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PPO 10-116 – HSR&D Study

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PPO 10-116
Implementation of Person-Centered Care Practices in VA CLCs: A Pilot
Jennifer L. Sullivan PhD MS BA
VA Boston Healthcare System Jamaica Plain Campus, Jamaica Plain, MA
Boston, MA
Funding Period: April 2011 - March 2012

BACKGROUND/RATIONALE:
Implementation of the person-centered care (PCC) practices is theorized to improve both resident quality of life and care and staff outcomes such as autonomy and satisfaction. To date, the VA has relied on the Artifacts of Culture Change Tool as completed by facilities' Point of Contact managers to evaluate the degree to which Community Living Centers (CLCs) are implementing PCC. Culture change describes attempts to move from an institutional to person-centered model of care. The person-centered care is multi-dimensional and complex. As a result, accurate and comprehensive measurement of PCC is challenging. Although VA has undertaken the culture change process to move toward a PCC model, it is unclear how and to what extent CLCs are implementing the facets of the PCC. The Artifacts Tool has several limitations and may not adequately capture the complexity of person-centered care practices. While the PCC assessment instrument has been used in non-VA nursing homes and has good psychometric properties, it has not been used in VA.

OBJECTIVE(S):
The goal of this pilot study is to examine an alternative staff measure of person-centered care. The findings from this pilot study will support a large-scale IIR aimed at measuring PCC implementation and its association with CLC staff and resident outcomes across VA medical centers. The primary research objective is to test the PCC staff assessment survey instrument within VA CLCs.

METHODS:
Starting with measures of PCC initially developed through a Better Jobs Better Care (BJBC) study (White, 2008), we conducted two focus groups with CLC staff to assess applicability to the VA setting. We then 1) modified the questionnaire based on respondent feedback, 2) administered the revised PCC survey via internet to 958 staff at eight VA CLCs and 3) examined the psychometric properties of the PCC instrument using multitrait analysis.

FINDINGS/RESULTS:
Based on focus group findings, items on the survey were all applicable to the VA setting and only minor modifications were made to the questions. Following the revisions, we tested the psychometric properties of the 50-item BJBC PCC instrument using data obtained from 8 VA CLCs. The response rate was 36%. The pattern of convergent and divergent correlations present strong evidence of the reliability and validity of the hypothesized scales. Cronbach's alpha coefficients ranged from 0.84-0.91 and were comparable to those reported by White (2008) outside the VA setting.

IMPACT:
We observed excellent evidence for discriminant validity (100%), convergent validity (100%), and reliability (all scales demonstrated alpha levels exceeding the criterion for group comparisons). Thus, our results support the broader use of the BJBC survey within VA. To boost response rates in future studies, we would advocate adding a paper mode of survey administration. This instrument may be used in future studies to better understand the impact PCC has on staff and resident outcomes in VA. The PCC survey is valuable because it is a staff assessment and measures some PCC domains omitted by the Artifacts Tool.

PUBLICATIONS:

Journal Articles

  1. Sullivan JL, Meterko M, Baker E, Stolzmann K, Adjognon O, Ballah K, Parker VA. Reliability and validity of a person-centered care staff survey in veterans health administration community living centers. The Gerontologist. 2013 Aug 1; 53(4):596-607.
Conference Presentations

  1. Sullivan JL, Meterko MM, Parker VA, Stolzman KL, Baker E, Adjognon O, Ballah K. Implementation of Person-Centered Care Practices in VHA CLCs: Reliability of a Person-Centered Care Staff Survey. Poster session presented at: VA HSR&D National Meeting; 2012 Jul 16; Washington, DC.
  2. Sullivan JL, Meterko MM, Parker VA, Stolzman KL, Baker E, Adjognon O, Ballah K. Implementation of Person-Centered Care Practices in VHA CLCs: Reliability of a Person-Centered Care Staff Survey. Poster session presented at: AcademyHealth Annual Research Meeting; 2012 Jun 24; Orlando, FL.


DRA: Health Systems, Aging, Older Veterans' Health and Care
DRE: Treatment - Comparative Effectiveness, Research Infrastructure
Keywords: Medication Management, Patient Preferences, Research Measure Development, Research Tools
MeSH Terms: none

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