Protocol-guided Rapid Evaluation of Veterans Experiencing New Transient Neurological Symptoms "PREVENT"

Recruiting

Phase N/A Results N/A

Update History

19 Apr '17
The description was updated.
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Aim 1. To develop a quality improvement program to improve the care of Veterans with TIA or minor stroke that can be deployed nationwide. The program will include multiple components: a reporting system that is based on validated electronic quality measures (eCQMs) that will allow staff to monitor the time-sensitive processes of care and outcomes of their population of Veterans with TIA or minor stroke; clinical protocols to improve the timeliness and completeness of care; professional education materials; and clinical note templates for use by nursing and pharmacy staff. Lessons learned at the individual sites engaged in the quality improvement program will be shared across sites by use of a web-based platform and a virtual collaborative. Aim 2. To evaluate the effectiveness of the Aim 1 QI intervention program for Veterans with TIA or minor stroke against usual care. Teams at the 6 intervention sites will be given the quality improvement program components. The primary effectiveness outcome is the proportion of Veterans who received all of the guideline-concordant processes of care for which they are eligible referred to as the "Without-Fail" care rate. The secondary effectiveness outcome is the 90-day recurrent vascular event rate. Aim 3. To evaluate the implementation of the QI intervention program across the 6 participating sites. The implementation outcomes will be: participating clinician satisfaction with the quality improvement program; participating staff members' assessment of the quality improvement program components including the eCQM and the web-based platform in terms of usability, complexity, and relative advantage; and the adaptability of the program over the course of the study. Aim 4. To evaluate CFIR constructs and contextual factors associated with successful and suboptimal implementation of this new program for Veterans with an acute medical problem requiring timely care. Secondary Aim To evaluate the sustainability of the program. Sustainability will be evaluated over a one-year period that begins immediately after the one-year active implementation period.
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BACKGROUND Approximately 10,000 Veterans with transient ischemic attack (TIA) or minor stroke are cared for in a Department of Veterans Affairs (VA) Emergency Department (ED) or inpatient ward annually. Patients with transient ischemic attack (TIA) are at very high risk of recurrent vascular events; over the long-term 11% per year will have a stroke, myocardial infarction or vascular death; the highest risk period is early after the index TIA event. Because patients with TIA and minor stroke have little neurological impairment yet are at high risk of recurrent events, including disabling stroke, they are ideal candidates for interventions to reduce their risk of adverse events. Several studies have demonstrated that interventions which deliver timely care, in the immediate post-TIA period, reduce the risk of recurrent vascular events by 80%. OBJECTIVES The investigators' group has assessed the quality of care for Veterans with TIA and minor stroke nationwide and has found key gaps in care quality. The objective of the proposed project is to develop and evaluate a quality improvement program to enhance the quality of care for Veterans with TIA and minor stroke that includes a new model of telehealth called "acute telehealth; a set of validated eCQMs to provide teams with actionable information about the quality of care for their Veterans (QI feedback); and staff education. Aim 1. To develop a quality improvement program to enhance the care of Veterans with TIA or minor stroke that can be deployed nationwide. The investigators hypothesize that they can develop a program to improve guideline-concordant care for Veterans with a recent TIA or minor stroke. Aim 2. To evaluate the effectiveness of the quality improvement program for Veterans with TIA or minor stroke. The primary effectiveness outcome is the proportion of Veterans who received all of the guideline-concordant processes of care for which they are eligible referred to as the "defect-free" care rate. The secondary effectiveness outcome is the 30-day recurrent vascular event rate. The investigators hypothesize that the defect-free care rate will be higher among Veterans who are cared for at the 6 participating sites than among Veterans receiving usual care at non-participating sites (75% versus 20%). Aim 3. To evaluate the implementation of the quality improvement program across the 6 participating sites. The five implementation outcomes will be: (1) the proportion of eligible Veterans who are enrolled in the telehealth program; (2) clinician satisfaction with the quality improvement program; (3) provider assessment of the telehealth, training, and eCQM program in terms of usability, complexity, and relative advantage; and (4) the adaptability of the program over the course of the study. The investigators hypothesize that sites with the highest proportion of admitted Veterans (as compared with Veterans who receive care in the Emergency Department only without admission) will achieve the greatest success and satisfaction with program implementation. Aim 4. To evaluate Consolidated Framework for Implementation Research (CFIR) constructs and contextual factors associated with successful and suboptimal implementation of this new program for Veterans with an acute medical problem requiring timely care. The investigators hypothesize that facilities with existing high use of telehealth services, extended networks and communication across clinical service areas, and with engaged facility leadership will be more likely to implement the program. Secondary Aim To evaluate the sustainability of the program. Sustainability will be evaluated over a one-year period that begins immediately after the one-year active implementation period. The investigators' hypothesis is that sites with the greatest use of their own eCQM data will demonstrate the greatest program sustainability as measured by the proportion of eligible Veterans who participate in the telehealth program. METHODS This five-year stepped-wedge evaluation includes a total of 6 sites with three waves comprised of 2 sites. IMPACT This project will develop tools for quality improvement (including data monitoring and quality improvement planning), and identify site characteristics that are associated with improvements in quality of care.
The gender criteria for eligibility was updated to "All."
The eligibility criteria were updated.
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Inclusion Criteria: - This program will seek VA hospitals that are self-designated as either a VHA Primary Stroke Center or a Limited Hours Stroke Facility or Supporting Stroke Center. - That have >25 stroke/TIA patients per year and are willing to participate in the quality improvement program. - Eligibility for staff interviews is based on involvement in the QI intervention and willingness to participate. Exclusion Criteria: - Unwilling to participate
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Inclusion Criteria: - This program will seek VA hospitals that are self-designated as either a VHA Primary Stroke Center or a Limited Hours Stroke Facility or Supporting Stroke Center. - That have >25 stroke/TIA patients per year and are willing to participate. - These 6 sites will be randomized. Additionally, the investigators will conduct staff interviews at these sites. - Eligibility for staff interviews is based on involvement in the QI intervention and willingness to participate. Exclusion Criteria: Unwilling to participate
A location was updated in Indianapolis.
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The overall status was updated to "Recruiting" at Richard L. Roudebush VA Medical Center, Indianapolis, IN.