Outcome
| Type |
Measure |
Description |
Time frame |
Safety issue |
| Other |
Change in Employee Engagement in Quality Improvement |
3-item pilot measure of the extent to which employees engage in quality improvement activities. Scores are 1-5 with higher ratings indicating more engagement in QI. |
Baseline to 18-months post-baseline |
|
| Other |
Change in Employee Burnout |
3-item measure comprising one item each for exhaustion, depersonalization, and reduced achievement (reverse scored). "High Burnout" measures the percent of staff who are feeling burned out on all three burnout items at a frequency of "once a week" to "every day." Scored: 0-100%, where LOWER score is more favorable. |
Baseline to 18-months post-baseline |
|
| Other |
Change in Best Places to Work Score |
3-item scale. "Best Places to Work" is a summary measure of the group's satisfaction with the job, organization, and likelihood to recommend VA as a good place to work. This is a measure normally administered within the All-employee Survey (AES). This score is functionally similar to those reported for Federal agencies by the Partnership for Public Service (http://bestplacestowork.org). Overall Satisfaction (% Positive), Organization Satisfaction (% Positive), and Recommend My Organization (% Positive). Score as Percent positive = "Very Satisfied/Satisfied" or "Strongly Agree/Agree." |
Baseline to 18-months post-baseline |
|
| Other |
Change in Workgroup Cohesion & Engagement |
7-item measure from the VA's newly developed Patient Safety Culture. Values 1 to 5 where higher values indicate more positive scores. |
Baseline to 18-months post-baseline |
|
| Primary |
Change in Monthly facility percent of inappropriate medication use |
Monthly facility percent of potentially inappropriate medication use for the 18-month period following baseline with months 13-18 as the post-baseline follow-up period. Lower ratios indicate better outcome. Data will be collected monthly at patient level and collapsed by clinic-month for patients who are at risk of potentially inappropriate medication use. Clinic-month outcome will be computed as: 1) VIONE; proportion of patients who possessed one or more medications from the Beers' list out of patients 65 or older, actively following with the clinic, and not in hospice/palliative care; 2) DOACs; proportion of patients with flags for potentially inappropriate use on a DOAC safety dashboard out of those using DOACs; 3) CBTI; proportion of patients with a new prescription for a sleep medication for insomnia who have not had CBTI, who are actively followed by the clinic and not in hospice/palliative care. Outcomes will be assessed in pooled analyses and for two of the three trials. |
Baseline to 18-months post-baseline |
|
| Secondary |
Change in prevalence of potentially inappropriate use of specific medications |
Specific medications include proton pump inhibitors (PPIs), aspirin, CNS active medications (muscle relaxants, anti-psychotics, Z-drugs, and benzodiazepines), or anticholinergic drugs. This will be a secondary outcome for the VIONE trial when analyzed as a stand-alone trial. |
Baseline to 18-months post-baseline |
|
| Secondary |
Change in monthly medication costs for all drugs |
Cost of all drugs without regard to appropriateness. This will be a secondary outcome for the VIONE trial when analyzed as a stand-alone trial. |
Baseline to 18-months post-baseline |
|
| Secondary |
Change in number of medication reviews |
Number of medication reviews completed by a pharmacist. This will be a secondary outcome for the VIONE trial when analyzed as a stand-alone trial. |
Baseline to 18-months post-baseline |
|
| Secondary |
Change in number of inappropriate medications at a patient-level |
This is a measure of count of medications used at the patient (not facility) level. This will be a secondary outcome for the VIONE trial when analyzed as a stand-alone trial. |
Baseline to 18-months post-baseline |
|
| Secondary |
Change in prevalence of high-risk direct oral anticoagulant (DOAC) use |
High-risk DOAC use will be assessed by "flags" using the algorithm from an operations DOAC dashboard. Dashboard flags include potential mis-dosing, potential medication interactions, or concern for nonadherence. This will be a secondary outcome for the DOAC trial when analyzed as a stand-alone trial. |
Baseline to 18-months post-baseline |
|
| Secondary |
Change in prevalence of any receipt of cognitive behavioral therapy for insomnia (CBTI) |
Receipt of any CBTI will be measured by extracting from the medical records CBTI note templates completed by CBTI therapists. The denominator will consist of primary care patients who are not in hospice/palliative care. This will be the primary outcome for the CBTI trial when analyzed as a stand-alone trial. |
Baseline to 18-months post-baseline |
|
| Secondary |
Change in mean cognitive behavioral therapy for insomnia (CBTI) sessions completed |
Mean number of sessions will be measured by extracting from the medical records CBTI note templates completed by CBTI therapists. The denominator will consist of primary care patients who are not in hospice/palliative care. This will be a secondary outcome for the CBTI trial when analyzed as a stand-alone trial. |
Baseline to 18-months |
|
| Secondary |
Change in the monthly percentage of patients referred to cognitive behavioral therapy for insomnia (CBTI) |
CBTI referrals will be measured according to counts of CBTI consult requests in the medical record. For clinics that do not use medical record consult requests specific to CBTI, referrals will be measured using monthly counts provided by CBTI therapists. The denominator will consist of primary care patients who are not in hospice/palliative care. This will be a secondary outcome for the CBTI trial when analyzed as a stand-alone trial. |
Baseline to 18-months |
|
