Measuring Patient Well-Being During Whole-Person Clinical Care: Lessons From the Veterans Health Administration Well-Beings Signs Implementation Pilot.

Background: Measuring patient well-being during clinical care may enhance patient-centered communication and treatment planning. The Veterans Health Administration (VHA) piloted the use of the Well-Being Signs (WBS), a self-report measure of psychosocial well-being, in clinical care.

Objective: To understand early WBS implementation and health care team member experiences with its use before developing detailed support materials and finalizing the measure.

Overcoming barriers to implementation: mapping implementation strategies in four hospital in home programs within the Veterans Health Administration.

The Hospital at Home model, called Hospital-in-Home (HIH) in the Department of Veterans Affairs, delivers coordinated, high-value care aligned with older adult and caregiver preferences. Documenting implementation barriers and corresponding strategies to overcome them can address challenges to widespread adoption. To evaluate HIH implementation barriers and identify strategies to address them, we conducted interviews with 8 HIH staff at 4 hospitals between 2010 and 2013.

Factors Related to Higher and Lower Performance and Adherence in STAR-VA Program Sustainment in Department of Veterans Affairs (VA) Community Living Centers (CLCs).

Objectives: We identify factors associated with sustainment of an intervention (STAR-VA) to address distress behaviors in dementia (DBD), guided by the Organizational Memory Knowledge Reservoir (KR) framework, compared across 2 types of outcomes: (1) site performance improvement on a clinical outcome, the magnitude of change in levels of DBD, and (2) self-rated adherence to STAR-VA core components, a process outcome.

Design: We used a cross-sectional sequential explanatory mixed methods design guided by the Organizational Memory Framework.

Setting And Participants: We selected 20 of 79 sites that completed STAR-VA training and consultation based on rankings on 2 outcomes-change in an indicator of DBD and reported adherence to STAR-VA core components.

Factors affecting the implementation of employee whole health in the veterans health administration: a qualitative evaluation.

Background: There is increasing recognition of the need to focus on the health and well-being of healthcare employees given high rates of burnout and turnover. Employee wellness programs are effective at addressing these issues; however, participation in these programs is often a challenge and requires large scale organizational transformation. The Veterans Health Administration (VA) has begun to roll out their own employee wellness program-Employee Whole Health (EWH)-focused on the holistic needs of all employees.

Integrating Intimate Partner Violence Screening Programs in Primary Care: Results from a Hybrid-II Implementation-Effectiveness RCT.

Introduction: The Veterans Health Administration initiated implementation facilitation to integrate intimate partner screening programs in primary care. This study investigates implementation facilitation's impact on implementation and clinical effectiveness outcomes.

Study Design: A cluster randomized, stepped-wedge, hybrid-II implementation-effectiveness trial (January 2021-April 2022) was conducted amidst the COVID-19 pandemic.

Intimate Partner Violence Screening for Women in the Veterans Health Administration: Temporal Trends from the Early Years of Implementation 2014-2020.

Thousands of women Veterans experience intimate partner violence (IPV) each year. The Veterans Health Administration (VHA) has encouraged IPV screening in Veterans Affairs medical centers (VAMCs) since 2014. Through retrospective analysis of VHA administrative data from fiscal year (FY) 2014 into FY2020, we examined IPV screening implementation outcomes of reach and adoption, as well as screen-positive rates using descriptive and multivariate linear regression analyses.

Identification of Implementation Strategies Using the CFIR-ERIC Matching Tool to Mitigate Barriers in a Primary Care Model for Older Veterans.

Background And Objectives: As the proportion of the U.S. population over 65 and living with complex chronic conditions grows, understanding how to strengthen the implementation of age-sensitive primary care models for older adults, such as the Veterans Health Administration's Geriatric Patient-Aligned Care Teams (GeriPACT), is critical.

Supporting Veterans with dementia to remain in the community: strategies used in 12 Veterans Health Administration programs.

The Veterans Health Administration (VA) provides services to growing numbers of Veterans with dementIa, individuals at heightened risk for hospitalizations and nursing home placement. Beginning in 2010, the VA funded 12 innovative pilot programs to improve dementia care and help Veterans remain at home. We conducted a retrospective qualitative analysis of program materials and interviews with physicians, nurses, social workers, and other personnel (n = 33) to understand the strategies these programs adopted.

Factors affecting primary care implementation for older veterans with multimorbidity in Veterans Health Administration (VA).

Objective: To identify factors affecting implementation of Geriatric Patient-Aligned Care Teams (GeriPACTs), a patient-centered medical home model for older adults with complex care needs including multiple chronic conditions (MCC), designed to provide them with comprehensive, managed, and coordinated primary care.

Data Sources: Qualitative data were collected from key informants at eight Veterans Health Administration Medical Centers geographically spread across the United States.

Study Design: Guided by the Consolidated Framework for Implementation Research (CFIR), we collected prospective primary data through semi-structured interviews with GeriPACT team members (e.

Getting Routine Intimate Partner Violence Screening Right: Implementation Strategies Used in Veterans Health Administration (VHA) Primary Care.

Background: Evidence supports the clinical effectiveness of intimate partner violence (IPV) screening programs, but less is known about implementing and sustaining them. This qualitative study identified implementation strategies used to integrate IPV screening programs within Veterans Health Administration (VHA) women's health primary care.

