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Mukherjee M, Okusi C, Jamie G, Byford R, Ferreira F, Fletcher M, de Lusignan S, Sheikh A. Deploying an asthma dashboard to support quality improvement across a nationally representative sentinel network of 7.6 million people in England. NPJ Prim Care Respir Med 2024; 34:18. [PMID: 38951547 PMCID: PMC11217285 DOI: 10.1038/s41533-024-00377-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 06/21/2024] [Indexed: 07/03/2024] Open
Abstract
Every year, there are ~100,000 hospital admissions for asthma in the UK, many of which are potentially preventable. Evidence suggests that carefully conceptualised and implemented audit and feedback (A&F) cycles have the potential to improve clinical outcomes for those with chronic conditions. We wanted to investigate the technical feasibility of developing a near-real time asthma dashboard to support A&F interventions for asthma management in primary care. We extracted cross-sectional data on asthma from 756 participating GP practices in the Oxford-Royal College of General Practitioners Research and Surveillance Centre (RCGP RSC) database in England comprising 7.6 million registered people. Summary indicators for a GP practice were compared to all participating RCGP RSC practices using practice-level data, for the week 6-12th-Mar-2023. A weekly, automated asthma dashboard with features that can support electronic-A&F cycles that compared key asthma indicators for a GP practice to RCGP RSC could be created ( https://tinyurl.com/3ydtrt85 ): 12-weeks-incidence 0.4% vs 0.4%, annual prevalence 6.1% vs 6.7%, inhaled relievers to preventer 1.2 vs 1.1, self-management plan given 83.4% vs 60.8%, annual reviews 36.8% vs 57.3%, prednisolone prescriptions 2.0% vs 3.2%, influenza vaccination 56.6% vs 55.5%, pneumococcal vaccination ever (aged ≥65 years) 90.2% vs 84.1% and current smokers 14.9% vs 14.8%. Across the RCGP RSC, the rate of hospitalisations was 0.024%; comparative data had to be suppressed for the study practice because of small numbers. We have successfully created an automated near real-time asthma dashboard that can be used to support A&F initiatives to improve asthma care and outcomes in primary care.
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Grants
- This work is carried out with the support of BREATHE - The Health Data Research Hub for Respiratory Health [MC_PC_19004] in partnership with Oxford-RCGP Clinical Informatics Digital Hub (ORCHID), a trusted research environment. BREATHE is funded through the UK Research and Innovation Industrial Strategy Challenge Fund and delivered through Health Data Research UK. Health Data Research UK is funded by UK Research and Innovation, the Medical Research Council, the British Heart Foundation, Cancer Research UK, the National Institute for Health and Care Research, the Economic and Social Research Council, the Engineering and Physical Sciences Research Council, Health and Care Research Wales, Health and Social Care Research and Development Division (Public Health Agency, Northern Ireland), Chief Scientist Office of the Scottish Government Health and Social Care Directorates. This work was also funded by The Health Data Research UK, reference EDIN1 and Asthma + Lung UK, reference AUK-AC-2018-01.
- No Relevant Funding
- Health Data Research UK, grant number EDIN1
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Affiliation(s)
- Mome Mukherjee
- Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, UK.
- HDR UK BREATHE Respiratory Data Hub, Usher Institute, The University of Edinburgh, Edinburgh, UK.
- HDR UK Better Care, Usher Institute, The University of Edinburgh, Edinburgh, UK.
| | - Cecilia Okusi
- Clinical Informatics and Health Outcomes Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Gavin Jamie
- Clinical Informatics and Health Outcomes Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Rachel Byford
- Clinical Informatics and Health Outcomes Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Filipa Ferreira
- Clinical Informatics and Health Outcomes Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Monica Fletcher
- Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, UK
- HDR UK BREATHE Respiratory Data Hub, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Simon de Lusignan
- Clinical Informatics and Health Outcomes Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC), London, UK
| | - Aziz Sheikh
- Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, UK
- HDR UK BREATHE Respiratory Data Hub, Usher Institute, The University of Edinburgh, Edinburgh, UK
- HDR UK Better Care, Usher Institute, The University of Edinburgh, Edinburgh, UK
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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2
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Hammond M, Law V, de Launay KQ, Cooper J, Togo E, Silveira K, MacKinnon D, Lo N, Ward SE, Chan SKW, Straus SE, Fahim C, Wong CL. Using implementation science to promote the use of the fascia iliaca blocks in hip fracture care. Can J Anaesth 2024; 71:741-750. [PMID: 38085456 DOI: 10.1007/s12630-023-02665-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 06/30/2023] [Accepted: 07/04/2023] [Indexed: 02/15/2024] Open
Abstract
PURPOSE There is variable and suboptimal use of fascia iliaca compartment nerve blocks (FICBs) in hip fracture care. Our objective was to use an evidence-based and theory-informed implementation science approach to analyze barriers and facilitators to timely administration of FICB and select evidence-based interventions to enhance uptake. METHODS We conducted a qualitative study at a single centre using semistructured interviews and site observations. We interviewed 35 stakeholders including health care providers, managers, patients, and caregivers. We mapped barriers and facilitators to the Theoretical Domains Framework (TDF) and Consolidated Framework for Implementation Research (CFIR). We compared the rate and timeliness of FICB administration before and after evidence-based implementation strategies were applied. RESULTS The study identified 18 barriers and 11 facilitators within seven themes of influences of FICB use: interpersonal relationships between health care professionals; clinician knowledge and skills related to FICB; roles, responsibilities, and processes for delivering FICB; perceptions on using FICB for pain; patient and caregiver perceptions on using FICB for pain; communication of hip fracture care between departments; and resources for delivering FICBs. We mapped the behaviour change domains to eight implementation strategies: restructure the environment, create and distribute educational materials, prepare patients to be active participants, perform audits and give feedback, use local opinion leaders, use champions, train staff on FICB procedures, and mandate change. We observed an increase in the rates of FICBs administered (48% vs 65%) and a decrease in the median time to administration (1.63 vs 0.81 days). CONCLUSION Our study explains why FICBs are underused and shows that the TDF and CFIR provide a framework to identify barriers and facilitators to FICB implementation. The mapped implementation strategies can guide institutions to improve use of FICB in hip fracture care.
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Affiliation(s)
- Marjorie Hammond
- St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Vivian Law
- St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Keelia Quinn de Launay
- St. Michael's Hospital, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
| | - Jeanette Cooper
- St. Michael's Hospital, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
| | - Elikem Togo
- St. Michael's Hospital, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
| | - Kyle Silveira
- St. Michael's Hospital, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
| | - David MacKinnon
- St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Nick Lo
- St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Sarah E Ward
- St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- St. Michael's Hospital, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
| | - Stephen K W Chan
- St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- St. Michael's Hospital, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
| | - Sharon E Straus
- St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- St. Michael's Hospital, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
| | - Christine Fahim
- St. Michael's Hospital, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
| | - Camilla L Wong
- St. Michael's Hospital, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada.
- St. Michael's Hospital, Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
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3
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Candon M, Shen S, Rothbard A, Reed A, Everett M, Demp N, Weingartner M, Fadeyibi O. Incorporating clinician insight and care plans into an audit and feedback initiative for antipsychotic prescribing to Medicaid-enrolled youth in Philadelphia. BMC Health Serv Res 2024; 24:574. [PMID: 38702737 PMCID: PMC11067128 DOI: 10.1186/s12913-024-11029-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 04/22/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Audit and feedback (A/F), which include initiatives like report cards, have an inconsistent impact on clinicians' prescribing behavior. This may be attributable to their focus on aggregate prescribing measures, a one-size-fits-all approach, and the fact that A/F initiatives rarely engage with the clinicians they target. METHODS In this study, we describe the development and delivery of a report card that summarized antipsychotic prescribing to publicly-insured youth in Philadelphia, which was introduced by a Medicaid managed care organization in 2020. In addition to measuring aggregate prescribing behavior, the report card included different elements of care plans, including whether youth were receiving polypharmacy, proper medication management, and the concurrent use of behavioral health outpatient services. The A/F initiative elicited feedback from clinicians, which we refer to as an "audit and feedback loop." We also evaluate the impact of the report card by comparing pre-post differences in prescribing measures for clinicians who received the report card with a group of clinicians who did not receive the report card. RESULTS Report cards indicated that many youth who were prescribed antipsychotics were not receiving proper medication management or using behavioral health outpatient services alongside the antipsychotic prescription, but that polypharmacy was rare. In their feedback, clinicians who received report cards cited several challenges related to antipsychotic prescribing, such as the logistical difficulties of entering lab orders and family members' hesitancy to change care plans. The impact of the report card was mixed: there was a modest reduction in the share of youth receiving polypharmacy following the receipt of the report card, while other measures did not change. However, we documented a large reduction in the number of youth with one or more antipsychotic prescription fill among clinicians who received a report card. CONCLUSIONS A/F initiatives are a common approach to improving the quality of care, and often target specific practices such as antipsychotic prescribing. Report cards are a low-cost and feasible intervention but there is room for quality improvement, such as adding measures that track medication management or eliciting feedback from clinicians who receive report cards. To ensure that the benefits of antipsychotic prescribing outweigh its risks, it is important to promote quality and safety of antipsychotic prescribing within a broader care plan.
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Affiliation(s)
- Molly Candon
- Penn Center for Mental Health, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, 3rd Floor, Philadelphia, PA, 19104, USA.
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
| | - Siyuan Shen
- Penn Center for Mental Health, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, 3rd Floor, Philadelphia, PA, 19104, USA
| | - Aileen Rothbard
- Penn Center for Mental Health, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, 3rd Floor, Philadelphia, PA, 19104, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, USA
| | - Abigail Reed
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mia Everett
- Community Behavioral Health, Philadelphia, PA, USA
| | - Neal Demp
- Community Behavioral Health, Philadelphia, PA, USA
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Gillespie C, Wilhite JA, Hanley K, Hardowar K, Altshuler L, Fisher H, Porter B, Wallach A, Zabar S. Addressing social determinants of health in primary care: a quasi-experimental study using unannounced standardised patients to evaluate the impact of audit/feedback on physicians' rates of identifying and responding to social needs. BMJ Qual Saf 2023; 32:632-643. [PMID: 35623722 DOI: 10.1136/bmjqs-2021-013904] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 05/07/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Although efforts are underway to address social determinants of health (SDOH), little is known about physicians' SDOH practices despite evidence that failing to fully elicit and respond to social needs can compromise patient safety and undermine both the quality and effectiveness of treatment. In particular, interventions designed to enhance response to social needs have not been assessed using actual practice behaviour. In this study, we evaluate the degree to which providing primary care physicians with feedback on their SDOH practice behaviours is associated with increased rates of eliciting and responding to housing and social isolation needs. METHODS Unannounced standardised patients (USPs), actors trained to consistently portray clinical scenarios, were sent, incognito, to all five primary care teams in an urban, safety-net healthcare system. Scenarios involved common primary care conditions and each included an underlying housing (eg, mould in the apartment, crowding) and social isolation issue and USPs assessed whether the physician fully elicited these needs and if so, whether or not they addressed them. The intervention consisted of providing physicians with audit/feedback reports of their SDOH practices, along with brief written educational material. A prepost comparison group design was used to evaluate the intervention; four teams received the intervention and one team served as a 'proxy' comparison (no intervention). Preintervention (February 2017 to December 2017) rates of screening for and response to the scripted housing and social needs were compared with intervention period (January 2018 to March 2019) rates for both intervention and comparison teams. RESULTS 108 visits were completed preintervention and 183 during the intervention period. Overall, social needs were not elicited half of the time and fully addressed even less frequently. Rates of identifying the housing issue increased for teams that received audit/feedback reports (46%-60%; p=0.045) and declined for the proxy comparison (61%-42%; p=0.174). Rates of responding to housing needs increased significantly for intervention teams (15%-41%; p=0.004) but not for the comparison team (21%-29%; p=0.663). Social isolation was identified more frequently postintervention (53%) compared with baseline (39%; p=0.041) among the intervention teams but remained unchanged for the comparison team (39% vs 32%; p=0.601). Full exploration of social isolation remained low for both intervention and comparison teams. CONCLUSIONS Results suggest that physicians may not be consistently screening for or responding to social needs but that receiving feedback on those practices, along with brief targeted education, can improve rates of SDOH screening and response.
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Affiliation(s)
- Colleen Gillespie
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
- Institute for Innovations in Medical Education, NYU Grossman School of Medicine, New York, New York, USA
| | - Jeffrey A Wilhite
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Kathleen Hanley
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
- Ambulatory Care, New York City Health + Hospitals, New York, New York, USA
| | - Khemraj Hardowar
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Lisa Altshuler
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Harriet Fisher
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Barbara Porter
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Andrew Wallach
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
- Ambulatory Care, New York City Health + Hospitals, New York, New York, USA
| | - Sondra Zabar
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
- Ambulatory Care, New York City Health + Hospitals, New York, New York, USA
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5
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Klaiman T, Nelson MN, Yan XS, Navathe AS, Patel MS, Refai F, Delgado MK, Pagnotti DR, Liao JM. Clinician Perceptions of Receiving Different Forms of Feedback on their Opioid Prescribing. Am J Med Qual 2023; 38:1-8. [PMID: 36579960 DOI: 10.1097/jmq.0000000000000092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Opioid misuse represents a major public health issue in the United States. One driver is overprescription for acute pain, with the size of initial prescription associated with subsequent long-term use. However, little work has been done to elicit clinician feedback about interventions to reduce opioid prescribing. To address this knowledge gap, qualitative analyses were conducted with clinicians who participated in a randomized controlled trial in which clinicians received monthly emailed feedback notifications about their opioid prescribing behaviors. Semistructured telephone interviews were conducted (N = 12) with urgent care (N = 7) and emergency department (N = 5) clinicians who participated in the trial between November 2020 and April 2021. Clinicians appreciated feedback about their prescribing behavior and found comparative data with peer clinicians to be most useful. Sharing opioid prescribing feedback data with clinicians can be an acceptable way to address opioid prescribing among emergency and urgent care clinicians.
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Affiliation(s)
- Tamar Klaiman
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Maria N Nelson
- CIO Peer and Practitioner Research and Analytics Department, Gartner, Philadelphia, PA
| | - Xiaowei S Yan
- Sutter Health, Center for Health System Research, Walnut Creek, CA
| | - Amol S Navathe
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Mitesh S Patel
- Department of Clinical Transformation, Ascension, St. Louis, MO
| | - Farah Refai
- Gilead Sciences, Research Department (Virology), Foster City, CA
| | - M Kit Delgado
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA
| | - David R Pagnotti
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Joshua M Liao
- School of Medicine, University of Washington, Seattle, WA
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6
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Haut ER, Owodunni OP, Wang J, Shaffer DL, Hobson DB, Yenokyan G, Kraus PS, Farrow NE, Canner JK, Florecki KL, Webster KLW, Holzmueller CG, Aboagye JK, Popoola VO, Kia MV, Pronovost PJ, Streiff MB, Lau BD. Alert-Triggered Patient Education Versus Nurse Feedback for Nonadministered Venous Thromboembolism Prophylaxis Doses: A Cluster-Randomized Controlled Trial. J Am Heart Assoc 2022; 11:e027119. [PMID: 36047732 DOI: 10.1161/jaha.122.027119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Many hospitalized patients are not administered prescribed doses of pharmacologic venous thromboembolism prophylaxis. Methods and Results In this cluster-randomized controlled trial, all adult non-intensive care units (10 medical, 6 surgical) in 1 academic hospital were randomized to either a real-time, electronic alert-triggered, patient-centered education bundle intervention or nurse feedback intervention to evaluate their effectiveness for reducing nonadministration of venous thromboembolism prophylaxis. Primary outcome was the proportion of nonadministered doses of prescribed pharmacologic prophylaxis. Secondary outcomes were proportions of nonadministered doses stratified by nonadministration reasons (patient refusal, other). To test our primary hypothesis that both interventions would reduce nonadministration, we compared outcomes pre- versus postintervention within each cohort. Secondary hypotheses were tested comparing the effectiveness between cohorts. Of 11 098 patient visits, overall dose nonadministration declined significantly after the interventions (13.4% versus 9.2%; odds ratio [OR], 0.64 [95% CI, 0.57-0.71]). Nonadministration decreased significantly (P<0.001) in both arms: patient-centered education bundle, 12.2% versus 7.4% (OR, 0.56 [95% CI, 0.48-0.66]), and nurse feedback, 14.7% versus 11.2% (OR, 0.72 [95% CI, 0.62-0.84]). Patient refusal decreased significantly in both arms: patient-centered education bundle, 7.3% versus 3.7% (OR, 0.46 [95% CI, 0.37-0.58]), and nurse feedback, 9.5% versus 7.1% (OR, 0.71 [95% CI, 0.59-0.86]). No differential effect occurred on medical versus surgical units. The patient-centered education bundle was significantly more effective in reducing all nonadministered (P=0.03) and refused doses (P=0.003) compared with nurse feedback (OR, 1.28 [95% CI, 1.0-1.61]; P=0.03 for interaction). Conclusions Information technology strategies like the alert-triggered, targeted patient-centered education bundle, and nurse-focused audit and feedback can improve venous thromboembolism prophylaxis administration. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03367364.
