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Health Systems Research

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IIR 17-046 – HSR Study

IIR 17-046
Measuring Veterans' Safe Patient Handling and Mobility Experiences
Deborah A Gurewich, PhD
VA Boston Healthcare System Jamaica Plain Campus, Jamaica Plain, MA
Boston, MA
Funding Period: October 2019 - September 2023


Background: Safe Patient Handling and Mobility (SPHM) consists of ergonomic techniques and equipment to move patients who cannot move independently. SPHM helps minimize adverse events (pressure ulcers, falls), and staff injuries. Despite benefits, we know little about how patients experience assisted mobility. With valid and reliable scales, we can measure patient experiences, thus facilitating improved care, more tailored evaluation, and more targeted clinical staff education. Patients in rehabilitation are an ideal group to study. Specific aims: We will develop a valid and reliable self-report survey based upon patients' experiences of assisted mobility: the (PEAM). We have three aims. First, the analysis of qualitative interview data will identify and describe important concepts of patients' experiences. Scales and items will be generated from the interviews. The items will be reviewed by patients and subject experts, assuring content validity. Second, the PEAM will be fielded and the data analyzed to provide support for reliability and construct validity. Third, we will examine the statistical relation between PEAM and associated outcomes to establish criterion validity. Significance: Patient experiences of care are one of the pillars of health care quality. Yet, no measures assess patients' perceptions of assisted mobility. The VA national directive for SPHM mandates program evaluation, yet the Voice of the Veteran is not part of the assessment. The sheer number of rehabilitation unit Veterans calls for their input. The PEAM will provide a valid and reliable measure to address this gap. PEAM will allow identification of best practices, areas in need of improvement, and clinical staff educational priorities. Priority domain: Our study addresses the HSR&D priority of patient-centered care and care management. We examine how methods of care delivery can influence Veterans' experiences and relevant outcomes. Innovation: PEAM will be the first reliable and validated patient-report survey of assisted mobility experiences. Methodology: For Aim 1, we will conduct telephone interviews with 60 Veterans discharged from inpatient rehabilitation units including: SCI, acute rehabilitation, short-stay nursing homes, and polytrauma. We will interview 30 staff at two medical centers about their experiences with SPHM. Our conceptual model and interview questions consist of patient, provider, equipment, environment, and task concepts. We will apply thematic analysis to data to develop and refine constructs. An expert panel will evaluate item fit to constructs. We will interview up to 15 Veterans to ensure items are understood as intended. For Aim 2, we will test the instrument with a sample of Veterans (n=800). Item response theory and confirmatory factor analysis will identify the best performing items. We will assess construct validity between the PEAM and other validated measures. For Aim 3, we will assess criterion validity through field-based observational assessments and surveys of Veterans (n=3500) at more than 20 facilities. We will model the relation between patient and unit characteristics with PEAM. We will also examine patient and unit-level outcomes to establish criterion validity. Expected results: Our resultant instrument will provide a unique measure of assisted mobility for this understudied population and assess an important, yet understudied, aspect of the care recovery process. Next steps: VA operational partners – including SCI/D and SPHM – will be provided with findings, insights, and recommendations that can support evaluation from their directives. PEAM use in evaluation programs nation-wide can be planned. Enriched evaluation using the PEAM by program offices could lead to changes in policies, staff education, equipment, and improved care. Through individual feedback to facilities in Aim 3, performance improvement efforts can be tailored around specific findings. We will work with program offices to develop and implement tablet-based data collection methods. With a validated instrument, we can also include the PEAM in surveys that VA regularly administers to assess patient experiences of rehabilitation care. Work can also adapt the instrument for bariatric patient handling and long-term care priority areas.

External Links for this Project

NIH Reporter

Grant Number: I01HX002431-01A2

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Journal Articles

  1. Beckman RJ, Hutton S, Czekanski E, Vance K, Mohr DC. A Comparison of Shift Length and Nursing and Quality Outcomes in Acute Inpatient Mental Health Units. The Journal of nursing administration. 2022 Oct 1; 52(10):560-565. [view]
  2. Mohr DC, Curyto K, Jedele JM, McConeghy KW, Intrator O, Karel MJ, Vance K. Impact of STAR-VA on Staff Injury and Disruptive Behavior Reports in VA Nursing Homes. Journal of The American Medical Directors Association. 2022 Jul 1; 23(7):1159-1165.e1. [view]
  3. Kennedy KA, Mohr DC. Job Characteristics Associated With Intent to Quit Among Nursing Home Employees and Managers. The Gerontologist. 2023 Jan 24; 63(1):108-119. [view]

DRA: Health Systems, Prosthetics, Orthotics, and Assistive Technology
DRE: TRL - Applied/Translational
Keywords: Mobility Impairment, Outcomes - Patient
MeSH Terms: None at this time.

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