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Journal of General Internal Medicine

, Volume 25, Supplement 1, pp 18–26 | Cite as

Practice Changes Associated with the Department of Veterans Affairs′ Family Care Collaborative

  • Carmen Hall
  • Barbara Sigford
  • Nina Sayer
Original Article

ABSTRACT

BACKGROUND

The Department of Veterans Affairs (VA) provides rehabilitation for veterans with moderate to severe war injuries through four regional Polytrauma Rehabilitation Centers (PRCs). To standardize and improve care provided to these veterans′ family members, health services researchers partnered with program leaders and rehabilitation specialists to implement a family care quality improvement collaborative.

OBJECTIVE

To describe practice changes associated with the Family Care Collaborative′s intervention.

DESIGN

Cross-site, mixed-method evaluation.

PARTICIPANTS

Rehabilitation interdisciplinary team members (n = 226) working at the four participating sites.

INTERVENTIONS

The collaborative developed and implemented in a 6-month pilot a web-based tool to standardize and promote family-centered care.

OUTCOMES

Provider survey of family care, satisfaction with family care, and perceived competence in working with families; specific practice changes at each site; provider and facilitator perceptions of the collaborative work; and a validated measure to predict likelihood of success of the selected intervention.

MAIN RESULTS

Family-centered practices and satisfaction improved at sites with lower baseline scores (P < 0.05) and was equivalent across sites after the pilot. Providers initiated specific family-centered practices that often began at one site and spread to the others through the collaborative. Sites standardized family education and collaboration. Providers believed that the collaborative produced a “culture change” from patient-centered to family-centered care and viewed program leadership and health services researchers' involvement as crucial for success. Scores on the measure to predict successful implementation of the intervention beyond the pilot were promising.

CONCLUSIONS

Collaboratives that bring together clinicians, program leaders, and researchers may be useful for fostering complex change involving interdisciplinary teams.

KEY WORDS

rehabilitation family-centered care veterans collaborative attitude of health personnel patient care team implementation evaluation polytrauma practice change 

Notes

Acknowledgments

This project was supported through a VA Health Services Research and Development Quality Enhancement Research Initiative (QUERI) Locally Initiated Project (LIP) (PLY 05-184-3). In addition, we would like to thank the Polytrauma Rehabilitation Center clinicians who participated in the collaborative; Amy Gravely, MS, who conducted the statistical analysis; and Nancy Rettmann, MS, who helped format the manuscript, both with the Minneapolis VA Center for Chronic Disease Outcomes Research. Last, we would like to acknowledge the developers of the Organizational Change Manager, David Gustafson, PhD, and Harry Steudel, PhD, from the University of Wisconsin, who provided consultation on the Organizational Change Manager.

Conflict of Interest

None disclosed.

Funding Source

VA HSR&D Quality Enhancement Research Initiative (QUERI) Locally

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Copyright information

© Society of General Internal Medicine 2009

Authors and Affiliations

  1. 1.Center for Chronic Disease Outcomes Research (152/2E)VA Medical CenterMinneapolisUSA
  2. 2.University of MinnesotaTwin CitiesUSA

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