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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

1017 — Development of the Resident-Centered Assessment of Interactions with Staff and Engagement (RAISE): A Nursing Home Quality of Care Observational Tool

Snow AL, Tuscaloosa VA Medical Center; Jacobs LParmelee PA, and Allen RS, University of Alabama; Berlowitz DPalmer JA, and Hartmann CW, VA HSR&D Center for Health Quality, Outcomes, and Economic Research;

Veteran-centered care has become a widespread care model in VHA. VHA nursing home units, called Community Living Centers (CLCs), have embraced this journey of “cultural transformation” under the guidance of the Office of Geriatrics and Extended Care (GEC). Yet measuring successful implementation of cultural transformation remains a challenge. Collaborating with GEC, we used an ethnographic approach to achieve the following objective: to develop a structured observational assessment tool for cultural transformation that could eventually be incorporated into GEC’s unannounced CLC site visit program.

First, we conducted over 60 hours of ethnographic observations on 4 units in one VA CLC and 20 hours of interviews with staff and residents. Thematic analysis revealed quality and frequency of staff-resident interactions and resident engagement as aspects of person-centered care not captured by current quality assurance systems (e.g., MDS 3.0, annual inspections, and GEC’s performance measurement tool). Based on our qualitative data and input from experts in the field, including from GEC, we next developed a structured observational tool, the RAISE (Resident-centered Assessment of Interactions with Staff and Engagement), to capture these identified constructs.

We conducted 100 hours of observation using the RAISE in 8 units in 2 CLCs. Using an iterative approach informed by ethnographic notes and coding meetings, we identified a set of coding rules and administration processes that were as simultaneously efficient, non-reactive, and representative of CLC life as possible. Inter-rater reliabilities of the RAISE have been adequate (Cohen’s kappa = .75; averaged across RAISE variables and protocol types, n = 47 observations).

We have developed the RAISE as a research instrument for measuring cultural transformation. GEC is interested in exploring how this instrument could be used. We are now also conducting a modified participatory action research process to work with CLC staff to modify the RAISE into a version appropriate for staff use as a practice improvement tool and as a patient-centered care education tool.

Reaching across research, education, and practice, this research effort capitalized on a strong collaboration with our partners at GEC, resulting in tools that can help assess and improve the quality of resident-centered care in CLCs.

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