Background: The expansion of Community Care (CC) through the MISSION Act, and the increasing numbers of Veterans using CC, make it critical for VHA to balance the need to improve access to care, and at the same time, ensure that the services that VHA purchases in the community are of high quality. As there is little known about the quality and safety of care that Veterans receive in the community, this timely study will begin to close these knowledge gaps.
Specific Aims :
Our specific aims are to: 1) Assess variation across VISNs and facilities in the implementation of Guidebook processes used for patient safety reporting investigation, and improvement; 2) Identify the organizational contextual factors that influence implementation for sites with high vs. low fidelity to Guidebook safety processes; 3) Describe variation across VISNs and sites in service outcomes: safety events, timeliness, and Veterans' perceptions of CC quality and safety; and 4) Identify specific configurations of implementation strategies and organizational contextual factors that distinguish high- vs. low-performing sites on their implementation and service outcomes. Unique Features/Innovations of Project: This timely, innovative study will evaluate a national, mandated implementation of safety processes that are described in the VHA Office of Community Care (OCC) ?Patient Safety Guidebook.? The Guidebook was developed by OCC and VHA National Center for Patient Safety (NCPS) in response to gaps in safety identified in CC. Through collaboration with our operational partners (OCC and NCPS), we will provide VHA with critical information on whether use of the Guidebook as an implementation strategy is effective in improving safety of CC, and whether safety processes to report and investigate safety events in VHA are transferrable and applicable to the community setting. Methodology:
For Aim 1, we will conduct semi-structured telephone interviews with approximately 3 key informants (VHA patient safety staff, local CC staff) at 18 facilities across 18 VISNs. We will ask them questions on sites' fidelity to Guidebook's safety processes, feasibility of Guidebook implementation, and which implementation strategies worked well and which did not.
For Aim 2, we will obtain information from the staff interviews on their perceptions of the organizational contextual factors that influence implementation, differentiating between sites with high and low fidelity to the Guidebook's recommended processes.
For Aim 3, we will examine rates and trends in VHA and CC safety events, timeliness outcomes, and perceptions of CC quality and safety by Veterans. We will integrate the results from Aims 1-3 in Aim 4 to identify specific configurations of implementation strategies and organizational contextual factors that distinguish high- vs. low-performing sites. Expected Results: This partnered evaluation will be of benefit to both Veterans and our partners by generating context-specific findings that promote ongoing implementation of processes that improve quality and safety of care provided to Veterans in both VHA and CC.
This study represents a strong partnership with VHA Office of Community Care (OCC) and VHA National Center for Patient Safety (NCPS). We will evaluate a VHA mandate that required OCC/NCPS to implement a set of evidence-based safety practices across all VISNs by the end of December 2018. The ?VHA OCC Patient Safety Guidebook,? recently developed by OCC/NCPS to address identified safety gaps in Community Care (CC), contains specific safety processes designed to standardize safety event reporting, investigation, and improvement initiatives across VHA and CC. VHA patient safety staff will train local VHA CC staff to implement these safety processes in order to identify CC safety events; the Guidebook will serve as an implementation strategy. Through collaboration with our partners, we will provide VHA with important and timely information on the types of safety events reported in CC, and evaluate the impact of expanded use of CC through the VHA MISSION Act on the safety and quality of health care provided to Veterans who receive care in the community.