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Affiliation(s)
- Elliott R Haut
- Department of Surgery Johns Hopkins University School of Medicine Baltimore MD.,Department of Anesthesiology and Critical Care Medicine Johns Hopkins University School of Medicine Baltimore MD.,Department of Emergency Medicine Johns Hopkins University School of Medicine Baltimore MD.,The Johns Hopkins Surgery Center for Outcomes Research Johns Hopkins University School of Medicine Baltimore MD.,Armstrong Institute for Patient Safety and Quality Johns Hopkins Medicine Baltimore MD.,Department of Health Policy and Management Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | | | - Jiangxia Wang
- Department of Biostatistics Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Dauryne L Shaffer
- Department of Surgery Johns Hopkins University School of Medicine Baltimore MD.,Department of Nursing The Johns Hopkins Hospital Baltimore MD
| | - Deborah B Hobson
- Department of Surgery Johns Hopkins University School of Medicine Baltimore MD.,Armstrong Institute for Patient Safety and Quality Johns Hopkins Medicine Baltimore MD.,Department of Nursing The Johns Hopkins Hospital Baltimore MD
| | - Gayane Yenokyan
- Department of Biostatistics Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Peggy S Kraus
- Department of Pharmacy The Johns Hopkins Hospital Baltimore MD
| | - Norma E Farrow
- Department of Surgery Duke University Medical Center Durham NC
| | - Joseph K Canner
- The Johns Hopkins Surgery Center for Outcomes Research Johns Hopkins University School of Medicine Baltimore MD
| | | | - Kristen L W Webster
- Department of Anesthesiology and Critical Care Medicine Johns Hopkins University School of Medicine Baltimore MD
| | - Christine G Holzmueller
- Department of Surgery Johns Hopkins University School of Medicine Baltimore MD.,Armstrong Institute for Patient Safety and Quality Johns Hopkins Medicine Baltimore MD
| | - Jonathan K Aboagye
- Department of Surgery Johns Hopkins University School of Medicine Baltimore MD
| | - Victor O Popoola
- Department of Biostatistics Johns Hopkins Bloomberg School of Public Health Baltimore MD.,Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Mujan Varasteh Kia
- Department of Surgery Johns Hopkins University School of Medicine Baltimore MD
| | - Peter J Pronovost
- Department of Surgery Johns Hopkins University School of Medicine Baltimore MD.,Armstrong Institute for Patient Safety and Quality Johns Hopkins Medicine Baltimore MD.,Department of Health Policy and Management Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Michael B Streiff
- Division of Hematology, Department of Medicine Johns Hopkins University School of Medicine Baltimore MD.,Armstrong Institute for Patient Safety and Quality Johns Hopkins Medicine Baltimore MD
| | - Brandyn D Lau
- Division of Health Sciences Informatics, Russell H. Morgan Department of Radiology and Radiological Science Johns Hopkins University School of Medicine Baltimore MD.,Armstrong Institute for Patient Safety and Quality Johns Hopkins Medicine Baltimore MD.,Department of Health Policy and Management Johns Hopkins Bloomberg School of Public Health Baltimore MD
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7
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Ciurleo R, De Cola MC, Agabiti N, Di Martino M, Bramanti P, Corallo F. Audit and feedback in cardio- and cerebrovascular setting: Toward a path of high reliability in Italian healthcare. Front Public Health 2022; 10:907201. [PMID: 36033745 PMCID: PMC9403250 DOI: 10.3389/fpubh.2022.907201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 07/12/2022] [Indexed: 01/22/2023] Open
Abstract
Adopting audit and feedback (A&F) strategies could be a suitable healthcare intervention to fulfill the challenge of monitoring and improving clinical guidelines in evidence-based medicine. Indeed, A&F is used to encourage professionals to better adhere to standard guidelines to improve healthcare performance. Briefly, an audit is an inspection of professional practice in comparison to professional standards or targets whose results are subsequently communicated to professionals in a structured manner. Although A&F strategies have been adopted in several time-dependent settings, such as for acute myocardial infarction (AMI) and stroke, interest of audits in rehabilitation care is also emerging. Recently, the Italian Ministry of Health has funded a national network project called EASY-NET, whose main objective is to evaluate the effectiveness of A&F strategies to improve healthcare practice and equity in various clinical and organizational settings in seven Italian regions. Last but not the least of these regions is the Sicily, represented within the project by the IRCCS Centro Neurolesi Bonino-Pulejo of Messina as the work package 7 (WP7). The EASY-NET WP7 is focused on the effectiveness of A&F strategies in both AMI and ischemic stroke setting, from acute to rehabilitation process of care. In this study, we described the study protocol, including the study design and methodology, providing a detailed description of the new model of A&F based on telemedicine, and discussing the possible challenges of this project.
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Affiliation(s)
| | - Maria Cristina De Cola
- IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy,*Correspondence: Maria Cristina De Cola
| | - Nera Agabiti
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Mirko Di Martino
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
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8
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Cumbe VFJ, Muanido AG, Turner M, Ramiro I, Sherr K, Weiner BJ, Flaherty BP, Sharma M, Faduque F, Xerinda ER, Wagenaar BH. Systems analysis and improvement approach to optimize outpatient mental health treatment cascades in Mozambique (SAIA-MH): study protocol for a cluster randomized trial. Implement Sci 2022; 17:37. [PMID: 35668423 PMCID: PMC9169330 DOI: 10.1186/s13012-022-01213-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 05/15/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Significant investments are being made to close the mental health (MH) treatment gap, which often exceeds 90% in many low- and middle-income countries (LMICs). However, limited attention has been paid to patient quality of care in nascent and evolving LMIC MH systems. In system assessments across sub-Saharan Africa, MH loss-to-follow-up often exceeds 50% and sub-optimal medication adherence often exceeds 60%. This study aims to fill a gap of evidence-based implementation strategies targeting the optimization of MH treatment cascades in LMICs by testing a low-cost multicomponent implementation strategy integrated into routine government MH care in Mozambique. METHODS Using a cluster-randomized trial design, 16 clinics (8 intervention and 8 control) providing primary MH care will be randomized to the Systems Analysis and Improvement Approach for Mental Health (SAIA-MH) or an attentional placebo control. SAIA-MH is a multicomponent implementation strategy blending external facilitation, clinical consultation, and provider team meetings with system-engineering tools in an overall continuous quality improvement framework. Following a 6-month baseline period, intervention facilities will implement the SAIA-MH strategy for a 2-year intensive implementation period, followed by a 1-year sustainment phase. Primary outcomes will be the proportion of all patients diagnosed with a MH condition and receiving pharmaceutical-based treatment who achieve functional improvement, adherence to medication, and retention in MH care. The Consolidated Framework for Implementation Research (CFIR) will be used to assess determinants of implementation success. Specific Aim 1b will include the evaluation of mechanisms of the SAIA-MH strategy using longitudinal structural equation modeling as well as specific aim 2 estimating cost and cost-effectiveness of scaling-up SAIA-MH in Mozambique to provincial and national levels. DISCUSSION This study is innovative in being the first, to our knowledge, to test a multicomponent implementation strategy for MH care cascade optimization in LMICs. By design, SAIA-MH is a low-cost strategy to generate contextually relevant solutions to barriers to effective primary MH care, and thus focuses on system improvements that can be sustained over the long term. Since SAIA-MH is integrated into routine government MH service delivery, this pragmatic trial has the potential to inform potential SAIA-MH scale-up in Mozambique and other similar LMICs. TRIAL REGISTRATION ClinicalTrials.gov; NCT05103033 ; 11/2/2021.
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Affiliation(s)
- Vasco F J Cumbe
- Provincial Health Directorate, Sofala Province, Ministry of Health, Beira, Mozambique.
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.
- Department of Psychiatry, Beira Central Hospital, Beira, Mozambique.
| | | | - Morgan Turner
- Department of Global Health, University of Washington, Seattle, WA, USA
| | | | - Kenneth Sherr
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Industrial & Systems Engineering, University of Washington, Seattle, WA, USA
| | - Bryan J Weiner
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Brian P Flaherty
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Monisha Sharma
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Flávia Faduque
- Provincial Health Directorate, Manica Province, Ministry of Health, Chimoio, Mozambique
| | | | - Bradley H Wagenaar
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
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9
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Valanci-Aroesty S, Feldman LS, Fiore JF, Lee L, Fried GM, Mueller CL. Considerations for designing and implementing a surgical peer coaching program: an international survey. Surg Endosc 2022; 36:4593-4601. [PMID: 34622299 PMCID: PMC8497045 DOI: 10.1007/s00464-021-08760-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 09/27/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND Surgical peer coaching has been associated with high rates of practice change but remains largely unutilized. The purpose of this study was to survey surgeons internationally to investigate attitudes regarding peer coaching and to identify any international differences to inform the design of future coaching programs. METHODS Practicing surgeons in general surgery or related subspecialties were eligible to participate. Invitations to complete the survey were distributed through 13 surgical associations, social media, and personal e-mail invitations. Responses were obtained between June 1st and August 31st, 2020. RESULTS A total of 521 surveys were collected. The majority of participants practiced in North America (263; 50%) with remaining respondents from Asia (81; 16%), Europe (34;7%), South America (21; 4%), Africa (17; 3%), and Oceania (6; 1%). Duration of practice was equally distributed across 4 intervals (0-5 years; 6-15 years; 16-25 years; > 25 years). Respondents most frequently identified as general surgeons (290; 67%) and 325 (75%) were male. Awareness of peer coaching was reported by 275 (53%) respondents, with 197 (44%) never seeking formal feedback from peers. The majority of respondents (372; 84%) would be willing to participate in a peer coaching program, with monthly interactions the most desirable frequency reported (193; 51%). Coaching in the operating room was preferred by most participants (360; 86%). Few respondents (67; 14%) would accept coaching from someone unknown to them. Participants identified key coaching program elements as: feedback kept private and confidential (267; 63%); opportunity to provide feedback to the coach (247; 59%); personalized goal setting (244; 58%); and the option to choose one's own coach (205; 49%). The most commonly cited potential barrier to participation was logistical constraints (334; 79%). CONCLUSION This international survey of practicing surgeons demonstrated that peer feedback is rarely used in practice, but there is high interest and acceptance of the peer coaching model for continuous professional development. Findings regarding preferred program structure may be useful to inform the design of future peer coaching programs.
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Affiliation(s)
- Sofia Valanci-Aroesty
- Department of Surgery, Steinberg-Bernstein Centre for Minimally Invasive Surgery & Innovation, Montreal General Hospital, Montreal, Canada
- Department of Surgery, McGill University, 1650 Cedar Avenue, Montreal, QC, H3G 1A4, Canada
| | - Liane S Feldman
- Department of Surgery, Steinberg-Bernstein Centre for Minimally Invasive Surgery & Innovation, Montreal General Hospital, Montreal, Canada
- Department of Surgery, McGill University, 1650 Cedar Avenue, Montreal, QC, H3G 1A4, Canada
| | - Julio F Fiore
- Department of Surgery, Steinberg-Bernstein Centre for Minimally Invasive Surgery & Innovation, Montreal General Hospital, Montreal, Canada
- Department of Surgery, McGill University, 1650 Cedar Avenue, Montreal, QC, H3G 1A4, Canada
| | - Lawrence Lee
- Department of Surgery, Steinberg-Bernstein Centre for Minimally Invasive Surgery & Innovation, Montreal General Hospital, Montreal, Canada
- Department of Surgery, McGill University, 1650 Cedar Avenue, Montreal, QC, H3G 1A4, Canada
| | - Gerald M Fried
- Department of Surgery, Steinberg-Bernstein Centre for Minimally Invasive Surgery & Innovation, Montreal General Hospital, Montreal, Canada
- Department of Surgery, McGill University, 1650 Cedar Avenue, Montreal, QC, H3G 1A4, Canada
- Steinberg Centre for Simulation and Interactive Learning, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Carmen L Mueller
- Department of Surgery, Steinberg-Bernstein Centre for Minimally Invasive Surgery & Innovation, Montreal General Hospital, Montreal, Canada.
- Department of Surgery, McGill University, 1650 Cedar Avenue, Montreal, QC, H3G 1A4, Canada.
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10
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Zhang X, Zhao J, Zheng L, Li X, Hao Y. Implementation strategies to improve evidence-based practice for post-stroke dysphagia identification and management: A before-and-after study. Int J Nurs Sci 2022; 9:295-302. [PMID: 35891917 PMCID: PMC9305012 DOI: 10.1016/j.ijnss.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/26/2022] [Accepted: 06/11/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Xiaoyan Zhang
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Junqiang Zhao
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ontario, Canada
| | - Liping Zheng
- Department of Neurosurgery, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Xuejing Li
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Yufang Hao
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
- Corresponding author.
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11
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Zalmay P, Collis J, Wilson H. Patients Lacking the Capacity to Consent to Hip Fracture Surgery May Be Undergoing Major Operations Without Their Next of Kin Being Involved in Best-Interests Decisions: A Quality Improvement Report. Cureus 2021; 13:e20322. [PMID: 35028219 PMCID: PMC8742997 DOI: 10.7759/cureus.20322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2021] [Indexed: 11/16/2022] Open
Abstract
Background Cognitively impaired patients with a hip fracture may be undergoing major operations without attempts being made to involve their next of kin (NoK) in best-interest decisions. Methods We used the Plan-Do-Study-Act (PDSA) methodology to guide our quality improvement (QI) project. Cognitively impaired hip fracture patients were identified retrospectively by searching the hip fracture database of a medium-sized district general hospital (DGH). Their medical notes were reviewed for documented attempts at contacting their NoK prior to surgery as well as on completion of the NoK section of the Consent Form Four. Intervention A simple feedback intervention was delivered in the form of a mixed verbal and visual presentation to the orthopaedic registrars responsible for obtaining consent from these patients. Results Post-intervention, there were documented attempts at contacting the NoK before surgery for all patients, a significant improvement from only 80%. There was also a significant increase in completion of the NoK section of the consent form, from 30% to 64.3%. Conclusions Simple audit and feedback interventions can produce significant positive changes in communication between clinicians and the NoK of cognitively impaired patients with hip fractures. Further interventions have been implemented to sustain these improvements.
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Affiliation(s)
- Pardis Zalmay
- Trauma and Orthopaedics, Royal Surrey County Hospital NHS Foundation Trust, London, GBR
| | - Justin Collis
- Trauma and Orthopaedics, Medway Maritime NHS Foundation Trust, Gillingham, GBR
| | - Helen Wilson
- Geriatrics, Royal Surrey County Hospital NHS Foundation Trust, London, GBR
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12
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Aboagye JK, Haut ER, Streiff MB, Hobson DB, Kraus PS, Shaffer DL, Holzmueller CG, Lau BD. Audit and Feedback to Surgery Interns and Residents on Prescribing Risk-Appropriate Venous Thromboembolism Prophylaxis. JOURNAL OF SURGICAL EDUCATION 2021; 78:2011-2019. [PMID: 33879395 DOI: 10.1016/j.jsurg.2021.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 03/19/2021] [Accepted: 03/20/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of feedback using an emailed scorecard and a web-based dashboard on risk-appropriate VTE prophylaxis prescribing practices among general surgery interns and residents. DESIGN Prospective cohort study. SETTING The Johns Hopkins Hospital, an urban academic medical center. PARTICIPANTS All 45 trainees (19 post-graduate year [PGY] 1 interns and 26 PGY-2 to PGY-5 residents) in our general surgery program. INTERVENTION Feedback implementation encompassed three sequential periods: (1) scorecard (July 1, 2014 through June 30, 2015); (2) no feedback/wash-in (July 1 through October 31, 2015); and (3) web-based dashboard (November 1, 2015 through June 30, 2016). No feedback served as the baseline period for the intern cohort. The scorecard was a static document showing an individual's compliance with risk-appropriate VTE prophylaxis prescription compared to compliance of their de-identified peers. The web-based dashboard included other information (e.g., patient details for suboptimal prophylaxis orders) besides individual compliance compared to their de-identified peers. Trainees could access the dashboard anytime to view current and historic performance. We sent monthly emails to all trainees for both feedback mechanisms. Main outcome was proportion of patients prescribed risk-appropriate VTE prophylaxis, and mean percentages reported. RESULTS During this study, 4088 VTE prophylaxis orders were placed. Among residents, mean prescription of risk-appropriate prophylaxis was higher in the wash-in (98.4% vs 95.6%, p < 0.001) and dashboard (98.4 vs 95.6%, p < 0.001) periods compared to the scorecard period. There was no difference in mean compliance between the wash-in and dashboard periods (98.4% vs 98.4%, p = 0.99). Among interns, mean prescription of risk-appropriate VTE prophylaxis improved between the wash-in and dashboard periods (91.5% vs 96.4%, p < 0.001). CONCLUSIONS AND RELEVANCE Using audit and individualized performance feedback to general surgery trainees through a web-based dashboard improved prescribing of appropriate VTE prophylaxis to a near-perfect performance.
