Browsing by Author "Jackson, George L."

Now showing 1 - 5 of 5
  • Thumbnail Image
    Item
    The accuracy and completeness for receipt of colorectal cancer care using Veterans Health Administration administrative data.
    (BMC, 2016) Sherer, Eric A.; Fisher, Deborah A.; Barnd, Jeffrey; Jackson, George L.; Provenzale, Dawn; Haggstrom, David A.; Department of Medicine, IU School of Medicine
    The National Comprehensive Cancer Network and the American Society of Clinical Oncology have established guidelines for the treatment and surveillance of colorectal cancer (CRC), respectively. Considering these guidelines, an accurate and efficient method is needed to measure receipt of care.
  • Thumbnail Image
    Item
    Effects of Implementation of a Supervised Walking Program in Veterans Affairs Hospitals : A Stepped-Wedge, Cluster Randomized Trial
    (American College of Physicians, 2023) Hastings, Susan N.; Stechuchak, Karen M.; Choate, Ashley; Van Houtven, Courtney Harold; Allen, Kelli D.; Wang, Virginia; Colón-Emeric, Cathleen; Jackson, George L.; Damush, Teresa M.; Meyer, Cassie; Kappler, Caitlin B.; Hoenig, Helen; Sperber, Nina; Coffman, Cynthia J.; Medicine, School of Medicine
    Background: In trials, hospital walking programs have been shown to improve functional ability after discharge, but little evidence exists about their effectiveness under routine practice conditions. Objective: To 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. Design: Stepped-wedge, cluster randomized trial. (ClinicalTrials.gov: NCT03300336). Setting: 8 Veterans Affairs hospitals from 20 August 2017 to 19 August 2019. Patients: Analyses 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. Intervention: Hospitals 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. Measurements: The 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. Results: Patients 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]). Limitation: Direct program reach was low. Conclusion: Although 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.
  • Thumbnail Image
    Item
    The implementation of a translational study involving a primary care based behavioral program to improve blood pressure control: The HTN-IMPROVE study protocol (01295)
    (BMC, 2010-07-16) Bosworth, Hayden B.; Almirall, Daniel; Weiner, Bryan J.; Maciejewski, Mathew; Kaufman, Miriam A.; Powers, Benjamin J.; Oddone, Eugene Z.; Lee, Shoou-Yih D.; Damush, Teresa M.; Smith, Valerie; Olsen, Maren K.; Anderson, Daren; Roumie, Christianne L.; Rakley, Susan; Del Monte, Pamela S.; Bowen, Michael E.; Kravetz, Jeffrey D.; Jackson, George L.; Medicine, School of Medicine
    Background Despite the impact of hypertension and widely accepted target values for blood pressure (BP), interventions to improve BP control have had limited success. Objectives We describe the design of a 'translational' study that examines the implementation, impact, sustainability, and cost of an evidence-based nurse-delivered tailored behavioral self-management intervention to improve BP control as it moves from a research context to healthcare delivery. The study addresses four specific aims: assess the implementation of an evidence-based behavioral self-management intervention to improve BP levels; evaluate the clinical impact of the intervention as it is implemented; assess organizational factors associated with the sustainability of the intervention; and assess the cost of implementing and sustaining the intervention. Methods The project involves three geographically diverse VA intervention facilities and nine control sites. We first conduct an evaluation of barriers and facilitators for implementing the intervention at intervention sites. We examine the impact of the intervention by comparing 12-month pre/post changes in BP control between patients in intervention sites versus patients in the matched control sites. Next, we examine the sustainability of the intervention and organizational factors facilitating or hindering the sustained implementation. Finally, we examine the costs of intervention implementation. Key outcomes are acceptability and costs of the program, as well as changes in BP. Outcomes will be assessed using mixed methods (e.g., qualitative analyses--pattern matching; quantitative methods--linear mixed models). Discussion The study results will provide information about the challenges and costs to implement and sustain the intervention, and what clinical impact can be expected.