Methods: Thirty-two administrators and clinician key informants from 11 VHA facilities participated in semistructured interviews.

Assessing the Veterans Health Administration's response to intimate partner violence among women: protocol for a randomized hybrid type 2 implementation-effectiveness trial.

Background: Intimate partner violence (IPV) against women in the United States (US) remains a complex public health crisis. Women who experience IPV are among the most vulnerable patients seen in primary care. Screening increases the detection of IPV and, when paired with appropriate response interventions, can mitigate the health effects of IPV.

Using the PACT Resources Framework to Understand the Needs of Geriatric Primary Care Teams.

Objectives: To identify the perceived organizational resources required by healthcare workers to deliver geriatric primary care in a geriatric patient aligned care team (GeriPACT).

Design: Cross-sectional observational study using deductive analyses of qualitative interviews conducted with GeriPACT team members.

Setting: GeriPACTs practicing at eight geographically dispersed Department of Veterans Affairs (VA) healthcare systems.

Intimate Partner Violence Screening Programs in the Veterans Health Administration: Informing Scale-up of Successful Practices.

Objectives: Screening women for intimate partner violence (IPV) is increasingly expected in primary care, consistent with clinical prevention guidelines (e.g., United States Preventive Services Task Force).

Mental Health Integration in Geriatric Patient-Aligned Care Teams in the Department of Veterans Affairs.

Objectives: To inform geriatric mental health policy by describing the role of behavioral healthcare providers within a geriatric patient-aligned care team (GeriPACT), a patient-centered medical home model of care within the Veterans Health Administration (VHA), serving older veterans with chronic disease, functional dependency, cognitive decline, and psychosocial challenges, and/or those who have elder abuse, risk of long-term care placement, or impending disability.

Methods: The authors used mixed methods, consisting of a national survey and site visits between July 2016 and February 2017, at VHA outpatient clinics. The participants, 101 GeriPACTs at 44 sites, completed surveys, and 24 medical providers were interviewed.

Geriatric Patient-Aligned Care Teams in Department of Veterans Affairs: How Are They Structured?

Geriatric Patient-Aligned Care Teams (GeriPACT) were implemented in the Department of Veterans Affairs (VA) (i.e., Patient-Centered Medical Homes for older adults) to provide high quality coordinated care to older adults with more risk of negative health and psychosocial outcomes.

Is Variation in Resident-Centered Care and Quality Performance Related to Health System Factors in Veterans Health Administration Nursing Homes?

The purpose of this research was to explore and compare common health system factors for 5 Community Living Centers (ie Veterans Health Administration nursing homes) with high performance on both resident-centered care and clinical quality and for 5 Community Living Centers (CLC) with low performance on both resident-centered care and quality. In particular, we were interested in "how" and "why" some Community Living Centers were able to deliver high levels of resident-centered care and high quality of care, whereas others did not demonstrate this ability. Sites were identified based on their rankings on a composite quality measure calculated from 28 Minimum Data Set version 2.

Lessons Learned From a Multisite Evaluation of Geriatric and Extended Care Programs.

With the increased use of multisite evaluation and implementation studies in health care, our team of evaluators reflects on our evaluation of a large-scale multiyear geriatric and extended care program implementation. We share lessons from conducting multiple rounds of data collection, analyses, and reporting. We also identify some key factors that can facilitate or hinder multisite evaluation efforts involving programs with different models of implementation.

Identifying barriers to culture change: A qualitative analysis of the obstacles to delivering resident-centered care.

A growing number of healthcare organizations have moved from traditional, institutional nursing home models to ones that emphasize culture change, or resident-centered care (RCC). In 2006, the Department of Veterans Affairs (VA) began implementing a number of changes to VA nursing homes, now called (CLCs), to provide veterans with a more resident-centered and homelike environment. This study aimed to understand the barriers CLC staff face when delivering RCC.

Identifying and overcoming implementation challenges: Experience of 59 noninstitutional long-term services and support pilot programs in the Veterans Health Administration.

Background: From 2010 to 2013, the Department of Veterans Affairs (VA) funded a large pilot initiative to implement noninstitutional long-term services and supports (LTSS) programs to support aging Veterans. Our team evaluated implementation of 59 VA noninstitutional LTSS programs.

Purpose: The specific objectives of this study are to (a) examine the challenges influencing program implementation comparing active sites that remained open and inactive sites that closed during the funding period and (b) identify ways that active sites overcame the challenges they experienced.

Reliability and validity of a person-centered care staff survey in veterans health administration community living centers.

Purpose: The objective of this study was to test and revise a staff assessment of person-centered care (PCC) within the Veterans Health Administration (VA) Community Living Center (CLC) setting.

Design And Methods: Starting with measures of PCC initially developed through the Better Jobs Better Care (BJBC) study, we conducted cognitive interviews with CLC staff to assess applicability to the VA setting. We then (a) modified the questionnaire based on respondent feedback, (b) administered the revised survey via Internet to 265 staff at 8 VA CLCs, and (c) examined the psychometric properties of the revised 50-item BJBC PCC instrument using multitrait analysis.