Ignite Creation Date:
2024-05-05 @ 5:00 PM
Last Modification Date:
2024-10-26 @ 9:27 AM
Study NCT ID:
NCT00366028
Status:
COMPLETED
Last Update Posted:
2015-04-28
First Post:
2006-08-16
Brief Title:
Increasing Evidence-based Clinical Practices in VA
Sponsor:
US Department of Veterans Affairs
Organization:
VA Office of Research and Development
Study Overview
Official Title:
Strengthening Organization to Implement Evidence-based Clinical Practice
Status:
COMPLETED
Status Verified Date:
2014-05
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
False
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
None
Brief Summary:
Evidence-based clinical practices EBCPs are often not widely adopted despite extensive efforts to influence individual practitioners to use them The aim of the project is to work with Veterans Integrated Service Networks VISN 1 10 and 23 and their medical centers to create and test organizations that facilitate the use of EBCPs The research objectives are to Test the effectiveness of the proposed organizational model in comparison with a more limited data-feedback strategy in improving system use of a selected EBCP Identify and analyze organizational factors that affect model implementation Test the feasibility of intervention activities to introduce and support the model
Detailed Description:
Background
The Veterans Health Administration VHA needs to develop efficient ways to broadly implement evidence based practices and foster a learning organization culture that systematically and continuously applies research to improve VA healthcare Recognizing this need VHA Health Services Research and Development HSRD invited applications in the fall of 2003 for collaboration HSRD investigators and Integrated Service Networks VISNs on a implementing and evaluating an evidenced-based interventions or b undergoing and evaluating an organizational or structural change to transform the VISN in to a learning organization that can efficiently implement evidence-based practices Collaborations are intended to help improve clinical services locally within participating VISNs and provide templates for expanding successful changes nationwide
Objectives
Despite recognition that successful implementation of evidence-based clinical practices EBCPs usually depends on the on the structure and processes of the larger healthcare organization in which new clinical practices are introduced the processes and dynamics of implementation are not well understood The aim of this project was to deepen that understanding by testing an organizational model that we hypothesized would strengthen the ability of healthcare organizations to implement evidence-based clinical practices The research objectives were to - Test the hypothesis that medical centers with high fidelity to the organizational model would be more successful in improving system use of a selected EBCP - Identify and analyze organizational factors that affect model implementation - Test the feasibility of intervention activities to introduce and support the model
Methods
The three-year study used a mixed-methods pre-post comparison-group design to implement and evaluate the organizational model in medical centers in 3 VISNs in the Department of Veterans Affairs The model posits that the implementation of evidence-based practices will be enhanced through the presence of three interacting components in the organization 1 active leadership commitment to quality 2 robust clinical process redesign to incorporate evidence-based practices into routine operations and 3 use of management structures and processes to support and align redesign The target clinical practice was hand-hygiene compliance One VISN was randomly assigned to the intervention arm that implemented the organizational model two VISNs were assigned to a comparison arm that participated in a more limited data feedback strategy Measures included 1 ratings of implementation fidelity as measured on a 0-4 scale at the site level supported by narrative evidence by research team 2 percent compliance with national hand-hygiene guidelines for each site as measured through structured observations by medical center staff 3 staff ratings of team effectiveness and facility emphasis on quality as measured through a written survey and 4 factors affecting model implementation as identified qualitatively through interviews and quantitatively through staff surveys
Status
Data collection and analysis is complete Manuscript preparation is ongoing
The Veterans Health Administration VHA needs to develop efficient ways to broadly implement evidence based practices and foster a learning organization culture that systematically and continuously applies research to improve VA healthcare Recognizing this need VHA Health Services Research and Development HSRD invited applications in the fall of 2003 for collaboration HSRD investigators and Integrated Service Networks VISNs on a implementing and evaluating an evidenced-based interventions or b undergoing and evaluating an organizational or structural change to transform the VISN in to a learning organization that can efficiently implement evidence-based practices Collaborations are intended to help improve clinical services locally within participating VISNs and provide templates for expanding successful changes nationwide
Objectives
Despite recognition that successful implementation of evidence-based clinical practices EBCPs usually depends on the on the structure and processes of the larger healthcare organization in which new clinical practices are introduced the processes and dynamics of implementation are not well understood The aim of this project was to deepen that understanding by testing an organizational model that we hypothesized would strengthen the ability of healthcare organizations to implement evidence-based clinical practices The research objectives were to - Test the hypothesis that medical centers with high fidelity to the organizational model would be more successful in improving system use of a selected EBCP - Identify and analyze organizational factors that affect model implementation - Test the feasibility of intervention activities to introduce and support the model
Methods
The three-year study used a mixed-methods pre-post comparison-group design to implement and evaluate the organizational model in medical centers in 3 VISNs in the Department of Veterans Affairs The model posits that the implementation of evidence-based practices will be enhanced through the presence of three interacting components in the organization 1 active leadership commitment to quality 2 robust clinical process redesign to incorporate evidence-based practices into routine operations and 3 use of management structures and processes to support and align redesign The target clinical practice was hand-hygiene compliance One VISN was randomly assigned to the intervention arm that implemented the organizational model two VISNs were assigned to a comparison arm that participated in a more limited data feedback strategy Measures included 1 ratings of implementation fidelity as measured on a 0-4 scale at the site level supported by narrative evidence by research team 2 percent compliance with national hand-hygiene guidelines for each site as measured through structured observations by medical center staff 3 staff ratings of team effectiveness and facility emphasis on quality as measured through a written survey and 4 factors affecting model implementation as identified qualitatively through interviews and quantitatively through staff surveys
Status
Data collection and analysis is complete Manuscript preparation is ongoing
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
None
Is a FDA Regulated Device?:
None
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None