Practice changes associated with the Department of Veterans Affairs' Family Care Collaborative

Abstract

Background: The Department of Veterans Affairs (VA) provides rehabilitation for veterans with moderate to severe war injuries through four regional Polytrauma Rehabilitation Centers (PRCs). To standardize and improve care provided to these veterans' family members, health services researchers partnered with program leaders and rehabilitation specialists to implement a family care quality improvement collaborative.

Objective: To describe practice changes associated with the Family Care Collaborative's intervention.

Design: Cross-site, mixed-method evaluation.

Participants: Rehabilitation interdisciplinary team members (n = 226) working at the four participating sites.

Interventions: The collaborative developed and implemented in a 6-month pilot a web-based tool to standardize and promote family-centered care.

Outcomes: Provider survey of family care, satisfaction with family care, and perceived competence in working with families; specific practice changes at each site; provider and facilitator perceptions of the collaborative work; and a validated measure to predict likelihood of success of the selected intervention.

Main results: Family-centered practices and satisfaction improved at sites with lower baseline scores (P < 0.05) and was equivalent across sites after the pilot. Providers initiated specific family-centered practices that often began at one site and spread to the others through the collaborative. Sites standardized family education and collaboration. Providers believed that the collaborative produced a "culture change" from patient-centered to family-centered care and viewed program leadership and health services researchers' involvement as crucial for success. Scores on the measure to predict successful implementation of the intervention beyond the pilot were promising.

Conclusions: Collaboratives that bring together clinicians, program leaders, and researchers may be useful for fostering complex change involving interdisciplinary teams.

Figure 1

FCM.

Figure 2

Timeline of FCC. Bold lines represent collection of outcome data. Each square of the timeline represents 1 month. LS: Learning session. OCM: Organizational Change Manager. PRC: Polytrauma Rehabilitation Center.