  • Thumbnail Image
    Item
    Implementing a Mandated Program Across a Regional Health Care System: A Rapid Qualitative Assessment to Evaluate Early Implementation Strategies
    (Wolters Kluwer, 2019-09-01) Sperber, Nina R.; Bruening, Rebecca A.; Choate, Ashley; Mahanna, Elizabeth; Wang, Virginia; Powell, Byron J.; Damush, Teresa; Jackson, George L.; Van Houtven, Courtney H.; Allen, Kelli D.; Hastings, Susan N.; Medicine, School of Medicine
    Rapid qualitative assessement was used to describe early strategies to implement an evidence-based walking program for hospitalized older adults, assiSTed eaRly mobIlity for hospitalizeD older vEterans (STRIDE), mandated by a regional Veterans Affairs health care system office (VISN). Data were collected from 6 hospital sites via semi-structured interviews with key informants, observations of telephone-based technical assistance (TA), and review of VISN-requested program documents (e.g., initial implementation plans). An overaching framework of actionable feedback for VISN leadership and specification of locally initiated implementation strategies, using the Expert Recommendations for Implementing Change (ERIC) compilation, was used. Actionable feedback was shared with VISN leadership one month after the initiative. ERIC implementation strategies identified were: 1) Promoting Adaptability- Four sites had physical therapists (PT)/ kinesiotherapists (KT) instead of assistants walk patients, 2) Promoting Network Weaving- Strengthening nursing and PT/ KT partnership with regular communication opportunities or a point person was important for implementation, 3) Distributing Educational Materials – Two sites distributed information about STRIDE via email and in-person, and 4) Organizing Clinician Implementation Team Meetings – Three sites used interdisciplinary team meetings to communicate with clinical staff about STRIDE. This qualitative study sheds light on early experiences with implementing STRIDE; the results have been instructive for ongoing implementation and future dissemination of STRIDE, and the approach can be applied across contexts to inform implementation of other programs.
  • Thumbnail Image
    Item
    Supporting teams to optimize function and independence in Veterans: a multi-study program and mixed methods protocol
    (BMC, 2018-04-20) Wang, Virginia; Allen, Kelli; Van Houtven, Courtney H.; Coffman, Cynthia; Sperber, Nina; Mahanna, Elizabeth P.; Colón-Emeric, Cathleen; Hoenig, Helen; Jackson, George L.; Damush, Teresa M.; Price, Erika; Hastings, Susan N.; Medicine, School of Medicine
    BACKGROUND: Successful implementation of new clinical programs depends on effectively establishing, reorganizing, or enhancing team structures and processes to coordinate the work of individuals who are interdependent in their tasks, manage relationships, and share responsibility for outcomes. However, a one-size-fits-all approach is rarely effective. In partnership with VA national clinical leaders and local clinical champions, the Optimizing Function and Independence VA Quality Enhancement Research Initiative program (Function QUERI) will evaluate efforts to implement team-based clinical programs for Veterans at risk for functional decline and disability. METHODS: Function QUERI will implement and evaluate three innovative, evidence-based clinical programs in VA medical centers: (1) a group physical therapy program for knee osteoarthritis (Group PT); (2) assisted early mobility for hospitalized older veterans (STRIDE), a supervised walking program for hospitalized older veterans; and (3) implementation of helping invested family members improve veteran experiences study (iHI-FIVES), a skills training program for caregivers of disabled Veterans. A common reason for clinical care gaps in these populations is poor communication and coordination among the many interdisciplinary providers involved in their care. To facilitate the implementation of the clinical programs, Function QUERI will evaluate the impact of complexity science-based implementation intervention to promote team readiness (CONNECT), an implementation intervention designed as a bundle of interaction-oriented activities to promote team function and readiness for change, on the implementation of clinical programs across multiple sites. The evaluation will use a mixed methods design. Group PT is a local, single-site quality improvement project where a modified CONNECT intervention will be tested to inform the remaining program implementation projects. For STRIDE and iHI-FIVES projects, we will randomize participating sites to implement the clinical program, with the CONNECT intervention or not, and will use a stepped-wedge cluster randomized trial design. DISCUSSION: Function QUERI will translate its findings across its projects to identify the contextual factors and components from CONNECT that improve team processes and function to optimize effective implementation for future rollout of VA clinical programs. Synthesizing findings within and across projects, we will specify dimensions of team characteristics and function that enhance capacity for clinical innovation and uptake of evidence-based programs.