Frameworks Engineering and Implementation Partnership: The INSPIRE Stroke Project

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Frameworks Designing and Usage Organization: The Move Stroke Venture. VA HSR&D SDP 09-158 Teresa Damush, PhD Heather Woodward-Hagg, MS Marianne Matthias, PhD Virginia Daggett, DNS, MSN Joseph Ross, MD, MHS Zhangsheng Yu, PhD Xinli Li, PHD, MS. How the organization started

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Frameworks Engineering and Implementation Partnership: The INSPIRE Stroke Project VA HSR&D SDP 09-158 Teresa Damush, PhD Heather Woodward-Hagg, MS Marianne Matthias, PhD Virginia Daggett, DNS, MSN Joseph Ross, MD, MHS Zhangsheng Yu, PhD Xinli Li, PHD, MS

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How the association started… Chose enhancing stroke mind as one component of their far reaching center for FY08 OQP VISN 11 Conducted national estimation of inpatient stroke mind in FY07-09 Stroke QUERI Worked with OQP to create and measure stroke mind, utilized these information to pilot a Systems Redesign-based shared in VISN 11 FY08-09, dispatch multi-site INSPIRE in FY10

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OQP Stroke Special Project: National stroke execution information benchmarking Goals : Measure in-healing center stroke mind quality inside the VA framework utilizing both Joint Commission and VA particular in-patient care execution measures Provide VA restorative focuses their information for inpatient stroke mind quality Assemble toolbox of existing projects, formats, and methodologies to enhance stroke mind Assess stroke hazard figure administration at 6 months and one-year post-release for veterans in the companion with VA outpatient mind

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Stroke QUERI and OQP coordinated effort built up Multidisciplinary group amassed Data accumulation device pilot testing Scoring calculations finished Data gathering finished Toolkit finished FY 2006 FY 2007 FY 2008 FY 2009 Quality pointers characterized Data accumulation device created Abstractor (n=90) preparing Stroke arrange set up Field survey and redress of office level information Final national information announced

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OQP Stroke Special Project: Main Results

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VISN 11 Pilot: Introducing Systems Engineering Methods in a Stroke Collaborative VISN11 authority Dr. Pamela Reeves, CMO; Ann Herm, Clinical Program Manager; Mary Sherrill, Systems Redesign lead 7 VAMC interdisciplinary groups of cutting edge staff required in stroke mind Stroke QUERI Center agents and research organizers System Redesign/OSE Expertise – VISN 11 SR staff, Heather Woodward-Hagg/Indy COE

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VISN 11 Pilot: Methods Identification of stroke care change groups at all 7 VISN 11 offices in 2008 Facility overview about stroke frameworks of care Pre-synergistic work: Baseline information gathering Choice of 2 execution pointers: dysphagia screening before oral admission and release on lipid-bringing down pharmaceutical OSE techniques preparing (phone call and video) Inpatient stroke stream guide and "Voice of the client" interviews Collaborative: Shared benchmark information (outline audit)— dysphagia screening, d/c on lipid bringing down drug, created standard confirmation arrange layout Paired pedantic and group break-out sessions: More stream mapping, affect/exertion appraisals, PDSA cycles, future state handle maps/activity arranges Shared arrangements with gathering after each group session

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Collaborative Didactic and group break-out sessions

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VISN 11 Pilot: Methods Post-cooperative work: Systems Redesign "mentors" doled out to each group 6 semiweekly mentor group calls and month to month assemble calls Monthly information survey and total information contribution on Sharepoint site for 12 months Analysis: Pre-community oriented information on markers from OQP contrasted with post-communitarian information Follow-up meetings with each group to evaluate how changes were made, boundaries to and facilitators of progress, spread of strategies Developed preparing materials consequently utilized as a part of other VA collaboratives

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VISN 11 Pilot: Results Cholesterol comes about Dysphagia comes about

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INSPIRE SDP: In tervention for S troke P erformance I mprovement utilizing R edesign E ngineering Study points : 1. To assess the impact of open giving an account of hierarchical change to enhance stroke mind quality in VA 2. To lead a developmental formative assessment in 14 of the biggest volume VAMCs to comprehend authoritative hindrances and facilitators to the conveyance of top notch stroke mind 3. To test a Systems Redesign/OSE-based mediation versus execution criticism alone in enhancing 2 stroke pointers Stratify randomization by benchmark execution Work on two markers; anticipate DVT prophylaxis and dysphagia screening before oral admission however will be founded on pattern information gathering and site input

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INSPIRE timetable 1 In-person site interviews 2 Telephone site interviews

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INSPIRE Interview and standard stage (Aims 1 and 2) Interviews masterminded by site PI, 2 questioners to each site 2 distinct meetings Receipt of and reaction to the OQP Stroke Special Project information: who got it, who else saw it, what action(s) came about, by what means can the field best utilize/get this kind of information? Current condition of stroke frameworks of care from bleeding edge suppliers: structure and staff included, any progressing change groups or exercises, appraisal of the general level of care gave, what is functioning admirably, what could be moved forward? Interviews recorded, deciphered, examined Baseline stroke execution information gathered by means of focal graph audit for CY2009

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INSPIRE Intervention Phase (Aim 3) Sites randomized to mediation versus control, stratified by pattern execution All destinations with no less than 50 stroke confirmations every year Intervention locales : In-person shared with OSE/SR preparing, trailed by 6 months of guiding through fast trial of progress; month to month execution information criticism Control locales : quarterly execution information input Data gathering for 12 months post-intercession Analyses: Primary: change in individual and composite execution markers Secondary: worldly pace of progress in execution, supportability of progress, subjective appraisals of nearby setting and relationship to changes watched

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INSPIRE status 11 locales on board; dynamic enlistment of 3 others Bay Pine, Birmingham, Chicago (Jesse Brown), Cleveland, Durham, Houston, Loma Linda, Miami, Oklahoma City, Tennessee Valley, Tucson Site interviews in progress VistaWeb get to pending; arrangement for standard information accumulation by means of diagram reflections July-November In-person community oriented January 2011 Planned SDP September: RE-INSPIRE: Rich-setting assessment of INSPIRE; Edward Miech, PI

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