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Affiliation(s)
- Jonathan K Aboagye
- Division of Acute Care Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Elliott R Haut
- Division of Acute Care Surgery, Department of Surgery; Department of Anesthesiology and Critical Care Medicine; Department of Emergency Medicine; Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
| | - Michael B Streiff
- Division of Hematology, Department of Medicine; Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Deborah B Hobson
- Department of Nursing, The Johns Hopkins Hospital; Division of Acute Care Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Peggy S Kraus
- Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Dauryne L Shaffer
- Division of Acute Care Surgery, Department of Surgery, Johns Hopkins University School of Medicine; Department of Nursing, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Christine G Holzmueller
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Brandyn D Lau
- Russell H. Morgan Department of Radiology and Radiological Science; Division of Health Sciences Informatics; Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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13
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Ablordeppey EA, Powell B, McKay V, Keating S, James A, Carpenter C, Kollef M, Griffey R. Protocol for DRAUP: a deimplementation programme to decrease routine chest radiographs after central venous catheter insertion. BMJ Open Qual 2021; 10:bmjoq-2020-001222. [PMID: 34663588 PMCID: PMC8524291 DOI: 10.1136/bmjoq-2020-001222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 10/02/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction Avoiding low value medical practices is an important focus in current healthcare utilisation. Despite advantages of point-of-care ultrasound (POCUS) over chest X-ray including improved workflow and timeliness of results, POCUS-guided central venous catheter (CVC) position confirmation has slow rate of adoption. This demonstrates a gap that is ripe for the development of an intervention. Methods The intervention is a deimplementation programme called DRAUP (deimplementation of routine chest radiographs after adoption of ultrasound-guided insertion and confirmation of central venous catheter protocol) that will be created to address one unnecessary imaging modality in the acute care environment. We propose a three-phase approach to changing low-value practices. In phase 1, we will be guided by the Consolidated Framework for Implementation Research framework to explore barriers and facilitators of POCUS for CVC confirmation in a single centre, large tertiary, academic hospital via focus groups. The qualitative methods will inform the development and adaptation of strategies that address identified determinants of change. In phase 2, the multifaceted strategies will be conceptualised using Morgan’s framework for understanding and reducing medical overuse. In phase 3, we will locally implement these strategies and assess them using Proctor’s outcomes (adoption, deadoption, fidelity and penetration) in an observational study to demonstrate proof of concept, gaining valuable insights on the programme. Secondary outcomes will include POCUS-guided CVC confirmation efficacy measured by time and effectiveness measured by sensitivity and specificity of POCUS confirmation after CVC insertion. With limited data available to inform interventions that use concurrent implementation and deimplementation strategies to substitute chest X-ray for POCUS using the DRAUP programme, we propose that this primary implementation and secondary effectiveness pilot study will provide novel data that will expand the knowledge of implementation approaches to replacing low value or unnecessary care in acute care environments. Ethics and dissemination Approval of the study by the Human Research Protection Office has been obtained. This work will be disseminated by publication of peer-reviewed manuscripts, presentation in abstract form at scientific meetings and data sharing with other investigators through academically established means. Trial registration number ClinicalTrials.gov Identifier, NCT04324762, registered on 27 March 2020.
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Affiliation(s)
- Enyo A Ablordeppey
- Department of Anesthesiology and Emergency Medicine, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Byron Powell
- Brown School at Washington University in St Louis, St Louis, Missouri, USA
| | - Virginia McKay
- Brown School at Washington University in St Louis, St Louis, Missouri, USA
| | - Shannon Keating
- Department of Anesthesiology, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Aimee James
- Department of Surgery, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Christopher Carpenter
- Department of Emergency Medicine, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Marin Kollef
- Department of Internal Medicine, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Richard Griffey
- Department of Emergency Medicine, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
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14
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Johnson AL, Ecker AH, Fletcher TL, Hundt N, Kauth MR, Martin LA, Curran GM, Cully JA. Increasing the impact of randomized controlled trials: an example of a hybrid effectiveness-implementation design in psychotherapy research. Transl Behav Med 2021; 10:629-636. [PMID: 30476315 DOI: 10.1093/tbm/iby116] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Randomized controlled trials (RCTs) are the gold standard for clinical research. However, significant delays between completion of RCTs and adoption of evidence-based practices into clinical settings remain. Engagement of stakeholders and implementation-focused outcomes to augment traditional RCTs hold the potential to increase the impact of RCT outcomes for clinical practice and more rapidly lead to the adoption of evidence-based practices in clinical settings. The purpose of this study is to discuss hybrid effectiveness-implementation designs and use a project example to highlight important methodological considerations to enhance the impact of RCTs. A hybrid effectiveness-implementation study assessed the effectiveness and implementation potential of brief cognitive behavioral therapy (bCBT) for rural Veterans. A patient-randomized trial (bCBT vs. enhanced usual care) explored the impact on depression symptoms. Implementation elements included engagement of stakeholders and a multifaceted provider training and support program to increase bCBT use by providers in Veterans Health Administration (VA) community-based outpatient clinics. Implementation outcomes included the number of providers who adopted bCBT, provider fidelity, and delivery outcomes (e.g., use of measurement-based care, treatment engagement, and completion). Hybrid designs offer opportunities to improve the alignment between research and practice, potentially improving dissemination of evidence-based interventions and reducing known delays in the translation from research to practice. Expansion of traditional RCTs through collaborative stakeholder contributions and stakeholder/consumer-informed implementation approaches is critical to improve adoption postproject. Although hybrid designs offer significant benefits related to generalizability and adoption, these approaches involve complex procedures and processes and often come at the cost of reduced internal study controls.
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Affiliation(s)
- Adrienne L Johnson
- Department of Psychology, University of Cincinnati, Cincinnati, OH, USA.,Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, USA.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Anthony H Ecker
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, USA.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.,South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA
| | - Terri L Fletcher
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, USA.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.,South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA
| | - Natalie Hundt
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, USA.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.,South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA
| | - Michael R Kauth
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, USA.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.,South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA
| | - Lindsey A Martin
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, USA.,South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Geoffrey M Curran
- Department of Veterans Affairs, Center for Mental Health Care and Outcomes Research, Central Arkansas Veterans Health Care System, North Little Rock, AR, USA.,Department of Pharmacy Practice, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jeffrey A Cully
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, USA.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.,South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA
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15
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Rosiello G, Gandaglia G, Scuderi S, Barletta F, Fossati N, Stabile A, Gallina A, Mazzone E, Vitale LM, Pellegrino A, Bravi C, Martini A, Cucchiara V, Karakiewicz PI, Mottrie A, Briganti A, Montorsi F. Reducing the Risk of Postoperative Complications After Robot-assisted Radical Prostatectomy in Prostate Cancer Patients: Results of an Audit and Feedback Intervention Following the Implementation of Prospective Data Collection. Eur Urol Focus 2021; 8:431-437. [PMID: 33879394 DOI: 10.1016/j.euf.2021.03.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/11/2021] [Accepted: 03/28/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Prospective data collection for perioperative outcomes might increase awareness of surgical results obtained for patients with prostate cancer (PCa) undergoing robot-assisted radical prostatectomy (RARP). This would prompt the implementation of measures aimed at reducing the risk of adverse outcomes. OBJECTIVE To assess the efficacy of an audit and feedback process aimed at identifying the most common complications after RARP and at implementing measures to improve outcomes. DESIGN, SETTING, AND PARTICIPANTS Overall, 415 patients treated with RARP by a high-volume surgeon were included. Perioperative outcomes for 187 patients treated between September 2016 and December 2017 were prospectively collected at 30 d according to the European Association of Urology guideline recommendations (group 1). An audit and feedback process was implemented in January 2018 whereby the most common complication (anastomotic leak) was identified and measures aimed at improving outcomes (changes in the anastomotic technique) were implemented. The outcomes for group 1 were then compared to 228 patients treated after implementation of the modified surgical technique (group 2). SURGICAL PROCEDURE A novel technique for posterior reconstruction and urethrovesical anastomosis was introduced. MEASUREMENTS Perioperative outcomes included blood loss, operative time, length of stay, and 30-d postoperative complications. Logistic regression models tested the effect of the novel surgical technique on anastomotic leaks. RESULTS AND LIMITATIONS Overall, 97 patients (23%) experienced postoperative complications at 30 d. The rate of anastomotic leaks was significantly lower in group 2 compared to group 1 (3.1% vs 9.6%; p < 0.01). Similarly, overall and Clavien-Dindo grade ≥2 complication rates were lower in group 2 versus group 1 (17% vs 31%, and 6% vs 20%; both p ≤ 0.001). In multivariable analyses, treatment after implementation of changes in the anastomotic technique independently predicted a lower risk of complications (odds ratio [OR] 0.58, 95% confidence interval [CI] 0.38-0.89) and of anastomotic leaks (OR 0.43, 95% CI 0.17-0.97). The lack of randomization represents the main limitation. CONCLUSIONS Implementation of changes in the urethrovesical anastomosis technique arising from increased awareness of surgical outcomes reduced the risk of anastomotic leaks. These findings highlight the importance of audit and feedback processes using a standardized method for reporting surgical morbidity. PATIENT SUMMARY Increased awareness of surgical outcomes prompted us to change our technique for connecting the bladder to the urethra during robot-assisted surgery to remove the prostate in patients with prostate cancer. These changes resulted in significant improvements in surgical outcomes.
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Affiliation(s)
- Giuseppe Rosiello
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Giorgio Gandaglia
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Simone Scuderi
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Barletta
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nicola Fossati
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Armando Stabile
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Gallina
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elio Mazzone
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luca Maria Vitale
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antony Pellegrino
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Carlo Bravi
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Martini
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vito Cucchiara
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, QC, Canada
| | - Alexandre Mottrie
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Alberto Briganti
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Francesco Montorsi
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
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16
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Ragusa R, Marranzano M, Lombardo A, Quattrocchi R, Bellia MA, Lupo L. Has the COVID 19 Virus Changed Adherence to Hand Washing among Healthcare Workers? Behav Sci (Basel) 2021; 11:53. [PMID: 33920791 PMCID: PMC8071195 DOI: 10.3390/bs11040053] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/11/2021] [Accepted: 04/13/2021] [Indexed: 12/11/2022] Open
Abstract
The aim of the study was to assess adherence to hand washing by healthcare workers (HCWs) and its variations over time in hospital wards. We wanted to check whether the pandemic had changed the behavior of HCWs. The study was conducted between 1 January 2015, and 31 December 2020. The HCWs were observed to assess their compliance with the Five Moments for Hand Hygiene. We described the percentage of adherence to World Health Organization (WHO) guidelines stratified per year, per specialty areas, per different types of HCWs. We also observed the use of gloves. Descriptive data were reported as frequencies and percentages. We observed 13,494 hand hygiene opportunities. The majority of observations concerned nurses who were confirmed as the category most frequently involved with patients. Hospital's global adherence to WHO guidelines did not change in the last six years. During the pandemic, the rate of adherence to the procedure increased significantly only in Intensive Care Unit (ICU). In 2020, the use of gloves increased in pre-patient contact. The hand-washing permanent monitoring confirmed that it is very difficult to obtain the respect of correct hand hygiene in all opportunities, despite the ongoing pandemic and the fear of contagion.
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Affiliation(s)
- Rosalia Ragusa
- Health Technology Assessment Committee, University Hospital “G. Rodolico”, Via Santa Sofia, 78 95123 Catania, Italy
| | - Marina Marranzano
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, Via Santa Sofia, 87 95123 Catania, Italy; (M.M.); (L.L.)
| | - Alessandro Lombardo
- Committee for the Control of Hospital Infections, University Hospital “G. Rodolico”, Via Santa Sofia, 78 95128 Catania, Italy;
| | - Rosalba Quattrocchi
- U.O. Health Education, University Hospital “G. Rodolico”, Via Santa Sofia, 78 95128 Catania, Italy;
| | - Maria Alessandra Bellia
- School of Specialization in Microbiology, University of Catania, Via Santa Sofia, 78 95123 Catania, Italy;
| | - Lorenzo Lupo
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, Via Santa Sofia, 87 95123 Catania, Italy; (M.M.); (L.L.)
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17
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Paul CL, Warren G, Vinod S, Meiser B, Stone E, Barker D, White K, McLennan J, Day F, McCarter K, McEnallay M, Tait J, Canfell K, Weber M, Segan C. Care to Quit: a stepped wedge cluster randomised controlled trial to implement best practice smoking cessation care in cancer centres. Implement Sci 2021; 16:23. [PMID: 33663518 PMCID: PMC7934502 DOI: 10.1186/s13012-021-01092-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 02/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cigarette smoking in people with cancer is associated with negative treatment-related outcomes including increased treatment toxicity and complications, medication side effects, decreased performance status and morbidity. Evidence-based smoking cessation care is not routinely provided to patients with cancer. The purpose of this study is to determine the effectiveness of a smoking cessation implementation intervention on abstinence from smoking in people diagnosed with cancer. METHODS A stepped wedge cluster randomised design will be used. All sites begin in the control condition providing treatment as usual. In a randomly generated order, sites will move to the intervention condition. Based on the Theoretical Domains Framework, implementation of Care to Quit will include (i) building the capability and motivation of a critical mass of key clinical staff and identifying champions; and (ii) identifying and implementing cessation care models/pathways. Two thousand one hundred sixty patients with cancer (diagnosed in the prior six months), aged 18+, who report recent combustible tobacco use (past 90 days or in the 30 days prior to cancer diagnosis) and are accessing anti-cancer therapy, will be recruited at nine sites. Assessments will be conducted at baseline and 7-month follow-up. The primary outcome will be 6-month abstinence from smoking. Secondary outcomes include biochemical verification of abstinence from smoking, duration of quit attempts, tobacco consumption, nicotine dependence, provision and receipt of smoking cessation care, mental health and quality of life and cost effectiveness of the intervention. DISCUSSION This study will implement best practice smoking cessation care in cancer centres and has the potential for wide dissemination. TRIAL REGISTRATION The trial is registered with ANZCTR (www.anzctr.org.au): ACTRN ( ACTRN12621000154808 ) prior to the accrual of the first participant and will be updated regularly as per registry guidelines.
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Affiliation(s)
- Christine L Paul
- University of Newcastle Priority Research Centre for Cancer Research, Innovation and Translation, Callaghan, Australia. .,University of Newcastle School of Medicine and Public Health, Callaghan, NSW, Australia. .,Level 4 West, Hunter Medical Research Institute, John Hunter Hospital, New Lambton Heights, Newcastle, NSW, Australia. .,Hunter Cancer Research Alliance, John Hunter Hospital, New Lambton Heights, Newcastle, NSW, Australia.
| | - Graham Warren
- Department of Radiation Oncology, Department of Cell and Molecular Pharmacology, Medical University of South Carolina, Charleston, SC, USA
| | - Shalini Vinod
- Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW, Australia.,South Western Sydney Clinical School and Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Bettina Meiser
- Prince of Wales Clinical School, University of New South Wales, Kensington, NSW, 2052, Australia
| | - Emily Stone
- St Vincent's Hospital Sydney, Kinghorn Cancer Centre, University of NSW, Kensington, Australia
| | - Daniel Barker
- University of Newcastle School of Medicine and Public Health, Callaghan, NSW, Australia
| | - Kate White
- Faculty of Medicine and Health, University of Sydney, CNRU Sydney Local Health District, Sydney, Australia
| | - James McLennan
- St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia
| | - Fiona Day
- University of Newcastle School of Medicine and Public Health, Callaghan, NSW, Australia.,Hunter Cancer Research Alliance, John Hunter Hospital, New Lambton Heights, Newcastle, NSW, Australia.,Calvary Mater Newcastle, Hunter Region Mail Centre, Waratah, NSW, Australia
| | - Kristen McCarter
- University of Newcastle Priority Research Centre for Cancer Research, Innovation and Translation, Callaghan, Australia.,University of Newcastle School of Medicine and Public Health, Callaghan, NSW, Australia.,Level 4 West, Hunter Medical Research Institute, John Hunter Hospital, New Lambton Heights, Newcastle, NSW, Australia.,Hunter Cancer Research Alliance, John Hunter Hospital, New Lambton Heights, Newcastle, NSW, Australia
| | - Melissa McEnallay
- University of Newcastle Priority Research Centre for Cancer Research, Innovation and Translation, Callaghan, Australia.,University of Newcastle School of Medicine and Public Health, Callaghan, NSW, Australia.,Level 4 West, Hunter Medical Research Institute, John Hunter Hospital, New Lambton Heights, Newcastle, NSW, Australia.,Hunter Cancer Research Alliance, John Hunter Hospital, New Lambton Heights, Newcastle, NSW, Australia
| | - Jordan Tait
- University of Newcastle School of Medicine and Public Health, Callaghan, NSW, Australia.,Level 4 West, Hunter Medical Research Institute, John Hunter Hospital, New Lambton Heights, Newcastle, NSW, Australia.,Hunter Cancer Research Alliance, John Hunter Hospital, New Lambton Heights, Newcastle, NSW, Australia
| | - Karen Canfell
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, NSW, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Marianne Weber
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, NSW, Australia.,Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Catherine Segan
- Cancer Council Victoria, Melbourne, VIC, Australia.,Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
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Ladwar DO, Sembatya MN, Amony NM, Seru M, Ross-Degnan D, Garabedian L, Trap B. Article 4: Impact assessment of supervision performance assessment and recognition strategy (SPARS) to improve supply chain management in health facilities in Uganda: a national pre and post study. J Pharm Policy Pract 2021; 14:14. [PMID: 33536063 PMCID: PMC7857862 DOI: 10.1186/s40545-020-00290-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 12/28/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND To strengthen medicines management capacity, including supply chain management, at public sector health facilities in Uganda, the Ministry of Health introduced a multipronged supervision, performance assessment, and recognition strategy (SPARS). The aim of this study was to assess the impact of SPARS on improving supply chain management. A series of four papers on SPARS described the SPARS concept, its impact on overall and domain practices and appropriate medicines use, and now in the fourth paper describing the effect on supply chain management. METHODS District-based health workers trained as supervisors build facility-level capacity in medicines management using an indicator-based performance assessment followed by targeted supervisory visits. From 2010 to 2013, 1222 SPARS visits were implemented, and the SPARS performance indicator scores determined. This article assesses impact on 13 indicators in three of the five SPARS domains-stock management, storage management, and ordering and reporting quality-using a pre-post design. We also explored factors that may have influenced these outcomes. RESULTS Between the first and last visit within one year of SPARS implementation, we found an average improvement of 16 percentage points (p < 0.001) in supply chain management measures across all levels of care. The improvement in scores for stock management, storage management, and ordering and reporting was 22 (ns), 16 (p < 0.001), and 11 (p = 0.032) percentage points, respectively. The study identified the key predictors of positive change as a low initial indicator score, frequent supervisory visits, and engagement of the district health officer. CONCLUSIONS The multipronged SPARS approach was effective in building supply chain management capacity in lower-level health care facilities with statistically significant improvements in supply chain management overall and in almost all stock and storage- management and ordering and reporting measures after one year of implementation. We recommend broad dissemination of the SPARS approach as an effective strategy to strengthen supply chain management in low-income countries. TRIAL REGISTRATION The study did not involve or use human participants or identifiable personal data, human tissue, or animals and thus did not require ethical approval or a waiver. It is a study implemented in collaboration with the Ministry of Health and does not require trial registration.
