). PSA levels, prior ADT duration, and ALP was associated with TTD, and TTD was shorter for CT vs AT (HR: 2.339 [95% CI: 1.969–2.779], p < 0.0001). Longer prior ADT duration was associated with longer OS (HR: 0.566, p < 0.0001) and TTD (HR: 0.831, p = 0.0363) in the AT cohort, but not in the CT cohort. Treatment-free interval (TFI) (between first- and second-line treatment) was longer for CT vs AT (mean: 53 vs 39 days; p = 0.0303). Conclusions: To our knowledge, this is one of the largest mCRPC datasets analyzed at the individual pt level comparing first-line CT vs AT. OS was not significantly different for first-line CT vs AT after adjusting for key prognostic factors, despite shorter TTD with CT and longer TFI after first-line CT. Prior ADT duration ≤ 464 days was associated with shorter OS and TTD in the AT cohort, but not the CT cohort, suggesting that such pts may benefit from receiving CT over AT. The results are hypothesis-generating and prospective validation is required. Funding: Sanofi Genzyme

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