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Implementation of a Patient and Family-Centered Intensive Care Unit Peer Support Program at a Veterans Affairs Hospital.

ABSTRACT: Peer support is a novel strategy to mitigate postintensive care syndrome and postintensive care syndrome-family. This project implemented a peer support program to address postintensive care syndrome for patients and family members. Using a free-flow, unstructured format, a chaplain, social worker, nurse, and intensive care unit survivor led veterans and loved ones in discussion of intensive care unit experiences, fears, and the challenges of recovery. Evaluations indicated group participation is beneficial for emotional support, coping, and understanding common situations related to prolonged intensive care unit stay. A majority reported they would strongly recommend group participation to a friend.

SUBMITTER: Boehm LM

PROVIDER: S-EPMC7393793 | biostudies-literature | 2020 Jun

REPOSITORIES: biostudies-literature

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Implementation of a Patient and Family-Centered Intensive Care Unit Peer Support Program at a Veterans Affairs Hospital.

Boehm Leanne M LM Drumright Kelly K Gervasio Ralph R Hill Christopher C Reed Nancy N

Critical care nursing clinics of North America 20200331 2

Peer support is a novel strategy to mitigate postintensive care syndrome and postintensive care syndrome-family. This project implemented a peer support program to address postintensive care syndrome for patients and family members. Using a free-flow, unstructured format, a chaplain, social worker, nurse, and intensive care unit survivor led veterans and loved ones in discussion of intensive care unit experiences, fears, and the challenges of recovery. Evaluations indicated group participation i ...[more]

PMID: 32402316

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Project description:BackgroundHealthcare systems nationwide are implementing intensive outpatient care programs to optimize care for high-need patients; however, little is known about these patients' personal goals and factors associated with goal progress.ObjectiveTo describe high-need patients' goals, and to identify factors associated with their goal progress DESIGN: Retrospective cohort study PARTICIPANTS: A total of 113 high-need patients participated in a single-site Veterans Affairs intensive outpatient care program.Main measuresTwo independent reviewers examined patients' goals recorded in the electronic health record, categorized each goal into one of three domains (medical, behavioral, or social), and determined whether patients attained goal progress during program participation. Logistic regression was used to determine factors associated with goal progress.ResultsThe majority (n = 72, 64%) of the 113 patients attained goal progress. Among the 100 (88%) patients with at least one identified goal, 58 set goal(s) in the medical domain; 60 in the behavioral domain; and 52 in the social domain. Within each respective domain, 41 (71%) attained medical goal progress; 34 (57%) attained behavioral goal progress; and 32 (62%) attained social goal progress. Patients with mental health condition(s) (aOR 0.3; 95% CI 0.1-0.9; p = 0.03) and those living alone (aOR 0.4; 95% CI 0.1-1.0; p = 0.05) were less likely to attain goal progress. Those with mental health condition(s) and those who were living alone were least likely to attain goal progress (interaction aOR 0.1 compared to those with neither characteristic; 95% CI 0.0-0.7; p = 0.02).ConclusionsAmong high-need patients participating in an intensive outpatient care program, patient goals were fairly evenly distributed across medical, behavioral, and social domains. Notably, individuals living alone with mental health conditions were least likely to attain progress. Future care coordination interventions might incorporate strategies to address this gap, e.g., broader integration of behavioral and social service components.

Project description:IntroductionThe increasing number of women Veterans receiving health care from the Veterans Health Administration (VHA) has spurred the need for more women's health primary care providers (PCPs) and nurses, including in rural areas nationwide. Here we report on the implementation of a women's health rural workforce training program, demonstrate initial evidence of its effectiveness within VHA as a Learning Health System, and present lessons learned and implications for other workforce training programs.MethodsThe Women's Health Primary Care Mini-Residency for Rural Providers and Nurses (Rural WH-MR) is a mobile VHA training initiative adapted from a national training model. The Rural WH-MR uses asynchronous blended learning paired with in-person hands-on instruction delivered directly at rural VHA sites. Mixed methods evaluation using quantitative data, qualitative interviews, and observational feedback assessed the program's implementation feasibility, fidelity, acceptability, and appropriateness. Longitudinal survey data were used to assess the initial program impact via changes in participating PCP and nurse knowledge, attitudes, practices, and skills (KAPS).ResultsInclusive of the pilot and fiscal years 2018 and 2019 Rural WH-MR trainings, 181 PCPs, and 320 nurses were trained through 56 training events nationwide. Cumulative survey data using 5-point measures showed high participant satisfaction, achievement of program-specific objectives, and usefulness of training activities to the rural practice of both PCPs and nurses. Both a pre-training and 6-month-follow-up survey were completed by 52 PCPs (32.9%) and 93 nurses (32.2%) and revealed significant sustained improvements in 18 out of 22 KAPS (p < 0.01-0.03) areas assessed for PCPs and all 17 KAPS (p < 0.01) areas assessed for nurses.ConclusionsThis adapted training program benefitted VHA's rural clinical workforce thereby contributing to the VHA goal of increasing the numbers of rural women Veterans with access to PCPs and nurses with women's health expertise.

Project description:BackgroundIn trials, hospital walking programs have been shown to improve functional ability after discharge, but little evidence exists about their effectiveness under routine practice conditions.ObjectiveTo evaluate the effect of implementation of a supervised walking program known as STRIDE (AssiSTed EaRly MobIlity for HospitalizeD VEterans) on discharge to a skilled-nursing facility (SNF), length of stay (LOS), and inpatient falls.DesignStepped-wedge, cluster randomized trial. (ClinicalTrials.gov: NCT03300336).Setting8 Veterans Affairs hospitals from 20 August 2017 to 19 August 2019.PatientsAnalyses included hospitalizations involving patients aged 60 years or older who were community dwelling and admitted for 2 or more days to a participating medicine ward.InterventionHospitals were randomly assigned in 2 stratified blocks to a launch date for STRIDE. All hospitals received implementation support according to the Replicating Effective Programs framework.MeasurementsThe prespecified primary outcomes were discharge to a SNF and hospital LOS, and having 1 or more inpatient falls was exploratory. Generalized linear mixed models were fit to account for clustering of patients within hospitals and included patient-level covariates.ResultsPatients in pre-STRIDE time periods (n = 6722) were similar to post-STRIDE time periods (n = 6141). The proportion of patients with any documented walk during a potentially eligible hospitalization ranged from 0.6% to 22.7% per hospital. The estimated rates of discharge to a SNF were 13% pre-STRIDE and 8% post-STRIDE. In adjusted models, odds of discharge to a SNF were lower among eligible patients hospitalized in post-STRIDE time periods (odds ratio [OR], 0.6 [95% CI, 0.5 to 0.8]) compared with pre-STRIDE. Findings were robust to sensitivity analyses. There were no differences in LOS (rate ratio, 1.0 [CI, 0.9 to 1.1]) or having an inpatient fall (OR, 0.8 [CI, 0.5 to 1.1]).LimitationDirect program reach was low.ConclusionAlthough the reach was limited and variable, hospitalizations occurring during the STRIDE hospital walking program implementation period had lower odds of discharge to a SNF, with no change in hospital LOS or inpatient falls.Primary funding sourceU.S. Department of Veterans Affairs Quality Enhancement Research Initiative (Optimizing Function and Independence QUERI).

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Implementation of a Patient and Family-Centered Intensive Care Unit Peer Support Program at a Veterans Affairs Hospital.

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Implementation of a Patient and Family-Centered Intensive Care Unit Peer Support Program at a Veterans Affairs Hospital.

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