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2019 HSR&D/QUERI National Conference Abstract

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4034 — A Blended, Advanced Care Coordination Education Program for Nurses: Evaluation of the rural Transitions Nurse Training Program

Lead/Presenter: Lynette Kelley,  COIN - Seattle/Denver
All Authors: Kelley L (Seattle/Denver Center for Innovation for Veteran-Centered & Value Driven Care/ Rocky Mountain Regional VAMC), Gilmartin, H (Seattle/Denver Center for Innovation for Veteran-Centered & Value Driven Care),

Objectives:
The rural Transitions Nurse Program (TNP) is a national nurse-led, Veteran-centered, quality improvement intervention that facilitates care coordination for rural Veterans. There is little training guidance for educating new nurses in advanced care coordination transitions management. To support the TNP intervention, an evidence-based curriculum was created to standardize the training approach to ensure high-quality and safe transitional care for Veterans. The literature supports the use of in-person and virtual (i.e., blended) training to increase student engagement, knowledge attainment, and result in sustained behavior change. The TNP blended, advanced care coordination program curriculum includes on-line modules, a 3-day group training on effective communication, skills practice and assessment with standardized actors in a high-fidelity simulation lab, participation in a virtual learning collaborative, and individualized audit and feedback. To understand the impact of this novel training program, we conducted a rigorous evaluation to assess participant reaction, knowledge attained, changes to practice and impact on Veteran satisfaction.

Methods:
Using a mixed-methods approach guided by Kirkpatrick's four level model we studied participants reaction and knowledge gained using pre/post surveys. Feedback from standardized actors assessed immediate application of advance care coordination principles and effective communication, while clinical observations 9-months post-training assessed sustained behavior changes. Veteran satisfaction was assessed using interviews and surveys.

Results:
12 Transitions Nurses at 10 VA facilities have successfully completed the TNP training and provided care coordination to over 3,000 Veterans. Reactions to the training have been overwhelmingly positive (mean: 3.6;1-4 Likert scale). An increase in advanced care coordination knowledge pre-post training was observed (pre-training mean score: 89%; post-training mean score 98%, 1-100% scale). Immediate and sustained use of advanced care coordination principles and effective communication skills were observed (mean: 3.5, 1-4 Likert scale). Veterans have reported high satisfaction (80 to 95%) with their transitional care.

Implications:
The TNP blended training program positively impacted nurse care coordinators knowledge and practice. This positively impacted Veterans transitions of care experience.

Impacts:
The TNP advanced care coordination education program is an effective method to provide standardized training for nurses to ensure high-quality and safe transitions of care for Veterans.