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Affiliation(s)
- Denis Okidi Ladwar
- USAID/Uganda Health Supply Chain Program, Management Sciences for Health, Plot 15, Princess Anne Drive, Bugolobi, P.O. Box 71419, Kampala, Uganda
| | - Moses Nixon Sembatya
- USAID/Uganda Health Supply Chain Program, Management Sciences for Health, Plot 15, Princess Anne Drive, Bugolobi, P.O. Box 71419, Kampala, Uganda
| | - Nancy Miriam Amony
- USAID/Uganda Health Supply Chain Program, Management Sciences for Health, Plot 15, Princess Anne Drive, Bugolobi, P.O. Box 71419, Kampala, Uganda
| | - Morries Seru
- Pharmacy Division, Ministry of Health Uganda, Plot 6/P.O. Box 7272 Lourdel Rd, Kampala, Uganda
| | - Dennis Ross-Degnan
- Harvard Pilgrim Health Care Institute, 133 Brookline Avenue, 6th Floor, Boston, MA 02215 USA
| | - Laura Garabedian
- Harvard Pilgrim Health Care Institute, 133 Brookline Avenue, 6th Floor, Boston, MA 02215 USA
| | - Birna Trap
- USAID/Uganda Health Supply Chain Program, Management Sciences for Health, Plot 15, Princess Anne Drive, Bugolobi, P.O. Box 71419, Kampala, Uganda
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Cases C, Gallini A, Lafont Rapnouil S, Bougon E, Mathur A, Brismontier A, Taib S, Sporer M, Arbus C, Salles J. Developing and Testing a Local Expert-Based Reading Process for Use to Examine Discrepancies Between Guidelines and Current Clinical Practices. Front Psychiatry 2021; 12:581449. [PMID: 33868036 PMCID: PMC8044516 DOI: 10.3389/fpsyt.2021.581449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 02/23/2021] [Indexed: 11/13/2022] Open
Abstract
The use of relevant guidelines is critical in psychiatric clinical practice to ensure the homogeneity of the global care provided. Consequently, it is important to identify whether they are utilized successfully and, if not, why. This would enable pragmatic solutions to be agreed to improve the organization of care and the removal of any barriers to the guidelines' implementation. The first step in this process, before any exploration of the limitations of the guidelines themselves, involves a determination of whether they are actually applied in clinical practice. We therefore evaluated discrepancies between the guidelines relating to patients with borderline personality disorder and current practices in the psychiatric Emergency Department at Toulouse University Hospital. This was achieved using a reading process involving a panel of eight local experts who analyzed relevant medical files extracted from a database. They were guided by, and instructed to answer, six standardized questions in relation to each file to determine the method's feasibility. A total of 333 files were analyzed to determine whether, in the local experts' judgment, the care provided reflected current guidance. This reading process revealed substantial agreement (0.85%; Fleiss Kappa -0.69), which is a promising outcome and suggests that such methods could be used in future protocols. Moreover, the process is practical and reliable and requires very few materials.
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Affiliation(s)
- Cécile Cases
- CHU Toulouse, Service de psychiatrie et psychologie, psychiatrie Toulouse, Toulouse, France
| | - Adeline Gallini
- CHU de Toulouse, Service d'épidémiologie, Unité de Soutien Méthodologique à la Recherche (USMR), Toulouse, France.,Inserm, Unité 1027 Epidémiologie et analyses en santé publique, Vieillissement et maladie d'Alzheimer: de l'observation à l'intervention, Toulouse, France
| | | | - Emmanuelle Bougon
- CHU Toulouse, Service de psychiatrie et psychologie, psychiatrie Toulouse, Toulouse, France
| | - Anjali Mathur
- CHU Toulouse, Service de psychiatrie et psychologie, psychiatrie Toulouse, Toulouse, France
| | - Ariane Brismontier
- CHU Toulouse, Service de psychiatrie et psychologie, psychiatrie Toulouse, Toulouse, France
| | - Simon Taib
- CHU Toulouse, Service de psychiatrie et psychologie, psychiatrie Toulouse, Toulouse, France
| | - Marie Sporer
- CHU Toulouse, Service de psychiatrie et psychologie, psychiatrie Toulouse, Toulouse, France
| | - Christophe Arbus
- CHU Toulouse, Service de psychiatrie et psychologie, psychiatrie Toulouse, Toulouse, France.,Institut des Handicaps Neurologiques, Psychiatriques et Sensoriels-CHU de Toulouse, Toulouse, France
| | - Juliette Salles
- CHU Toulouse, Service de psychiatrie et psychologie, psychiatrie Toulouse, Toulouse, France.,Institut des Handicaps Neurologiques, Psychiatriques et Sensoriels-CHU de Toulouse, Toulouse, France.,Infinity (Toulouse Institute for Infectious and Inflammatory Diseases), INSERM UMR1291, CNRS UMR5051, Université Toulouse III, Toulouse, France
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20
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Lloyd M, Watmough SD, O'Brien SV, Hardy K, Furlong N. Evaluating the impact of a pharmacist-led prescribing feedback intervention on prescribing errors in a hospital setting. Res Social Adm Pharm 2020; 17:1579-1587. [PMID: 33341404 DOI: 10.1016/j.sapharm.2020.12.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 11/19/2020] [Accepted: 12/13/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Prescribing errors are prevalent in hospital settings with provision of feedback recommended to support prescribing of doctors. Feedback on prescribing has been described as feasible and valued but limited by doctors, with pharmacists described as credible facilitators of prescribing feedback. Evidence supporting prescribing feedback has been limited to date. A formalised programme of pharmacist-led prescribing error feedback was designed and implemented to support prescribers. OBJECTIVE To evaluate the impact of a prescribing feedback intervention on prescribing error rates and frequency of prescribing error severity and type. METHOD Prospective prescribing audits were undertaken across sixteen hospital wards in a UK teaching hospital over a five day period with 36 prescribers in the intervention group and 41 in the control group. The intervention group received pharmacist-led, individualised constructive feedback on their prescribing, whilst the control group continued with existing practice. Prescribing was re-audited after three months. Prescribing errors were classified by type and severity and data were analysed using relevant statistical tests. RESULTS A total of 5191 prescribed medications were audited at baseline and 5122 post-intervention. There was a mean prescribing error rate of 25.0% (SD 16.8, 95% CI 19.3 to 30.7) at baseline and 6.7% (SD 9.0, 95% CI 3.7 to 9.8) post-intervention for the intervention group, and 19.7% (SD 14.5, 95% CI 15.2 to 24.3) at baseline and 25.1% (SD 17.0, 95% CI 19.8 to 30.6) post-intervention for the control group with a significant overall change in prescribing error rates between groups of 23.7% (SD 3.5, 95% CI, -30.6 to -16.8), t(75) = -6.9, p < 0.05. The frequency of each error type and severity rating was reduced in the intervention group, whilst the error frequency of some error types and severity increased in the control group. CONCLUSION Pharmacist-led prescribing feedback has the potential to reduce prescribing errors and improve prescribing outcomes and patient safety.
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Affiliation(s)
- M Lloyd
- Clinical Education Department, St. Helens and Knowsley Hospitals NHS Trust, Whiston, Merseyside, L35 5DR, UK.
| | - S D Watmough
- School of Medicine, Faculty of Health and Social Care, Edge Hill University, Ormskirk, L39 4QP, UK
| | - S V O'Brien
- St. Helens CCG, St. Helens Chambers, St. Helens, Merseyside, WA10 1YF, UK
| | - K Hardy
- St. Helens and Knowsley Hospitals NHS Trust, Whiston, Merseyside, L35 5DR, UK
| | - N Furlong
- St. Helens and Knowsley Hospitals NHS Trust, Whiston, Merseyside, L35 5DR, UK
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21
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Hutchinson AM, Brotto V, Chapman A, Sales AE, Mohebbi M, Bucknall TK. Use of an audit with feedback implementation strategy to promote medication error reporting by nurses. J Clin Nurs 2020; 29:4180-4193. [PMID: 32757427 DOI: 10.1111/jocn.15447] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 06/18/2020] [Accepted: 07/16/2020] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To outline the development and effect of an audit with feedback implementation strategy that intended to increase the rate of voluntary medication error reporting by nurses. BACKGROUND Medication errors are a serious global health issue. Audit with feedback is a widely used implementation strategy that has potential to modify nurses' reporting behaviour and improve medication error reporting rates. DESIGN Quasi-experimental implementation study (fulfilling the TIDieR checklist) with two pairs of matched wards at a private hospital in Australia was conducted from March 2015-September 2016. One ward from each pair was randomised to either the intervention or control group. METHOD Nurses within intervention wards received audit with feedback on a quarterly basis over a 12-month implementation period. Control wards underwent quarterly audits only (without feedback). Feedback consisted of a one-page infographic poster, with content based on medication error data obtained from audits and the hospitals' risk management system (RiskMan). The primary outcome-rate of medication errors reported per month-was determined in both groups at pre-implementation, implementation and postimplementation phases. Differences between groups were compared using generalised linear mixed models with Poisson distribution and log link. RESULTS A nonsignificant intervention effect was found for rate of medication errors reported per month. Interestingly, when combining data from both groups, a significant increasing time trend was observed for medication errors reported per month across pre-implementation and implementation phases (80% increase). CONCLUSIONS The audit with feedback strategy developed in the present study did not effectively influence the voluntary reporting of medication errors by nurses. RELEVANCE TO CLINICAL PRACTICE Despite the lack of intervention effects, the use of a published checklist to optimise the reporting quality of this study will contribute to the field by furthering the understanding of how to enhance audit with feedback implementation strategies for nurses.
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Affiliation(s)
- Alison M Hutchinson
- School of Nursing & Midwifery, Centre for Quality & Patient Safety Research, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, VIC, Australia.,Monash Health, Clayton, VIC, Australia
| | - Vanessa Brotto
- School of Nursing & Midwifery, Centre for Quality & Patient Safety Research, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Anna Chapman
- School of Nursing & Midwifery, Centre for Quality & Patient Safety Research, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, VIC, Australia.,Monash Health, Clayton, VIC, Australia
| | - Anne E Sales
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, USA.,Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Mohammadreza Mohebbi
- Biostatistics Unit, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Tracey K Bucknall
- School of Nursing & Midwifery, Centre for Quality & Patient Safety Research, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, VIC, Australia.,Alfred Health, Melbourne, VIC, Australia
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22
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Kuwawenaruwa A, Tediosi F, Obrist B, Metta E, Chiluda F, Wiedenmayer K, Wyss K. The role of accountability in the performance of Jazia prime vendor system in Tanzania. J Pharm Policy Pract 2020; 13:25. [PMID: 32523700 PMCID: PMC7278176 DOI: 10.1186/s40545-020-00220-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 05/04/2020] [Indexed: 01/13/2023] Open
Abstract
Background Access to safe, effective, quality and affordable essential medicines for all is a central component of Universal Health Coverage (UHC). However, the availability of quality medicines in peripheral healthcare facilities is often limited. Several countries have developed integrated complementary pharmaceutical supply systems to address the shortage of medicines. Nevertheless, there is little evidence on how accountability contributes to the performance of such complementary pharmaceutical supply systems in low-income settings. The current study analyses how accountability mechanisms contributed to the performance of Jazia Prime Vendor System (Jazia PVS) in Tanzania. Methods The study analysed financial, performance and procedure accountability as defined in Boven's accountability framework. We conducted 30 in-depth interviews (IDIs), seven group discussions (GD) and 14 focus group discussions (FGDs) in 2018 in four districts that implemented Jazia PVS. We used a deductive and inductive approach to develop the themes and framework analysis to summarize the data. Results The study findings revealed that a number of accountability mechanisms implemented in conjunction with Jazia PVS contributed to the performance of Jazia PVS. These include inventory and financial auditing conducted by district pharmacists and the internal auditors, close monitoring of standard operating procedures by the prime vendor regional coordinating office and peer cascade coaching. Furthermore, the auditing activities allowed identifying challenges of delayed payment to the vendor and possible approaches for mitigation while peer cascade coaching played a crucial role in enabling staff at the primary facilities to improve skills to oversee and manage the medicines supply chain. Conclusion Financial, performance and procedure accountability measures played an important role for the successful performance of Jazia PVS in Tanzania. The study highlights the need for capacity building linked to financial and supply management at lower level health facilities, including health facility governing committees, which are responsible for priority-setting and decision-making at facility level.
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Affiliation(s)
- August Kuwawenaruwa
- Ifakara Health Institute, Plot 463, Kiko Avenue Mikocheni, P.O. Box 78 373, Dar es Salaam, Tanzania.,Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Fabrizio Tediosi
- Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Brigit Obrist
- Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Emmy Metta
- Ifakara Health Institute, Plot 463, Kiko Avenue Mikocheni, P.O. Box 78 373, Dar es Salaam, Tanzania.,The Muhimbili University of Health and Allied Sciences (MUHAS), School of Public Health and Social Sciences (SPHSS), Dar es Salaam, Tanzania
| | - Fiona Chiluda
- Health Promotion and System Strengthening (HPSS) project, Dodoma, Tanzania
| | - Karin Wiedenmayer
- Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland.,University of Basel, Basel, Switzerland.,Health Promotion and System Strengthening (HPSS) project, Dodoma, Tanzania
| | - Kaspar Wyss
- Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland.,University of Basel, Basel, Switzerland
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Stangl S, Haas K, Eichner FA, Grau A, Selig U, Ludwig T, Fehm T, Stüber T, Rashid A, Kerscher A, Bargou R, Hermann S, Arndt V, Meyer M, Wildner M, Faller H, Schrauder MG, Weigel M, Schlembach U, Heuschmann PU, Wöckel A. Development and proof-of-concept of a multicenter, patient-centered cancer registry for breast cancer patients with metastatic disease-the "Breast cancer care for patients with metastatic disease" (BRE-4-MED) registry. Pilot Feasibility Stud 2020; 6:11. [PMID: 32042437 PMCID: PMC7001276 DOI: 10.1186/s40814-019-0541-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 12/03/2019] [Indexed: 01/18/2023] Open
Abstract
Background Patients with metastatic breast cancer (MBC) are treated with a palliative approach with focus on controlling for disease symptoms and maintaining high quality of life. Information on individual needs of patients and their relatives as well as on treatment patterns in clinical routine care for this specific patient group are lacking or are not routinely documented in established Cancer Registries. Thus, we developed a registry concept specifically adapted for these incurable patients comprising primary and secondary data as well as mobile-health (m-health) data. Methods The concept for patient-centered “Breast cancer care for patients with metastatic disease” (BRE-4-MED) registry was developed and piloted exemplarily in the region of Main-Franconia, a mainly rural region in Germany comprising about 1.3 M inhabitants. The registry concept includes data on diagnosis, therapy, progression, patient-reported outcome measures (PROMs), and needs of family members from several sources of information including routine data from established Cancer Registries in different federal states, treating physicians in hospital as well as in outpatient settings, patients with metastatic breast cancer and their family members. Linkage with routine cancer registry data was performed to collect secondary data on diagnosis, therapy, and progression. Paper and online-based questionnaires were used to assess PROMs. A dedicated mobile application software (APP) was developed to monitor needs, progression, and therapy change of individual patients. Patient’s acceptance and feasibility of data collection in clinical routine was assessed within a proof-of-concept study. Results The concept for the BRE-4-MED registry was developed and piloted between September 2017 and May 2018. In total n = 31 patients were included in the pilot study, n = 22 patients were followed up after 1 month. Record linkage with the Cancer Registries of Bavaria and Baden-Württemberg demonstrated to be feasible. The voluntary APP/online questionnaire was used by n = 7 participants. The feasibility of the registry concept in clinical routine was positively evaluated by the participating hospitals. Conclusion The concept of the BRE-4-MED registry provides evidence that combinatorial evaluation of PROMs, needs of family members, and raising clinical parameters from primary and secondary data sources as well as m-health applications are feasible and accepted in an incurable cancer collective.
