Increasing Evidence-based Clinical Practices in VA

NCT00366028 | Completed Results

• 1 other identifier: IMV 04-055
• Study Type: interventional
• Target: 1,624
• Locations: 1 country
• Sites: 1

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.

Conditions

Hand Washing

Keywords

Organization Innovation; Diffusion of Innovation; Evidence-based Medicine; Infection Control

Outcome Measures

Primary Outcomes (2)

• Fidelity to the Organizational Model

  Final fidelity to the Organizational Model was assessed by averaging scores for each component of the model. Scores ranged from 0 (no evidence of that factor present) to 4 (factor fully present and used as intended). The 3 main components of the model included 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. Scores for each component of the model were measured by the study team using structured rating instruments based on data collected during interviews. Sites with an overall fidelity score above 3.0 were considered to have high fidelity to the organizational model.

  Fidelity was assessed at the end of the 3 year study.

• Effect Size of Improvement in Hand Hygiene Compliance

  The effect size of improvement in hand-hygiene compliance was calculated by comparing the baseline three-month periods to the last three-month periods of the study. To evaluate the statistical significance of changes in proportion adherence over time, we ran a weighted least squares regression model with time (i.e. month) as the independent variable and adherence proportion as the dependent variable. The sample size in each data collection period was used as the weight. Our interest is in the statistical significance of the coefficient associated with time. To evaluate the practical significance of the change pre and post intervention, we examined the effect size associated with the change in proportion adherence in the first 3-month period of data collection and the last 3-month period. Effect size was calculated as 2\*arcsin(sqr(p2)) - 2\*arcsin(sqr(p1)). Using Cohen's criteria, an effect size of .2 is interpreted as small, .5 as medium and .8 as large.

  3 months pre and post study intervention

Study Arms (2)

Organizational Model

OTHER

Organizational Model: Participants in this arm of the study will receive information regarding the organizational model and work closely with the research team throughout the project to implement various aspects of the model. Participants in this arm of the study will be interviewed and participate in the data feedback portion of the study as well.

Behavioral: Organization Model; Behavioral: Data Feedback Model

Data Feedback

OTHER

Data Feedback Only: Participants in this arm will be interviewed periodically and participate in the data feedback portion of the study.

Behavioral: Data Feedback Model

Interventions

Organization Model BEHAVIORAL

The organizational model contains three components: leadership support, a multidisciplinary redesign team, and management structures and processes to link the two.

Organizational Model

Data Feedback Model BEHAVIORAL

The research team will periodically interview the facilities and provide them with reported hand hygiene data.

Data Feedback; Organizational Model

Eligibility Criteria

• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• VA employees of VISNs 1, 10 and 23 working in participating clinical units or holding a leadership position in medical centers identified by facility leadership for participation in the study.

Sponsors & Collaborators

• US Department of Veterans Affairs: lead

Study Sites (1)

VA Boston Healthcare System Jamaica Plain Campus, Jamaica Plain, MA

Boston, Massachusetts, 02130, United States

Location

Related Publications (1)

• VanDeusen Lukas C, Engle RL, Holmes SK, Parker VA, Petzel RA, Nealon Seibert M, Shwartz M, Sullivan JL. Strengthening organizations to implement evidence-based clinical practices. Health Care Manage Rev. 2010 Jul-Sep;35(3):235-45. doi: 10.1097/HMR.0b013e3181dde6a5.

  PMID: 20551771 RESULT

Results Point of Contact

• Title: Dr. Carol VanDeusen Lukas
• Organization: Department of Veterans Affairs

carol.vandeusenlukas@va.gov

857-364-5685

Study Officials

• Carol VanDeusen-Lukas, EdD

  VA Boston Healthcare System Jamaica Plain Campus, Jamaica Plain, MA

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: Yes

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NON RANDOMIZED
• Masking: NONE
• Intervention Model: FACTORIAL
• Sponsor Type: FED
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: August 16, 2006
• First Posted: August 18, 2006
• Study Start: January 1, 2006
• Primary Completion: August 1, 2008
• Study Completion: January 1, 2009
• Last Updated: April 28, 2015
• Results First Posted: September 26, 2014

Record last verified: 2014-05

Locations

US (1)