# Pragmatic trial to increase quality of care in State Veterans Homes: Improving safety using an evidence-based, frontline staff huddling practice

> **NIH VA I01** · EDITH NOURSE  ROGERS MEMORIAL VETERANS HOSPITAL · 2024 · —

## Abstract

Background: State Veterans Home nursing homes (SVHs) care for 51% of all Veterans receiving VA-funded
nursing home care. SVHs cost VA $1.2 billion yearly in per diem payments. This critical system provides care
to a population of over 20,000 vulnerable Veterans annually but has been little researched and is in urgent
need of attention. In some SVHs, the COVID-19 pandemic has resulted in large numbers of preventable
illnesses, hospitalizations, and even deaths. Congress, the Government Accountability Office, and the
Secretary have all called for greater VA involvement in this system that lacks a national quality improvement
infrastructure and lags behind VA on many quality measures, including falls. This proposal addresses SVHs'
need to reduce high fall rates—55% of residents experience at least one fall per quarter—by implementing an
effective, evidence-based program known as LOCK. In LOCK, staff (1) “Learn from bright spots” (focus on
evidence of positive change); (2) “Observe” (collect data through systematic observation); (3) “Collaborate in
huddles” (conduct frontline staff huddles); and (4) “Keep it bite-size” (limit activities to 5-15 minutes). The
program avoids reliance on existing quality improvement infrastructures, can be easily integrated into frontline
staff routines, and has demonstrated success in improving clinical outcomes, including reductions in falls.
Significance: This study provides the following. (1) Timely, evidence-based research support to improve care
for SVHs' vulnerable population of aging Veterans. (2) Explicit integration of frontline staff expertise, ensuring
interventions are practicable and successful. (3) Direct alignment with high-reliability principles—such as
sensitivity to operations and deference to expertise—helping extend VA's high-reliability focus to SVHs.
Innovation and Impact: This study contributes the following. (1) Advances the science of how to intervene in
settings that do not have a strong, centralized quality improvement focus through rigorous investigation of how
and why an intervention works in SVHs. (2) Investigates sustainment of our intervention—the extent to which it
becomes part of usual care—for up to 12 months after completion of each step of our wedge-based design. (3)
Provides timely, systematic investigation of a new area for VA research, gathering information on VA
researcher-SVH partnerships to support future collaborations.
Specific Aims: Aim 1: Investigate the effectiveness of the LOCK program at improving our primary outcome of
any resident fall. We will also investigate other resident clinical outcomes (mobility, medication changes,
restraint and alarm use) and work-process outcomes for staff (job satisfaction, work engagement, burnout). We
will use both primary and secondary data collection. Aim 2: Evaluate the LOCK program's implementation. We
will use the replicating effective programs framework and multi-modal implementation facilitation strategies to
implement the program...

## Key facts

- **NIH application ID:** 10752605
- **Project number:** 5I01HX003420-02
- **Recipient organization:** EDITH NOURSE  ROGERS MEMORIAL VETERANS HOSPITAL
- **Principal Investigator:** CHRISTINE W HARTMANN
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2022-08-01 → 2026-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10752605

## Citation

> US National Institutes of Health, RePORTER application 10752605, Pragmatic trial to increase quality of care in State Veterans Homes: Improving safety using an evidence-based, frontline staff huddling practice (5I01HX003420-02). Retrieved via AI Analytics 2026-06-11 from https://api.ai-analytics.org/grant/nih/10752605. Licensed CC0.

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