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Affiliation(s)
- Stephanie Stangl
- 1Institute of Clinical Epidemiology and Biometry (ICE-B), University of Würzburg, Würzburg, Germany.,2Department of Gynecology and Obstetrics, University Hospital Würzburg, Würzburg, Germany
| | - Kirsten Haas
- 1Institute of Clinical Epidemiology and Biometry (ICE-B), University of Würzburg, Würzburg, Germany
| | - Felizitas A Eichner
- 1Institute of Clinical Epidemiology and Biometry (ICE-B), University of Würzburg, Würzburg, Germany
| | - Anna Grau
- 1Institute of Clinical Epidemiology and Biometry (ICE-B), University of Würzburg, Würzburg, Germany
| | - Udo Selig
- 1Institute of Clinical Epidemiology and Biometry (ICE-B), University of Würzburg, Würzburg, Germany
| | - Timo Ludwig
- 1Institute of Clinical Epidemiology and Biometry (ICE-B), University of Würzburg, Würzburg, Germany
| | - Tanja Fehm
- 3Department of Obstetrics and Gynecology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Tanja Stüber
- 2Department of Gynecology and Obstetrics, University Hospital Würzburg, Würzburg, Germany
| | - Asarnusch Rashid
- Zentrum für Telemedizin Bad Kissingen (ZTM), Bad Kissingen, Germany
| | - Alexander Kerscher
- 5Comprehensive Cancer Center Mainfranken, University Hospital Würzburg, Würzburg, Germany.,Clinical Cancer Registry Lower Franconia, Würzburg, Germany
| | - Ralf Bargou
- 5Comprehensive Cancer Center Mainfranken, University Hospital Würzburg, Würzburg, Germany
| | - Silke Hermann
- 7Epidemiological Cancer Registry Baden-Württemberg, German Cancer Research Center, Heidelberg, Germany
| | - Volker Arndt
- 7Epidemiological Cancer Registry Baden-Württemberg, German Cancer Research Center, Heidelberg, Germany
| | - Martin Meyer
- 8Centre of Early Cancer Detection and Cancer Registration, Bavarian Health and Food Safety Authority, Nürnberg, Germany
| | | | - Hermann Faller
- 5Comprehensive Cancer Center Mainfranken, University Hospital Würzburg, Würzburg, Germany.,10Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, University of Würzburg, Würzburg, Germany
| | - Michael G Schrauder
- Clinic of Gynecology and Obstetrics, Hospital Aschaffenburg-Alzenau, Aschaffenburg, Germany
| | - Michael Weigel
- Clinic for Gynecology and Obstetrics, Hospital Leopoldina Schweinfurt, Schweinfurt, Germany
| | - Ulrich Schlembach
- Clinic of Gynecology, Caritas Hospital Bad Mergentheim, Bad Mergentheim, Germany
| | - Peter U Heuschmann
- 1Institute of Clinical Epidemiology and Biometry (ICE-B), University of Würzburg, Würzburg, Germany.,14Center for Clinical Studies, University Hospital Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Centre, Würzburg, Germany
| | - Achim Wöckel
- 2Department of Gynecology and Obstetrics, University Hospital Würzburg, Würzburg, Germany
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Orchard J, Neubeck L, Freedman B, Li J, Webster R, Zwar N, Gallagher R, Ferguson C, Lowres N. eHealth Tools to Provide Structured Assistance for Atrial Fibrillation Screening, Management, and Guideline-Recommended Therapy in Metropolitan General Practice: The AF - SMART Study. J Am Heart Assoc 2020; 8:e010959. [PMID: 30590964 PMCID: PMC6405712 DOI: 10.1161/jaha.118.010959] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Background This eHealth implementation study aimed to evaluate strategies to promote opportunistic atrial fibrillation (AF) screening using electronic screening prompts and improve treatment using electronic decision support (EDS) software. Methods and Results An electronic screening prompt appeared whenever an eligible patient's (aged ≥65 years, no AF diagnosis) medical record was opened in participating general practices. General practitioners and practice nurses offered screening using a smartphone ECG, with validated AF algorithm. Guideline‐based EDS was provided to assist treatment decisions. Deidentified data were collected from practices using a data extraction tool. General practices (n=8) across Sydney, Australia, screened for a median of 6 months. A total of 1805 of 11 476 (16%) eligible patients who attended were screened (44% men, mean age 75.7 years). Screening identified 19 (1.1%) new cases of AF (mean age, 79 years; mean CHA2DS2‐VASc, 3.7; 53% men). General practitioners (n=30) performed 70% of all screenings (range 1–448 patients per general practitioner). The proportion of patients with AF who had CHA2DS2‐VASc ≥2 for men or ≥3 for women prescribed oral anticoagulants was higher for those diagnosed during the study: 15 of 18 (83%) for screen‐detected and 39 of 46 (85%) for clinically detected, compared with 933 of 1306 (71%) patients diagnosed before the study (P<0.001). The EDS was accessed 111 times for patients with AF and for 4 of 19 screen‐detected patients. Conclusions The eHealth tools showed promise. Adherence to guideline‐based oral anticoagulant prescription was significantly higher in patients diagnosed during the study period, although the EDS was only used in a minority. While the proportion of eligible patients screened and EDS use was relatively low, further refinements may improve uptake in clinical practice. Clinical Trial Registration URL: www.anzctr.org.au. Unique identifier: ACTRN12616000850471.
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Affiliation(s)
- Jessica Orchard
- 1 Faculty of Medicine & Health The University of Sydney Australia.,2 Heart Research Institute Charles Perkins Centre The University of Sydney Australia
| | - Lis Neubeck
- 3 Edinburgh Napier University Edinburgh United Kingdom
| | - Ben Freedman
- 2 Heart Research Institute Charles Perkins Centre The University of Sydney Australia
| | - Jialin Li
- 2 Heart Research Institute Charles Perkins Centre The University of Sydney Australia
| | - Ruth Webster
- 4 The George Institute for Global Health University of New South Wales Sydney Australia
| | - Nicholas Zwar
- 5 University of New South Wales Sydney New South Wales Australia
| | - Robyn Gallagher
- 1 Faculty of Medicine & Health The University of Sydney Australia
| | - Caleb Ferguson
- 6 Western Sydney Nursing & Midwifery Research Centre Western Sydney University Sydney Australia
| | - Nicole Lowres
- 2 Heart Research Institute Charles Perkins Centre The University of Sydney Australia
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Uptake of a primary care atrial fibrillation screening program (AF-SMART): a realist evaluation of implementation in metropolitan and rural general practice. BMC FAMILY PRACTICE 2019; 20:170. [PMID: 31810441 PMCID: PMC6896363 DOI: 10.1186/s12875-019-1058-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 11/22/2019] [Indexed: 11/17/2022]
Abstract
Background Screening for atrial fibrillation (AF) in people aged ≥65 years is recommended by international guidelines. The Atrial Fibrillation Screen, Management And guideline-Recommended Therapy (AF-SMART) studies of opportunistic AF screening in 16 metropolitan and rural general practices were conducted from November 2016–June 2019. These studies trialled custom-designed eHealth tools to support all stages of AF screening in general practice. Methods A realist evaluation of the AF-SMART studies, which aimed to explain the circumstances in which the program worked (or not) to increase the proportion of people screened for AF. The initial program theory was based on our previous research, policy documents and screening studies. To test this, we conducted 45 semi-structured interviews with general practitioners (GPs), nurses and practice managers across all participating practices, and collected observational and quantitative screening data. These data were analysed and interpreted to refine the program theory. Results GPs/nurses liked the eHealth tools, although technical problems sometimes disrupted screening. Time was the main barrier to screening for GPs/nurses, so systems need to be very efficient. Practices with leadership from a senior GP ‘screening champion’ had broader uptake, especially from the nursing team. Providing regular feedback on screening data was beneficial for quality improvement and motivation. Clear protocols for follow-up of abnormal results were required for successful nurse-led screening in a hierarchical system. Participation in the program had broader benefits of improving AF knowledge and raising the profile of cardiovascular health in the practice. Screening for a shorter, more intense period (eg during influenza vaccination) worked well for practices where sufficient staff time was allocated. Conclusions Introducing an AF screening program is likely to be successful in contexts where there is a senior GP ‘screening champion’, a clear protocol exists for abnormal results, and there is regular data reporting to staff. These contexts link to mechanisms around motivation, leadership, empowerment of nurses, and efficient screening systems. The contexts and mechanisms contribute to the longer-term outcomes of increasing the proportion of people screened and treated for AF, which is recommended by guidelines as a key strategy for the prevention of AF-related stroke. Trial registrations AF SMART (metropolitan): ACTRN12616000850471 (Australia New Zealand Clinical Trials Registry). AF SMART II (rural): ACTRN12618000004268 (Australia New Zealand Clinical Trials Registry).
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Gold R, Bunce A, Cowburn S, Davis JV, Nelson JC, Nelson CA, Hicks E, Cohen DJ, Horberg MA, Melgar G, Dearing JW, Seabrook J, Mossman N, Bulkley J. Does increased implementation support improve community clinics' guideline-concordant care? Results of a mixed methods, pragmatic comparative effectiveness trial. Implement Sci 2019; 14:100. [PMID: 31805968 PMCID: PMC6894475 DOI: 10.1186/s13012-019-0948-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 10/14/2019] [Indexed: 11/18/2022] Open
Abstract
Background Disseminating care guidelines into clinical practice remains challenging, partly due to inadequate evidence on how best to help clinics incorporate new guidelines into routine care. This is particularly true in safety net community health centers (CHCs). Methods This pragmatic comparative effectiveness trial used a parallel mixed methods design. Twenty-nine CHC clinics were randomized to receive increasingly intensive implementation support (implementation toolkit (arm 1); toolkit + in-person training + training webinars (arm 2); toolkit + training + webinars + offered practice facilitation (arm 3)) targeting uptake of electronic health record (EHR) tools focused on guideline-concordant cardioprotective prescribing for patients with diabetes. Outcomes were compared across study arms, to test whether increased support yielded additive improvements, and with 137 non-study CHCs that share the same EHR as the study clinics. Quantitative data from the CHCs’ EHR were used to compare the magnitude of change in guideline-concordant ACE/ARB and statin prescribing, using adjusted Poisson regressions. Qualitative data collected using diverse methods (e.g., interviews, observations) identified factors influencing the quantitative outcomes. Results Outcomes at CHCs receiving higher-intensity support did not improve in an additive pattern. ACE/ARB prescribing did not improve in any CHC group. Statin prescribing improved overall and was significantly greater only in the arm 1 and arm 2 CHCs compared with the non-study CHCs. Factors influencing the finding of no additive impact included: aspects of the EHR tools that reduced their utility, barriers to providing the intended implementation support, and study design elements, e.g., inability to adapt the provided support. Factors influencing overall improvements in statin outcomes likely included a secular trend in awareness of statin prescribing guidelines, selection bias where motivated clinics volunteered for the study, and study participation focusing clinic staff on the targeted outcomes. Conclusions Efforts to implement care guidelines should: ensure adaptability when providing implementation support and conduct formative evaluations to determine the optimal form of such support for a given clinic; consider how study data collection influences adoption; and consider barriers to clinics’ ability to use/accept implementation support as planned. More research is needed on supporting change implementation in under-resourced settings like CHCs. Trial registration ClinicalTrials.gov, NCT02325531. Registered 15 December 2014.
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Affiliation(s)
- Rachel Gold
- Kaiser Permanente Center for Health Research, 3800 N Interstate Ave, Portland, OR, 97227, USA. .,OCHIN, Inc., 1881 NW Naito Pkwy, Portland, OR, 97201, USA.
| | - Arwen Bunce
- OCHIN, Inc., 1881 NW Naito Pkwy, Portland, OR, 97201, USA
| | - Stuart Cowburn
- OCHIN, Inc., 1881 NW Naito Pkwy, Portland, OR, 97201, USA
| | - James V Davis
- Kaiser Permanente Center for Health Research, 3800 N Interstate Ave, Portland, OR, 97227, USA
| | - Joan C Nelson
- OCHIN, Inc., 1881 NW Naito Pkwy, Portland, OR, 97201, USA
| | | | - Elisabeth Hicks
- Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - Deborah J Cohen
- Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - Michael A Horberg
- Kaiser Permanente Mid-Atlantic Permanente Research Institute, 2101 East Jefferson St, Rockville, MD, 20852, USA
| | - Gerardo Melgar
- Cowlitz Family Health Center, 1057 12th Avenue, Longview, WA, 98632, USA
| | - James W Dearing
- Michigan State University, 404 Wilson Rd, Room 473, East Lansing, MI, 48824, USA
| | - Janet Seabrook
- Community HealthNet Health Centers, 1021 West 5th Avenue, Gary, IN, 46402, USA
| | - Ned Mossman
- OCHIN, Inc., 1881 NW Naito Pkwy, Portland, OR, 97201, USA
| | - Joanna Bulkley
- Kaiser Permanente Center for Health Research, 3800 N Interstate Ave, Portland, OR, 97227, USA
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Qureshi BM, Mansha MA, Karim MU, Hafiz A, Ali N, Mirkhan B, Shaukat F, Tariq M, Abbasi AN. Impact of Peer Review in the Radiation Treatment Planning Process: Experience of a Tertiary Care University Hospital in Pakistan. J Glob Oncol 2019; 5:1-7. [PMID: 31393752 PMCID: PMC6733206 DOI: 10.1200/jgo.19.00039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2019] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To evaluate and report the frequency of changes in radiation therapy treatment plans after peer review in a simulation review meeting once a week. MATERIALS AND METHODS Between July 1 and August 31, 2016, the radiation plans of 116 patients were discussed in departmental simulation review meetings. All plans were finalized by the primary radiation oncologist before presenting them in the meeting. A team of radiation oncologists reviewed each plan, and their suggestions were documented as no change, major change, minor change, or missing contour. Changes were further classified as changes in clinical target volume, treatment field, or dose. All recommendations were stratified on the basis of treatment intent, site, and technique. Data were analyzed by Statistical Package for the Social Sciences and are presented descriptively. RESULTS Out of 116 plans, 26 (22.4%) were recommended for changes. Minor changes were suggested in 15 treatment plans (12.9%) and a major change in 10 (8.6%), and only one plan was suggested for missing contour. The frequency of change recommendations was greater in radical radiation plans than in palliative plans (92.3% v 7.7%). The head and neck was the most common treatment site recommended for any changes (42.3%). Most of the changes were recommended in the technique planned with three-dimensional conformal radiation therapy (50%). Clinical target volume (73.1%) was identified as the most frequent parameter suggested for any change, followed by treatment field (19.2%) and dose (0.08%). CONCLUSION Peer review is an important tool that can be used to overcome deficiencies in radiation treatment plans, with a goal of improved and individualized patient care. Our study reports changes in up to a quarter of radiotherapy plans.
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Affiliation(s)
| | | | | | - Asim Hafiz
- The Aga Khan University, Karachi, Pakistan
| | - Nasir Ali
- The Aga Khan University, Karachi, Pakistan
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Khader Y, Alyahya M, Batieha A. Barriers to Implementation of Perinatal Death Audit in Maternity and Pediatric Hospitals in Jordan: Cross-Sectional Study. JMIR Public Health Surveill 2019; 5:e11653. [PMID: 30839277 PMCID: PMC6425304 DOI: 10.2196/11653] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 12/01/2018] [Accepted: 12/07/2018] [Indexed: 01/25/2023] Open
Abstract
Background Perinatal death audit is a feasible and cost-effective quality improvement tool that helps to improve the quality of health care and reduce perinatal deaths. Perinatal death audit is not implemented in almost all hospitals in Jordan. Objective This study aimed to assess health professionals’ attitude toward perinatal death auditing and determine the main barriers for effective implementation of perinatal death auditing as perceived by health professionals in Jordanian hospitals. Methods A cross-sectional study was conducted among health professionals in 4 hospitals in Jordan. All physicians (pediatricians and obstetricians) and nurses working in these hospitals were invited to participate in the study. The study questionnaire assessed the attitude of health professionals toward perinatal death audit and assessed barriers for implementation of perinatal death audit in their hospitals. Results This study included a total of 84 physicians and 218 nurses working in the 4 selected maternity hospitals. Only 35% (29/84) of physicians and 36.2% (79/218) of nurses reported that perinatal death audit would help to improve the quality of prenatal health care services to a great or very great extent. Lack of time was the first-mentioned barrier for implementing perinatal death audit by both physicians (35/84, 42%) and nurses (80/218, 36.7%). Almost the same proportions of health professionals reported inadequate patient information being documented in hospital records as a barrier. Lack of a health information system was the third-mentioned barrier by health professionals. Fear of having conflicts with the family of the dead baby was reported by almost one-third of physicians and nurses. Only 28% (23/83) of physicians and 16.9% (36/213) of nurses reported that they would like to be involved in perinatal death audit in their health facilities. Conclusions Health professionals in Jordan had poor attitude toward perinatal death audit. The main barriers for implementing perinatal death audit in Jordanian hospitals were lack of time, inadequate patient information being documented in hospital records, and lack of health information systems.
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Affiliation(s)
- Yousef Khader
- Department of Public Health and Community Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammad Alyahya
- Department of Health Management and Policy, Jordan University of Science and Technology, Irbid, Jordan
| | - Anwar Batieha
- Department of Public Health and Community Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Tzortziou Brown V, Underwood M, Westwood OM, Morrissey D. Improving the management of musculoskeletal conditions: can an alternative approach to referral management underpinned by quality improvement and behavioural change theories offer a solution and a better patient experience? A mixed-methods study. BMJ Open 2019; 9:e024710. [PMID: 30782916 PMCID: PMC6398779 DOI: 10.1136/bmjopen-2018-024710] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To assess whether a quality improvement-based approach to referral management can result in better musculoskeletal care within general practice. DESIGN Prospective cohort study using mixed methodology including random-effects meta-analysis and interrupted time series. SETTING AND PARTICIPANTS 36 general practices in East London. INTERVENTION Informed by the results of a Cochrane review on educational interventions to improve general practitioners' (GPs) musculoskeletal care, we developed a multifaceted intervention, underpinned by quality improvement and behavioural change theories. It combined locally agreed clinical pathways, feedback on referral rates, clinical audit and peer review. MAIN OUTCOME MEASURES Referral letter content, pathway adherence, referral rates, inter-practice variability and patient experience were evaluated before and after the intervention. RESULTS Referral letter content on suspected diagnosis and prior management improved from a pooled preintervention proportion of 59% (95% CI 53% to 65%) and 67% (95% CI 61% to 73%), respectively, to 77% (95% CI 70% to 84%) and 81% (95% CI 74% to 88%). Pathway adherence improved from a pooled preintervention percentage of 42% (95% CI 35% to 48%) to 66% (95% CI 57% to 76%). The effect was greater across all quality outcomes for practices with baseline performance below or equal to the pooled baseline performance. There were reductions in the variability and rates of orthopaedic referrals at 6, 12 and 18 months (referral rate relative effect 32% (95% CI 14% to 48%), 30% (95% CI 7% to 53%) and 30% (95% CI 0% to 59%), respectively). Patient rating of how well GPs explained the musculoskeletal condition improved by 29% (95% CI 14% to 43%) and patient perception on the usefulness of the GP appointment improved by 24% (95% CI 9% to 38%). CONCLUSIONS A quality improvement-based approach to referral management which values GPs' professionalism can result in improvements across a range of outcomes including referral quality, patient experience, referral rates and variability.
