# Evaluating the Implementation of Patient Safety Practices to Ensure Timely, High-Quality Community Care for Veterans

> **NIH VA I50** · VA BOSTON HEALTH CARE SYSTEM · 2021 · —

## Abstract

Background:
The expansion of Community Care (CC) through the MISSION Act, and the increasing numbers of Veterans
using CC, make it critical for VHA to balance the need to improve access to care, and at the same time, ensure
that the services that VHA purchases in the community are of high quality. As there is little known about the
quality and safety of care that Veterans receive in the community, this timely study will begin to close these
knowledge gaps.
Specific Aims:
Our specific aims are to: 1) Assess variation across VISNs and facilities in the implementation of Guidebook
processes used for patient safety reporting investigation, and improvement; 2) Identify the organizational
contextual factors that influence implementation for sites with high vs. low fidelity to Guidebook safety
processes; 3) Describe variation across VISNs and sites in service outcomes: safety events, timeliness, and
Veterans' perceptions of CC quality and safety; and 4) Identify specific configurations of implementation
strategies and organizational contextual factors that distinguish high- vs. low-performing sites on their
implementation and service outcomes.
Unique Features/Innovations of Project:
This timely, innovative study will evaluate a national, mandated implementation of safety processes that are
described in the VHA Office of Community Care (OCC) “Patient Safety Guidebook.” The Guidebook was
developed by OCC and VHA National Center for Patient Safety (NCPS) in response to gaps in safety identified
in CC. Through collaboration with our operational partners (OCC and NCPS), we will provide VHA with critical
information on whether use of the Guidebook as an implementation strategy is effective in improving safety of
CC, and whether safety processes to report and investigate safety events in VHA are transferrable and
applicable to the community setting.
Methodology:
For Aim 1, we will conduct semi-structured telephone interviews with approximately 3 key informants (VHA
patient safety staff, local CC staff) at 18 facilities across 18 VISNs. We will ask them questions on sites' fidelity
to Guidebook's safety processes, feasibility of Guidebook implementation, and which implementation
strategies worked well and which did not. For Aim 2, we will obtain information from the staff interviews on their
perceptions of the organizational contextual factors that influence implementation, differentiating between sites
with high and low fidelity to the Guidebook's recommended processes. For Aim 3, we will examine rates and
trends in VHA and CC safety events, timeliness outcomes, and perceptions of CC quality and safety by
Veterans. We will integrate the results from Aims 1-3 in Aim 4 to identify specific configurations of
implementation strategies and organizational contextual factors that distinguish high- vs. low-performing sites.
Expected Results:
This partnered evaluation will be of benefit to both Veterans and our partners by generating context-specific
findings that prom...

## Key facts

- **NIH application ID:** 10181058
- **Project number:** 5I50HX002800-02
- **Recipient organization:** VA BOSTON HEALTH CARE SYSTEM
- **Principal Investigator:** AMY K ROSEN
- **Activity code:** I50 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2021
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2019-04-01 → 2022-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10181058

## Citation

> US National Institutes of Health, RePORTER application 10181058, Evaluating the Implementation of Patient Safety Practices to Ensure Timely, High-Quality Community Care for Veterans (5I50HX002800-02). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10181058. Licensed CC0.

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