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Affiliation(s)
- Victoria Tzortziou Brown
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Martin Underwood
- Warwick Medical School, Warwick University, Coventry, UK
- University Hospitals of Coventry and Warwickshire, Coventry, UK
| | - Olwyn M Westwood
- CHLS Central Office, Brunel University London, London, Uxbridge, United Kingdom
| | - Dylan Morrissey
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Powell BJ, Fernandez ME, Williams NJ, Aarons GA, Beidas RS, Lewis CC, McHugh SM, Weiner BJ. Enhancing the Impact of Implementation Strategies in Healthcare: A Research Agenda. Front Public Health 2019; 7:3. [PMID: 30723713 PMCID: PMC6350272 DOI: 10.3389/fpubh.2019.00003] [Citation(s) in RCA: 350] [Impact Index Per Article: 70.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 01/04/2019] [Indexed: 01/10/2023] Open
Abstract
The field of implementation science was developed to better understand the factors that facilitate or impede implementation and generate evidence for implementation strategies. In this article, we briefly review progress in implementation science, and suggest five priorities for enhancing the impact of implementation strategies. Specifically, we suggest the need to: (1) enhance methods for designing and tailoring implementation strategies; (2) specify and test mechanisms of change; (3) conduct more effectiveness research on discrete, multi-faceted, and tailored implementation strategies; (4) increase economic evaluations of implementation strategies; and (5) improve the tracking and reporting of implementation strategies. We believe that pursuing these priorities will advance implementation science by helping us to understand when, where, why, and how implementation strategies improve implementation effectiveness and subsequent health outcomes.
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Affiliation(s)
- Byron J Powell
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Maria E Fernandez
- Center for Health Promotion and Prevention Research, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States
| | | | - Gregory A Aarons
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Rinad S Beidas
- Department of Psychiatry, Center for Mental Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States
| | - Cara C Lewis
- MacColl Center for Healthcare Innovation, Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Sheena M McHugh
- School of Public Health, University College Cork, Cork, Ireland
| | - Bryan J Weiner
- Department of Global Health, Department of Health Services, University of Washington, Seattle, WA, United States
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Brunette MF, Cotes RO, de Nesnera A, McHugo G, Dzebisashvili N, Xie H, Bartels SJ. Use of Academic Detailing With Audit and Feedback to Improve Antipsychotic Pharmacotherapy. Psychiatr Serv 2018; 69:1021-1028. [PMID: 29879874 PMCID: PMC6381589 DOI: 10.1176/appi.ps.201700536] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Second-generation antipsychotics vary in their propensity to cause serious cardiometabolic side effects. In addition, use of two or more antipsychotics (polypharmacy) may lead to additive side effects and has not been shown to be consistently more effective than monotherapy. This study examined the use of academic detailing with audit and feedback to improve antipsychotic prescribing practices, including antipsychotic polypharmacy and utilization of medication with high or low risk of cardiometabolic side effects ("high risk" or "low risk," respectively). METHODS Four intervention sessions were provided over two years to psychiatric care providers at community mental health centers. Segmented regression within the general estimating equation model framework used Medicaid pharmacy claims to examine prescribing patterns before and after the intervention among all beneficiaries (67,721 person-months) over a five-year period. RESULTS After the intervention, 10.9% of beneficiaries with antipsychotic claims were on polypharmacy, compared with 13.1% before the invention. Use of high-risk and low-risk antipsychotics did not change. The final adjusted polypharmacy model showed that antipsychotic polypharmacy decreased among young adults and adults ages 40 or older compared with beneficiaries ages 30-39 (β=-.02, p=.04, and β=-.02, p=.007, respectively). The raw proportion of beneficiaries on high- and low-risk agents did not change, although final adjusted models demonstrated changes in use of high- and low-risk agents by diagnosis and risk group. CONCLUSIONS Polypharmacy decreased among young and older adults after academic detailing with audit and feedback. Although further research is needed, this low-intensity intervention may help mental health systems reduce antipsychotic polypharmacy.
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Affiliation(s)
- Mary F. Brunette
- Dartmouth Medical School – Psychiatry, NH-Dartmouth Psychiatric Research Center, State Office Park South, Concord, New Hampshire
| | - Robert O. Cotes
- Emory University - Department of Psychiatry and Behavioral Sciences, Atlanta, Georgia,
| | - Alexander de Nesnera
- Geisel School of Medicine at Dartmouth - Department of Psychiatry, Lebanon, New Hampshire
| | - Gregory McHugo
- Dartmouth College - Dartmouth Psychiatric Research Center, Rivermill Commercial Center, Lebanon, New Hampshire
| | | | - Haiyi Xie
- NH-Dartmouth Psychiatric Research Center, Lebanon, New Hampshire
| | - Stephen J. Bartels
- Dartmouth-Hitchcock Medical Center - Department of Psychiatry, Lebanon, New Hampshire
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Clement M, Filteau P, Harvey B, Jin S, Laubscher T, Mukerji G, Sherifali D. Organization of Diabetes Care. Can J Diabetes 2018; 42 Suppl 1:S27-S35. [DOI: 10.1016/j.jcjd.2017.10.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Indexed: 02/06/2023]
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Brock JM, Lange A, Leonard KL. Giving and promising gifts: Experimental evidence on reciprocity from the field. JOURNAL OF HEALTH ECONOMICS 2018; 58:188-201. [PMID: 29524793 PMCID: PMC5909839 DOI: 10.1016/j.jhealeco.2018.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 02/09/2018] [Accepted: 02/10/2018] [Indexed: 06/13/2023]
Abstract
We test the value of unconditional non-monetary gifts as a way to improve health worker performance in a low income country health setting. We randomly assigned health workers to different gift treatments within a program that visited health workers, measured performance and encouraged them to provide high quality care for their patients. We show that unconditional non-monetary gifts improve performance by 20 percent over a six-week period, compared to the control group. We compare the impact of the unconditional gift to one in which a gift is offered conditional on meeting a performance target and show that only the unconditional gift results in a statistically significant improvement. This demonstrates that organizations can improve the performance of health workers in the medium term without using financial incentives.
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Affiliation(s)
- J Michelle Brock
- European Bank for Reconstruction and Development and CEPR, One Exchange Square, London EC2A 2JN, United Kingdom.
| | - Andreas Lange
- University of Hamburg, Department of Economics, Von Melle Park 5, 20146 Hamburg, Germany.
| | - Kenneth L Leonard
- Department of Agricultural and Resource Economics, University of Maryland, 2200 Symons Hall, College Park 20742, United States.
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Franco T, Aaronson B, Brown L, Blackmore C, Rupp S, Lee G. Effectiveness of a multi-component quality improvement intervention on rates of hyperglycaemia. BMJ Open Qual 2017; 6:e000059. [PMID: 29450273 PMCID: PMC5699161 DOI: 10.1136/bmjoq-2017-000059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 10/04/2017] [Accepted: 10/05/2017] [Indexed: 12/25/2022] Open
Abstract
Purpose To evaluate the effectiveness of a multifaceted, hospital-wide glycaemic control quality improvement programme. Methods The quality improvement intervention comprised three components, derived through root cause analysis: standardising and simplifying care (including evidence-based order sets), increasing visibility (through provider access to clinical data and direct feedback) and educational outreach (directed at the entire institution). Effectiveness was determined at a single urban acute care hospital through time-series analysis with statistical process control charts. Primary outcomes included rate of hyperglycaemia and rate of hypoglycaemia. Results The study included 70 992 hospital admissions for 50 404 patients, with 3 35 645 patient days. The hyperglycaemia ratio decreased 25.2% from 14.1% to 10.5% (95% CI 3.3 to 3.9 percentage points, p<0.001). The ratio of patient days with highly elevated blood glucose (>299 mg/dL) decreased 31.8% from 4.8% to 3.3% (95% CI 1.4 to 1.7 percentage points, p<0.001). Hypoglycaemia ratio decreased from 5.2% to 4.6% (95% CI 0.27 to 0.89 percentage points, p<0.001) in patients with diabetes, but increased in patients without diabetes from 1.2% to 1.7% (95% CI 0.46 to 0.70 percentage points, p<0.001). Conclusions We demonstrate improved hospital-wide glycaemic control after a multifaceted quality improvement intervention in the context of strong institutional commitment, national mentorship and Lean management
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Affiliation(s)
- Thérèse Franco
- Department of Medicine, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Barry Aaronson
- Department of Medicine, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Laurel Brown
- Department of Pharmacy, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Craig Blackmore
- Center for Health Care Improvement Science, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Stephen Rupp
- Department of Anesthesia, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Grace Lee
- Department of Medicine, Virginia Mason Medical Center, Seattle, Washington, USA
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Yoong SL, Grady A, Wiggers J, Flood V, Rissel C, Finch M, Searles A, Salajan D, O’Rourke R, Daly J, Gilham K, Stacey F, Fielding A, Pond N, Wyse R, Seward K, Wolfenden L. A randomised controlled trial of an online menu planning intervention to improve childcare service adherence to dietary guidelines: a study protocol. BMJ Open 2017; 7:e017498. [PMID: 28893755 PMCID: PMC5595182 DOI: 10.1136/bmjopen-2017-017498] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION The implementation of dietary guidelines in childcare settings is recommended to improve child public health nutrition. However, foods provided in childcare services are not consistent with guidelines. The primary aim of the trial is to assess the effectiveness of a web-based menu planning intervention in increasing the mean number of food groups on childcare service menus that comply with dietary guidelines regarding food provision to children in care. METHODS AND ANALYSIS A parallel group randomised controlled trial will be undertaken with 54 childcare services that provide food to children within New South Wales, Australia. Services will be randomised to a 12-month intervention or usual care. The experimental group will receive access to a web-based menu planning and decision support tool and online resources. To support uptake of the web program, services will be provided with training and follow-up support. The primary outcome will be the number of food groups, out of 6 (vegetables, fruit, breads and cereals, meat, dairy and 'discretionary'), on the menu that meet dietary guidelines (Caring for Children) across a 1-week menu at 12-month follow-up, assessed via menu review by dietitians or nutritionists blinded to group allocation. A nested evaluation of child dietary intake in care and child body mass index will be undertaken in up to 35 randomly selected childcare services and up to 420 children aged approximately 3-6 years. ETHICS AND DISSEMINATION Ethical approval has been provided by Hunter New England and University of Newcastle Human Research Ethics Committees. This research will provide high-quality evidence regarding the impact of a web-based menu planning intervention in facilitating the translation of dietary guidelines into childcare services. Trial findings will be disseminated widely through national and international peer-reviewed publications and conference presentations. TRIAL REGISTRATION Prospectively registered with Australian New Zealand Clinical Trial Registry (ANZCTR) ACTRN12616000974404.
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Affiliation(s)
- Sze Lin Yoong
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter New England Local Health District, Population Health, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia
| | - Alice Grady
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter New England Local Health District, Population Health, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia
| | - John Wiggers
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter New England Local Health District, Population Health, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia
| | - Victoria Flood
- Westmead Hospital, Western Sydney Local Health District, Westmead, Australia
- Faculty of Health Sciences and Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | - Chris Rissel
- The University of Sydney, School of Public Health, Camperdown, Australia
- NSW Office of Preventive Health, South Western Sydney Local Health District, Liverpool, Australia
| | - Meghan Finch
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter New England Local Health District, Population Health, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Andrew Searles
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - David Salajan
- Healthy Australia Ltd, St Kilda South, Victoria, Australia
| | - Ruby O’Rourke
- Healthy Australia Ltd, St Kilda South, Victoria, Australia
| | - Jaqueline Daly
- Healthy Australia Ltd, St Kilda South, Victoria, Australia
| | - Karen Gilham
- Hunter New England Local Health District, Population Health, Wallsend, Australia
| | - Fiona Stacey
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter New England Local Health District, Population Health, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia
| | - Alison Fielding
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter New England Local Health District, Population Health, Wallsend, Australia
| | - Nicole Pond
- Hunter New England Local Health District, Population Health, Wallsend, Australia
| | - Rebecca Wyse
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter New England Local Health District, Population Health, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia
| | - Kirsty Seward
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter New England Local Health District, Population Health, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter New England Local Health District, Population Health, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia
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Kc A, Wrammert J, Nelin V, Clark RB, Ewald U, Peterson S, Målqvist M. Evaluation of Helping Babies Breathe Quality Improvement Cycle (HBB-QIC) on retention of neonatal resuscitation skills six months after training in Nepal. BMC Pediatr 2017; 17:103. [PMID: 28399847 PMCID: PMC5387236 DOI: 10.1186/s12887-017-0853-5] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 03/31/2017] [Indexed: 12/03/2022] Open
Abstract
Background Each year 700,000 infants die due to intrapartum-related complications. Implementation of Helping Babies Breathe (HBB)-a simplified neonatal resuscitation protocol in low-resource clinical settings has shown to reduce intrapartum stillbirths and first-day neonatal mortality. However, there is a lack of evidence on the effect of different HBB implementation strategies to improve and sustain the clinical competency of health workers on bag-and-mask ventilation. This study was conducted to evaluate the impact of multi-faceted implementation strategy for HBB, as a quality improvement cycle (HBB-QIC), on the retention of neonatal resuscitation skills in a tertiary hospital of Nepal. Methods A time-series design was applied. The multi-faceted intervention for HBB-QIC included training, daily bag-and-mask skill checks, preparation for resuscitation before every birth, self-evaluation and peer review on neonatal resuscitation skills, and weekly review meetings. Knowledge and skills were assessed through questionnaires, skill checklists, and Objective Structured Clinical Examinations (OSCE) before implementation of the HBB-QIC, immediately after HBB training, and again at 6 months. Means were compared using paired t-tests, and associations between skill retention and HBB-QIC components were analyzed using logistic regression analysis. Results One hundred thirty seven health workers were enrolled in the study. Knowledge scores were higher immediately following the HBB training, 16.4 ± 1.4 compared to 12.8 ± 1.6 before (out of 17), and the knowledge was retained 6 months after the training (16.5 ± 1.1). Bag-and-mask skills improved immediately after the training and were retained 6 months after the training. The retention of bag-and-mask skills was associated with daily bag-and-mask skill checks, preparation for resuscitation before every birth, use of a self-evaluation checklist, and attendance at weekly review meetings. The implementation strategies with the highest association to skill retention were daily bag-and-mask skill checks (RR-5.1, 95% CI 1.9–13.5) and use of self-evaluation checklists after every delivery (RR-3.8, 95% CI 1.4–9.7). Conclusions Health workers who practiced bag-and-mask skills, prepared for resuscitation before every birth, used self-evaluation checklists, and attended weekly review meetings were more likely to retain their neonatal resuscitation skills. Further studies are required to evaluate HBB-QIC in primary care settings, where the number of deliveries is gradually increasing. Trial registration ISRCTN97846009. Date of Registration- 15 August 2012.
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Affiliation(s)
- Ashish Kc
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. .,United Nation's Children's Fund (UNICEF), Nepal Country Officer, UN House, Lalitpur, Nepal.
| | - Johan Wrammert
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Viktoria Nelin
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | - Uwe Ewald
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Stefan Peterson
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Global Health, Public Health Services, Karolinska Institute, Stockholm, Sweden.,School of Public Health, Makerere University, Kamala, Uganda.,Health Section, Programme Division, United Nations Children Fund (UNICEF), United Nations Plaza, New York, NY, 10017, USA
| | - Mats Målqvist
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Application of the Consolidated Framework for Implementation Research to assess factors that may influence implementation of tobacco use treatment guidelines in the Viet Nam public health care delivery system. Implement Sci 2017; 12:27. [PMID: 28241770 PMCID: PMC5330005 DOI: 10.1186/s13012-017-0558-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 02/14/2017] [Indexed: 11/10/2022] Open
Abstract
Background Services to treat tobacco dependence are not readily available to smokers in low-middle income countries (LMICs) where smoking prevalence remains high. We are conducting a cluster randomized controlled trial comparing the effectiveness of two strategies for implementing tobacco use treatment guidelines in 26 community health centers (CHCs) in Viet Nam. Guided by the Consolidated Framework for Implementation Research (CFIR), prior to implementing the trial, we conducted formative research to (1) identify factors that may influence guideline implementation and (2) inform further modifications to the intervention that may be necessary to translate a model of care delivery from a high-income country (HIC) to the local context of a LMIC. Methods We conducted semi-structured qualitative interviews with CHC medical directors, health care providers, and village health workers (VHWs) in eight CHCs (n = 40). Interviews were transcribed verbatim and translated into English. Two qualitative researchers used both deductive (CFIR theory driven) and inductive (open coding) approaches to analysis developed codes and themes relevant to the aims of this study. Results The interviews explored four out of five CFIR domains (i.e., intervention characteristics, outer setting, inner setting, and individual characteristics) that were relevant to the analysis. Potential facilitators of the intervention included the relative advantage of the intervention compared with current practice (intervention characteristics), awareness of the burden of tobacco use in the population (outer setting), tension for change due to a lack of training and need for skill building and leadership engagement (inner setting), and a strong sense of collective efficacy to provide tobacco cessation services (individual characteristics). Potential barriers included the perception that the intervention was more complex (intervention characteristic) and not necessarily compatible (inner setting) with current workflows and staffing historically designed to address infectious disease prevention and control rather than chronic disease prevention and competing priorities that are determined by the MOH (outer setting). Conclusions In this study, CFIR provided a valuable framework for evaluating factors that may influence implementation of a systems-level intervention for tobacco control in a LMIC and understand what adaptations may be needed to translate a model of care delivery from a HIC to a LMIC. Trial registration NCT02564653. Registered September 2015
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Fountoulakis KN, Young A, Yatham L, Grunze H, Vieta E, Blier P, Moeller HJ, Kasper S. The International College of Neuropsychopharmacology (CINP) Treatment Guidelines for Bipolar Disorder in Adults (CINP-BD-2017), Part 1: Background and Methods of the Development of Guidelines. Int J Neuropsychopharmacol 2017; 20:98-120. [PMID: 27815414 PMCID: PMC5408969 DOI: 10.1093/ijnp/pyw091] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 10/20/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND This paper includes a short description of the important clinical aspects of Bipolar Disorder with emphasis on issues that are important for the therapeutic considerations, including mixed and psychotic features, predominant polarity, and rapid cycling as well as comorbidity. METHODS The workgroup performed a review and critical analysis of the literature concerning grading methods and methods for the development of guidelines. RESULTS The workgroup arrived at a consensus to base the development of the guideline on randomized controlled trials and related meta-analyses alone in order to follow a strict evidence-based approach. A critical analysis of the existing methods for the grading of treatment options was followed by the development of a new grading method to arrive at efficacy and recommendation levels after the analysis of 32 distinct scenarios of available data for a given treatment option. CONCLUSION The current paper reports details on the design, method, and process for the development of CINP guidelines for the treatment of Bipolar Disorder. The rationale and the method with which all data and opinions are combined in order to produce an evidence-based operationalized but also user-friendly guideline and a specific algorithm are described in detail in this paper.
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Affiliation(s)
- Konstantinos N Fountoulakis
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Psychiatric Department, Ludwig Maximilians University, Munich, Germany; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria
| | - Allan Young
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Psychiatric Department, Ludwig Maximilians University, Munich, Germany; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria
| | - Lakshmi Yatham
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Psychiatric Department, Ludwig Maximilians University, Munich, Germany; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria
| | - Heinz Grunze
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Psychiatric Department, Ludwig Maximilians University, Munich, Germany; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria
| | - Eduard Vieta
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Psychiatric Department, Ludwig Maximilians University, Munich, Germany; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria
| | - Pierre Blier
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Psychiatric Department, Ludwig Maximilians University, Munich, Germany; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria
| | - Hans Jurgen Moeller
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Psychiatric Department, Ludwig Maximilians University, Munich, Germany; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria
| | - Siegfried Kasper
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Psychiatric Department, Ludwig Maximilians University, Munich, Germany; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria
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Davis ED, Harwood K, Midgett L, Mabrey M, Lien LF. Implementation of a New Intravenous Insulin Method on Intermediate-Care Units in Hospitalized Patients. DIABETES EDUCATOR 2016; 31:818-21, 823. [PMID: 16288089 DOI: 10.1177/0145721705283077] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Good blood glucose control in hospitalized adults leads to reduced mortality. Intravenous (IV) insulin has been shown to be an effective way to achieve tight control of blood glucose. Managing IV insulin is a labor-intensive task for nurses and is generally done in intensive care units with high nurse-to-patient ratios. In this 3-month study, intermediate-care general medicine units with a nurse-to-patient ratio of 1 to 5 or 6 were evaluated for effectiveness of monitoring IV insulin. The project, which relied on intensive in-service education, an audit tool, and continuous positive feedback for nurses, yielded positive results.
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Affiliation(s)
- Ellen D Davis
- The Department of Advanced Practice Nursing, Duke University Medical Center, Durham, North Carolina (Ms Davis, Ms Harwood)
| | - Kerry Harwood
- The Department of Advanced Practice Nursing, Duke University Medical Center, Durham, North Carolina (Ms Davis, Ms Harwood)
| | - Lea Midgett
- The General Medicine Unit, Duke University Medical Center, Durham, North Carolina (Ms Midgett)
| | - Melanie Mabrey
- The Division of Endocrinology, Metabolism, and Nutrition, Duke University Medical Center, Durham, North Carolina (Ms Mabrey, Dr Lien)
| | - Lillian F Lien
- The Division of Endocrinology, Metabolism, and Nutrition, Duke University Medical Center, Durham, North Carolina (Ms Mabrey, Dr Lien)
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Barry HE, Campbell JL, Asprey A, Richards SH. The use of patient experience survey data by out-of-hours primary care services: a qualitative interview study. BMJ Qual Saf 2016; 25:851-859. [PMID: 26490004 PMCID: PMC5136714 DOI: 10.1136/bmjqs-2015-003963] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 09/16/2015] [Accepted: 10/04/2015] [Indexed: 11/13/2022]
Abstract
BACKGROUND English National Quality Requirements mandate out-of-hours primary care services to routinely audit patient experience, but do not state how it should be done. OBJECTIVES We explored how providers collect patient feedback data and use it to inform service provision. We also explored staff views on the utility of out-of-hours questions from the English General Practice Patient Survey (GPPS). METHODS A qualitative study was conducted with 31 staff (comprising service managers, general practitioners and administrators) from 11 out-of-hours primary care providers in England, UK. Staff responsible for patient experience audits within their service were sampled and data collected via face-to-face semistructured interviews. RESULTS Although most providers regularly audited their patients' experiences by using patient surveys, many participants expressed a strong preference for additional qualitative feedback. Staff provided examples of small changes to service delivery resulting from patient feedback, but service-wide changes were not instigated. Perceptions that patients lacked sufficient understanding of the urgent care system in which out-of-hours primary care services operate were common and a barrier to using feedback to enable change. Participants recognised the value of using patient experience feedback to benchmark services, but perceived weaknesses in the out-of-hours items from the GPPS led them to question the validity of using these data for benchmarking in its current form. CONCLUSIONS The lack of clarity around how out-of-hours providers should audit patient experience hinders the utility of the National Quality Requirements. Although surveys were common, patient feedback data had only a limited role in service change. Data derived from the GPPS may be used to benchmark service providers, but refinement of the out-of-hours items is needed.
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Affiliation(s)
- Heather E Barry
- University of Exeter Medical School, University of Exeter, Exeter, Devon, UK
| | - John L Campbell
- University of Exeter Medical School, University of Exeter, Exeter, Devon, UK
| | - Anthea Asprey
- University of Exeter Medical School, University of Exeter, Exeter, Devon, UK
| | - Suzanne H Richards
- University of Exeter Medical School, University of Exeter, Exeter, Devon, UK
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Chau EMT, Manns BJ, Garg AX, Sood MM, Kim SJ, Naimark D, Nesrallah GE, Soroka SD, Beaulieu M, Dixon S, Alam A, Tangri N. Knowledge Translation Interventions to Improve the Timing of Dialysis Initiation: Protocol for a Cluster Randomized Trial. Can J Kidney Health Dis 2016; 3:2054358116665257. [PMID: 28270916 PMCID: PMC5332084 DOI: 10.1177/2054358116665257] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 07/28/2016] [Accepted: 07/28/2016] [Indexed: 11/30/2022] Open
Abstract
Background: Early initiation of chronic dialysis (starting dialysis with higher vs lower kidney function) has risen rapidly in the past 2 decades in Canada and internationally, despite absence of established health benefits and higher costs. In 2014, a Canadian guideline on the timing of dialysis initiation, recommending an intent-to-defer approach, was published. Objective: The objective of this study is to evaluate the efficacy and safety of a knowledge translation intervention to promote the intent-to-defer approach in clinical practice. Design: This study is a multicenter, 2-arm parallel, cluster randomized trial. Setting: The study involves 55 advanced chronic kidney disease clinics across Canada. Patients: Patients older than 18 years who are managed by nephrologists for more than 3 months, and initiate dialysis in the follow-up period are included in the study. Measurements: Outcomes will be measured at the patient-level and enumerated within a cluster. Data on characteristics of each dialysis start will be determined by linkages with the Canadian Organ Replacement Register. Primary outcomes include the proportion of patients who start dialysis early with an estimated glomerular filtration rate greater than 10.5 mL/min/1.73 m2 and start dialysis in hospital as inpatients or in an emergency room setting. Secondary outcomes include the rate of change in early dialysis starts; rates of hospitalizations, deaths, and cost of predialysis care (wherever available); quarterly proportion of new starts; and acceptability of the knowledge translation materials. Methods: We randomized 55 multidisciplinary chronic disease clinics (clusters) in Canada to receive either an active knowledge translation intervention or no intervention for the uptake of the guideline on the timing of dialysis initiation. The active knowledge translation intervention consists of audit and feedback as well as patient- and provider-directed educational tools delivered at a comprehensive in-person medical detailing visit. Control clinics are only exposed to guideline release without active dissemination. We hypothesize that the clinics randomized to the intervention group will have a lower proportion of early dialysis starts. Limitations: Limitations include passive dissemination of the guideline through publication, and lead-time and survivor bias, which favors delayed dialysis initiation. Conclusions: If successful, this active knowledge translation intervention will reduce early dialysis starts, lead to health and economic benefits, and provide a successful framework for evaluating and disseminating future guidelines. Trial Registration: ClinicalTrials.gov, NCT02183987
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Affiliation(s)
- Elaine M T Chau
- Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada; Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
| | - Braden J Manns
- Department of Medicine, University of Calgary, Alberta, Canada
| | - Amit X Garg
- Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Manish M Sood
- The Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada
| | - S Joseph Kim
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Department of Medicine, Division of Nephrology, University of Toronto, Ontario, Canada
| | - David Naimark
- Division of Nephrology, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada
| | - Gihad E Nesrallah
- Li Ka Shing Knowledge Institute, Keenan Research Centre, St Michael's Hospital, and Nephrology Program, Humber River Hospital, Toronto, Ontario, Canada
| | - Steven D Soroka
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Monica Beaulieu
- Division of Nephrology, University of British Columbia, Vancouver, Canada
| | - Stephanie Dixon
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Ahsan Alam
- Division of Nephrology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Navdeep Tangri
- Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada; Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Méndez Boo L, Coma E, Medina M, Hermosilla E, Iglesias M, Olmos C, Calero Muñoz S, Caro Mendivelso J. Effectiveness of computerized point-of-care reminders on adherence with multiple clinical recommendations by primary health care providers: protocol for a cluster-randomized controlled trial. SPRINGERPLUS 2016; 5:1505. [PMID: 27652078 PMCID: PMC5014773 DOI: 10.1186/s40064-016-3124-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 08/23/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND To determine the effectiveness of reminders compared to no reminders in improving adherence to multiple clinical recommendations measured as the resolution of the clinical condition that motivated the reminder, in a primary care setting with a well-established feedback system. METHODS/DESIGN A 12-month, cluster-randomized, controlled clinical trial was designed (randomized by primary care team) to evaluate the impact of computerized reminders. All study participants will continue to receive the usual feedback from the electronic health records system. The control group (well-established feedback) will be compared with reminders and a well-established feedback system. The study will include all general practitioners (3425) and nurses (3262) providing primary care for a population aged 14 years or older in the 282 primary care teams reporting to the Catalan Institute of Health. Up to 10 clinical reminders are offered for each patient, recommending action related to at least one of nine clinical conditions: arterial hypertension, elevated cardiovascular risk, type 2 diabetes mellitus, cerebrovascular accident, ischemic heart disease, heart failure, atrial fibrillation, smoking habit, and hepatitis C. The outcomes are the resolution of the clinical condition that motivated the reminder and the time elapsed between the first reminder message and implementation of the recommended action (months). Due to the obvious correlation between reminders about the same patient, the profile of patients assigned to a particular professional, and the professionals assigned to a particular centre, hierarchical modelling will be used to simultaneously estimate the effect of the study variables at these different levels of analysis. To estimate the impact of the intervention arm, an analysis of adherence to each type of reminder will be carried out, using multi-level logistical regression models at level of the primary care centre. Time to adherence will be estimated by the Kaplan-Meier method and comparisons will be done using the log-rank test. DISCUSSION The results of this study could provide new evidence on the impact of computerized reminders at the point of care on adherence to clinical guidelines in primary care with an established feedback system. Trial registration ISRCTN42391639. October 8, 2012.
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Affiliation(s)
- Leonardo Méndez Boo
- Sistemes d'Informació d'Atenció Primària (SISAP), Institut Català de la Salut, Barcelona, Catalonia Spain
| | - Ermengol Coma
- Sistemes d'Informació d'Atenció Primària (SISAP), Institut Català de la Salut, Barcelona, Catalonia Spain
| | - Manuel Medina
- Sistemes d'Informació d'Atenció Primària (SISAP), Institut Català de la Salut, Barcelona, Catalonia Spain
| | - Eduardo Hermosilla
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Gran Via de les Corts Catalanes 587, 08007 Barcelona, Catalonia Spain
| | - Manuel Iglesias
- Oficina Projecte ECAP, Centre de competència funcional, Institut Català de la Salut, Barcelona, Catalonia Spain
| | - Carmen Olmos
- Oficina Projecte ECAP, Centre de competència funcional, Institut Català de la Salut, Barcelona, Catalonia Spain
| | | | - Johanna Caro Mendivelso
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Gran Via de les Corts Catalanes 587, 08007 Barcelona, Catalonia Spain
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Huh K, Chung DR, Park HJ, Kim MJ, Lee NY, Ha YE, Kang CI, Peck KR, Song JH. Impact of monitoring surgical prophylactic antibiotics and a computerized decision support system on antimicrobial use and antimicrobial resistance. Am J Infect Control 2016; 44:e145-52. [PMID: 26975714 DOI: 10.1016/j.ajic.2016.01.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 01/07/2016] [Accepted: 01/13/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Monitoring of performance indicators and implementation of a computerized decision support system (CDSS) have been suggested as effective measures to improve quality of care. We conducted this study to evaluate the effect of monitoring of surgical prophylactic antibiotics (SPAs) and the CDSS on the antimicrobial use and resistance rate of major nosocomial pathogens. METHODS An interrupted time series with segmented regression analysis in 3 periods (preintervention, SPAs monitoring, and CDSS) was conducted in a tertiary care hospital. Immediate change and change in trends of antimicrobial use density, resistance rate of nosocomial pathogens, and cost of antibiotics in each intervention period were compared with those of the preintervention period. RESULTS Compared with the preintervention period, the change in the slope of the total use of antibiotics was -8.71 defined daily dose (DDD) per 1,000 patient days per month (95% confidence interval [CI], -11.43 to -5.98; P < .01) in the SPAs monitoring period and -1.95 DDD per 1,000 patient days per month (95% CI, -2.93 to -0.96; P < .01) in the CDSS period. Use of third-generation cephalosporins and aminoglycosides showed change comparable with that of total antibiotics use, but use of vancomycin and carbapenem was unchanged in the CDSS period. Trends of the proportions of extended-spectrum β-lactamase-producing Escherichia coli, meropenem-resistant Pseudomonas aeruginosa, and methicillin-resistant Staphylococcus aureus have been reversed or decreased in slope in the CDSS period. Length of hospital stay also showed a negative change in slope in the CDSS period. CONCLUSIONS Monitoring of SPAs and implementation of the CDSS can be effective measures for antimicrobial stewardship.
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Affiliation(s)
- Kyungmin Huh
- Division of Infectious Diseases, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Doo Ryeon Chung
- Division of Infectious Diseases, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Hyo Jung Park
- Department of Pharmacy, Samsung Medical Center, Seoul, Republic of Korea
| | - Min-Ji Kim
- Department of Biostatistics, Samsung Biomedical Research Institute, Seoul, Republic of Korea
| | - Nam Yong Lee
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Eun Ha
- Division of Infectious Diseases, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Cheol-In Kang
- Division of Infectious Diseases, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyong Ran Peck
- Division of Infectious Diseases, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae-Hoon Song
- Division of Infectious Diseases, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Cameron M, Penney G, Maclennan G, McLeer S, Walker A. Impact on Maternity Professionals of Novel Approaches to Clinical Audit Feedback. Eval Health Prof 2016; 30:75-95. [PMID: 17293610 DOI: 10.1177/0163278706297337] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The authors compared three approaches to feedback of clinical audit findings relating to miscarriage in 15 Scottish maternity services (printed report alone; report plus action planning letter; report plus face-to-face facilitated action planning). Clinicians were surveyed to measure theory of planned behavior constructs (in the context of two audit criteria) before and after feedback ( n = 253) and assessed perceptions of the audit through in-depth interviews ( n = 17). Prefeedback, clinicians had positive attitudes and strong subjective norms and intentions to comply, although perceived behavioral control was lower. Generally, positive attitudes, subjective norms, and intentions increased after feedback but for one of the two criteria (providing a 7-day miscarriage service), perceived behavioral control decreased. No changes over time reached statistical significance, and analysis of covariance (adjusting for prefeedback scores) showed no consistent relationships between method of feedback and postfeedback construct scores. Interviews revealed positive perceptions of audit but frustration at lack of capacity to implement changes. Although interventions that increased intensity of feedback proved feasible and acceptable to clinicians, the authors were unable to demonstrate that they increased intention to comply with audit criteria.
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Kiselev AR, Balashov SV, Posnenkova OM, Prokhorov MD, Gridnev VI. Which Measures of Health Status Assessment are the Most Significant in Organized Cohorts with Low Current Cardiovascular Risk? The Screening Study of Penitentiary Staff in Saratov Region, Russia. Eurasian J Med 2016; 48:42-52. [PMID: 27026764 DOI: 10.5152/eurasianjmed.2015.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The aim of the present study was to compare different methods of health status assessment in organized cohort of penitentiary employees in Saratov Region, Russian Federation. MATERIALS AND METHODS 1,014 penitentiary employees (81.8% male) aged 33.4±6.8 years were included in the cohort study. All participants underwent an annual preventive health examination in the Center of Medical and Social Rehabilitation of Russian Federal Penitentiary Service in Saratov Region. The prevalence of common cardiovascular risk factors was assessed. Risk Score and the number of fulfilled health metrics proposed by American Heart Association (AHA) were calculated for each participant. RESULTS It is shown that penitentiary staff in Saratov Region is characterized by low current risk score (1.2±0.8%), but high prevalence of such risk factors as increased body weight and obesity (51%), tobacco use or passive smoking (81%), and unhealthy diet (55%). 98.4% of participants had the Score level of ≤5%, but only 4.5% of penitentiary staff met the ideal cardiovascular health (they met all seven AHA health metrics). One fifth of the participants met three or less AHA health metrics. A statistically significant correlation between the risk Score and the number of fulfilled AHA health metrics is revealed (Chi-square = 5.1, p=0.024). The probability of fulfilment of less than 5 AHA health metrics in subjects with medium risk score is shown to be almost twofold greater than in subjects with low risk Score. However, there are a lot of differences in the assessment of cardiovascular health by risk Score and AHA health metrics. CONCLUSION AHA health metrics are more preferable than the risk Score or assessment of separate cardiovascular risk factors for preventive management in organized cohorts with low current cardiovascular risk such as penitentiary staff in Saratov Region.
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Affiliation(s)
- Anton R Kiselev
- Department of New Cardiological Informational Technologies, Research Institute of Cardiology, Saratov State Medical University n.a. V.I. Razumovsky, Saratov, Russia
| | - Sergey V Balashov
- Center of Medical and Social Rehabilitation of Medical Unit no.64 of Russian Federal Penitentiary Service, Saratov, Russia
| | - Olga M Posnenkova
- Department of New Cardiological Informational Technologies, Research Institute of Cardiology, Saratov State Medical University n.a. V.I. Razumovsky, Saratov, Russia
| | - Mikhail D Prokhorov
- Saratov Branch of the Institute of Radio Engineering and Electronics of Russian Academy of Sciences, Saratov, Russia
| | - Vladimir I Gridnev
- Department of New Cardiological Informational Technologies, Research Institute of Cardiology, Saratov State Medical University n.a. V.I. Razumovsky, Saratov, Russia
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Haw JS, Venkat Narayan KM, Ali MK. Quality improvement in diabetes-successful in achieving better care with hopes for prevention. Ann N Y Acad Sci 2015; 1353:138-51. [DOI: 10.1111/nyas.12950] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
| | - K. M. Venkat Narayan
- School of Medicine
- Rollins School of Public Health; Emory University; Atlanta Georgia
| | - Mohammed K. Ali
- Rollins School of Public Health; Emory University; Atlanta Georgia
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Gold R, Hollombe C, Bunce A, Nelson C, Davis JV, Cowburn S, Perrin N, DeVoe J, Mossman N, Boles B, Horberg M, Dearing JW, Jaworski V, Cohen D, Smith D. Study protocol for "Study of Practices Enabling Implementation and Adaptation in the Safety Net (SPREAD-NET)": a pragmatic trial comparing implementation strategies. Implement Sci 2015; 10:144. [PMID: 26474759 PMCID: PMC4609090 DOI: 10.1186/s13012-015-0333-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 10/05/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little research has directly compared the effectiveness of implementation strategies in any setting, and we know of no prior trials directly comparing how effectively different combinations of strategies support implementation in community health centers. This paper outlines the protocol of the Study of Practices Enabling Implementation and Adaptation in the Safety Net (SPREAD-NET), a trial designed to compare the effectiveness of several common strategies for supporting implementation of an intervention and explore contextual factors that impact the strategies' effectiveness in the community health center setting. METHODS/DESIGN This cluster-randomized trial compares how three increasingly hands-on implementation strategies support adoption of an evidence-based diabetes quality improvement intervention in 29 community health centers, managed by 12 healthcare organizations. The strategies are as follows: (arm 1) a toolkit, presented in paper and electronic form, which includes a training webinar; (arm 2) toolkit plus in-person training with a focus on practice change and change management strategies; and (arm 3) toolkit, in-person training, plus practice facilitation with on-site visits. We use a mixed methods approach to data collection and analysis: (i) baseline surveys on study clinic characteristics, to explore how these characteristics impact the clinics' ability to implement the tools and the effectiveness of each implementation strategy; (ii) quantitative data on change in rates of guideline-concordant prescribing; and (iii) qualitative data on the "how" and "why" underlying the quantitative results. The outcomes of interest are clinic-level results, categorized using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework, within an interrupted time-series design with segmented regression models. This pragmatic trial will compare how well each implementation strategy works in "real-world" practices. DISCUSSION Having a better understanding of how different strategies support implementation efforts could positively impact the field of implementation science, by comparing practical, generalizable methods for implementing clinical innovations in community health centers. Bridging this gap in the literature is a critical step towards the national long-term goal of effectively disseminating and implementing effective interventions into community health centers. TRIAL REGISTRATION ClinicalTrials.gov, NCT02325531.
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Affiliation(s)
- Rachel Gold
- Kaiser Permanente Northwest Center for Health Research, 3800 N. Interstate Avenue, Portland, OR, 97227, USA.
- OCHIN, Inc., 1881 SW Naito Parkway, Portland, OR, 97201, USA.
| | - Celine Hollombe
- Kaiser Permanente Northwest Center for Health Research, 3800 N. Interstate Avenue, Portland, OR, 97227, USA.
| | - Arwen Bunce
- Kaiser Permanente Northwest Center for Health Research, 3800 N. Interstate Avenue, Portland, OR, 97227, USA.
| | | | - James V Davis
- Kaiser Permanente Northwest Center for Health Research, 3800 N. Interstate Avenue, Portland, OR, 97227, USA.
| | - Stuart Cowburn
- OCHIN, Inc., 1881 SW Naito Parkway, Portland, OR, 97201, USA.
| | - Nancy Perrin
- Kaiser Permanente Northwest Center for Health Research, 3800 N. Interstate Avenue, Portland, OR, 97227, USA.
| | - Jennifer DeVoe
- OCHIN, Inc., 1881 SW Naito Parkway, Portland, OR, 97201, USA.
- Oregon Health Science University, 3181 S.W. Sam Jackson Park Rd., Portland, OR, 97239, USA.
| | - Ned Mossman
- OCHIN, Inc., 1881 SW Naito Parkway, Portland, OR, 97201, USA.
| | - Bruce Boles
- Kaiser Permanente Care Management Institute, 1 Kaiser Plaza, 16 L, Oakland, CA, 94612, USA.
| | - Michael Horberg
- Mid-Atlantic Permanente Research Institute, 2101 East Jefferson Street 3 West, Rockville, MD, 20852, USA.
| | - James W Dearing
- College of Communication Arts and Sciences, Michigan State University, 404 Wilson Road, 473, East Lansing, MI, 48824, USA.
| | - Victoria Jaworski
- Multnomah County Public Health Department, 426 SW Stark St, 8th Floor, Portland, OR, 97204, USA.
| | - Deborah Cohen
- Oregon Health Science University, 3181 S.W. Sam Jackson Park Rd., Portland, OR, 97239, USA.
| | - David Smith
- Kaiser Permanente Northwest Center for Health Research, 3800 N. Interstate Avenue, Portland, OR, 97227, USA.
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Benn J, Arnold G, D’Lima D, Wei I, Moore J, Aleva F, Smith A, Bottle A, Brett S. Evaluation of a continuous monitoring and feedback initiative to improve quality of anaesthetic care: a mixed-methods quasi-experimental study. HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03320] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BackgroundThis study evaluated the impact of a continuous quality monitoring and feedback initiative in anaesthesia.ObjectivesTo conduct a quasi-experimental evaluation of the feedback initiative and its effect on quality of anaesthetic care and perioperative efficiency. To understand the longitudinal effects of passive and active feedback and investigate the mechanisms and interactions underpinning those effects.DesignMixed-methods evaluation with analysis and synthesis of data from longitudinal qualitative interviews, longitudinal evaluative surveys and an interrupted time series study.InterventionContinuous measurement of a range of anaesthetic quality indicators was undertaken in a London teaching hospital alongside monthly personal feedback from case summary data to a cohort of anaesthetists, with follow-up roll-out to the whole NHS trust. Basic feedback consisted of the provision of passive monthly personalised feedback reports containing summary case data. In the enhanced phase, data feedback consisted of more sophisticated statistical breakdown of data, comparative and longitudinal views, and was paired with an active programme of dissemination and professional engagement.MethodsBaseline data collection began in March 2010. Implementation of basic feedback took place in October 2010, followed by implementation of the enhanced feedback protocol in July 2012. Weekly aggregated quality indicator data, coupled with surgical site infection and mortality rates, was modelled using interrupted time series analyses. The study anaesthetist cohort comprised 50,235 cases, performed by 44 anaesthetists over the course of the study, with 22,670 cases performed at the primary site. Anaesthetist responses to the surveys were collected pre and post implementation of feedback at all three sites in parallel with qualitative investigation. Seventy anaesthetists completed the survey at one or more time points and 35 health-care professionals, including 24 anaesthetists, were interviewed across two time points.ResultsResults from the time series analysis of longitudinal variation in perioperative indicators did not support the hypothesis that implementation of basic feedback improved quality of anaesthetic care. The implementation of enhanced feedback was found to have a significant positive impact on two postoperative pain measures, nurse-recorded freedom from nausea, mean patient temperature on arrival in recovery and Quality of Recovery Scale scores. Analysis of survey data demonstrated that anaesthetists value perceived credibility of data and local relevance of quality indicators above other criteria when assessing utility of feedback. A significant improvement in the perceived value of quality indicators, feedback, data use and overall effectiveness was observed between baseline and implementation of feedback at the primary site, a finding replicated at the two secondary sites. Findings from the qualitative research elucidated processes of interaction between context, intervention and user, demonstrating a positive response by clinicians to this type of initiative and willingness to interact with a sustained and comprehensive feedback protocol to understand variations in care.ConclusionsThe results support the potential of quality monitoring and feedback interventions as quality improvement mechanisms and provide insight into the positive response of clinicians to this type of initiative, including documentation of the experiences of anaesthetists that participated as users and codesigners of the feedback. Future work in this area might usefully investigate how this type of intervention may be transferred to other areas of clinical practice and further explore interactions between local context and the successful implementation of quality monitoring and feedback systems.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Jonathan Benn
- Imperial Patient Safety Translational Research Centre, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Glenn Arnold
- Department of Anaesthesia, Imperial College Healthcare NHS Trust, London, UK
| | - Danielle D’Lima
- Imperial Patient Safety Translational Research Centre, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Igor Wei
- Imperial Patient Safety Translational Research Centre, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Joanna Moore
- Imperial Patient Safety Translational Research Centre, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Floor Aleva
- IQ Scientific Institute for Quality of Healthcare, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Andrew Smith
- Department of Anaesthesia, Royal Lancaster Infirmary, Lancaster, UK
| | - Alex Bottle
- School of Public Health, Imperial College London, London, UK
| | - Stephen Brett
- Centre for Perioperative Medicine and Critical Care Research, Imperial College Healthcare NHS Trust, London, UK
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Williams CM, Nathan N, Delaney T, Yoong SL, Wiggers J, Preece S, Lubans N, Sutherland R, Pinfold J, Smith K, Small T, Reilly KL, Butler P, Wyse RJ, Wolfenden L. CAFÉ: a multicomponent audit and feedback intervention to improve implementation of healthy food policy in primary school canteens: protocol of a randomised controlled trial. BMJ Open 2015; 5:e006969. [PMID: 26109111 PMCID: PMC4480036 DOI: 10.1136/bmjopen-2014-006969] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 10/31/2014] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION A number of jurisdictions internationally have policies requiring schools to implement healthy canteens. However, many schools have not implemented such policies. One reason for this is that current support interventions cannot feasibly be delivered to large numbers of schools. A promising solution to support population-wide implementation of healthy canteen practices is audit and feedback. The effectiveness of this strategy has, however, not previously been assessed in school canteens. This study aims to assess the effectiveness and cost-effectiveness of an audit and feedback intervention, delivered by telephone and email, in increasing the number of school canteens that have menus complying with a government healthy-canteen policy. METHODS AND ANALYSIS Seventy-two schools, across the Hunter New England Local Health District in New South Wales Australia, will be randomised to receive the multicomponent audit and feedback implementation intervention or usual support. The intervention will consist of between two and four canteen menu audits over 12 months. Each menu audit will be followed by two modes of feedback: a written feedback report and a verbal feedback/support via telephone. Primary outcomes, assessed by dieticians blind to group status and as recommended by the Fresh Tastes @ School policy, are: (1) the proportion of schools with a canteen menu containing foods or beverages restricted for sale, and; (2) the proportion of schools that have a menu which contains more than 50% of foods classified as healthy canteen items. Secondary outcomes are: the proportion of menu items in each category ('red', 'amber' and 'green'), canteen profitability and cost-effectiveness. ETHICS AND DISSEMINATION Ethical approval has been obtained by from the Hunter New England Human Research Ethics Committee and the University of Newcastle Human Research Ethics Committee. The findings will be disseminated in usual forums, including peer-reviewed publication and conference presentations. TRIAL REGISTRATION NUMBER ACTRN12613000543785.
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Affiliation(s)
- Christopher M Williams
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Nicole Nathan
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia Hunter New England Area Health Service, Hunter New England Population Health, Newcastle, New South Wales, Australia
| | - Tessa Delaney
- Hunter New England Area Health Service, Hunter New England Population Health, Newcastle, New South Wales, Australia
| | - Sze Lin Yoong
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia Hunter New England Area Health Service, Hunter New England Population Health, Newcastle, New South Wales, Australia
| | - John Wiggers
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia Hunter New England Area Health Service, Hunter New England Population Health, Newcastle, New South Wales, Australia
| | - Sarah Preece
- Hunter New England Area Health Service, Hunter New England Population Health, Newcastle, New South Wales, Australia
| | - Nicole Lubans
- Hunter New England Area Health Service, Hunter New England Population Health, Newcastle, New South Wales, Australia
| | - Rachel Sutherland
- Hunter New England Area Health Service, Hunter New England Population Health, Newcastle, New South Wales, Australia
| | - Jessica Pinfold
- Hunter New England Area Health Service, Hunter New England Population Health, Newcastle, New South Wales, Australia
| | - Kay Smith
- Hunter New England Area Health Service, Hunter New England Population Health, Newcastle, New South Wales, Australia
| | - Tameka Small
- Hunter New England Area Health Service, Hunter New England Population Health, Newcastle, New South Wales, Australia
| | - Kathryn L Reilly
- Hunter New England Area Health Service, Hunter New England Population Health, Newcastle, New South Wales, Australia
| | - Peter Butler
- Hunter New England Area Health Service, Hunter New England Population Health, Newcastle, New South Wales, Australia
| | - Rebecca J Wyse
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Luke Wolfenden
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
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50
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Ivers NM, Grimshaw JM, Jamtvedt G, Flottorp S, O'Brien MA, French SD, Young J, Odgaard-Jensen J. Growing literature, stagnant science? Systematic review, meta-regression and cumulative analysis of audit and feedback interventions in health care. J Gen Intern Med 2014; 29:1534-41. [PMID: 24965281 PMCID: PMC4238192 DOI: 10.1007/s11606-014-2913-y] [Citation(s) in RCA: 238] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND This paper extends the findings of the Cochrane systematic review of audit and feedback on professional practice to explore the estimate of effect over time and examine whether new trials have added to knowledge regarding how optimize the effectiveness of audit and feedback. METHODS We searched the Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE for randomized trials of audit and feedback compared to usual care, with objectively measured outcomes assessing compliance with intended professional practice. Two reviewers independently screened articles and abstracted variables related to the intervention, the context, and trial methodology. The median absolute risk difference in compliance with intended professional practice was determined for each study, and adjusted for baseline performance. The effect size across studies was recalculated as studies were added to the cumulative analysis. Meta-regressions were conducted for studies published up to 2002, 2006, and 2010 in which characteristics of the intervention, the recipients, and trial risk of bias were tested as predictors of effect size. RESULTS Of the 140 randomized clinical trials (RCTs) included in the Cochrane review, 98 comparisons from 62 studies met the criteria for inclusion. The cumulative analysis indicated that the effect size became stable in 2003 after 51 comparisons from 30 trials. Cumulative meta-regressions suggested new trials are contributing little further information regarding the impact of common effect modifiers. Feedback appears most effective when: delivered by a supervisor or respected colleague; presented frequently; featuring both specific goals and action-plans; aiming to decrease the targeted behavior; baseline performance is lower; and recipients are non-physicians. DISCUSSION There is substantial evidence that audit and feedback can effectively improve quality of care, but little evidence of progress in the field. There are opportunity costs for patients, providers, and health care systems when investigators test quality improvement interventions that do not build upon, or contribute toward, extant knowledge.
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Affiliation(s)
- Noah M Ivers
- Family Practice Health Centre and Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada,
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