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Xu H, Chen ZH, She J, Zhang YH. Process management program to prevent falls in hospitalized patients with neuropsychiatric disorders: a quality improvement program. Int J Qual Health Care 2024; 36:mzae034. [PMID: 38619120 DOI: 10.1093/intqhc/mzae034] [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: 09/04/2023] [Revised: 03/18/2024] [Accepted: 04/09/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Falls were among the most common adverse nursing events. The incidence of falls in patients with neuropsychiatric disorders was high, and the occurrence of falls not only caused physical and psychological harm to patients but also led to medical disputes. Therefore, interventions for falls prevention were essential, but evaluations of the intervention process were lacking. METHODS In this study, a process management program to prevent falls based on the "structure-process-outcome" quality evaluation model was designed and applied to the clinical practice of falls prevention in hospitalized patients with neuropsychiatric disorders. The process quality evaluation checklist to prevent falls was used to supervise the implementation effect of intervention measures to prevent falls, identify the problems in the intervention measures, and make continuous improvements, to reduce the incidence of falls in such hospitalized patients as the final index. RESULTS The incidence of inpatient falls decreased from 0.199‰ (0.199 per 1000 patient-days) to 0.101‰ (0.101 per 1000 patient-days) before and after the implementation of the process management program for 12 months, 24 months, and 36 months, respectively, and the difference was statistically significant (P < .05). The probability of falls was reduced by 49% after 36 months of monitoring. Furthermore, the proportion of patients at high risk of falls exhibited a downward trend. CONCLUSION This quality improvement program was feasible and effective at reducing falls in hospitalized patients with neuropsychiatric disorders. Therefore, attention should be given to monitoring process quality in the management of falls.
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Affiliation(s)
- Hua Xu
- Department of Adult Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Zhao-Hong Chen
- Department of Adult Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Juan She
- Department of Adult Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yan-Hong Zhang
- Department of Nursing, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
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Kansara B, Basta A, Mikhael M, Perkins R, Reisman P, Hallanger-Johnson J, Rollison DE, Nguyen OT, Powell S, Gilbert SM, Turner K. Suicide Risk Screening for Head and Neck Cancer Patients: An Implementation Study. Appl Clin Inform 2024; 15:404-413. [PMID: 38777326 PMCID: PMC11111312 DOI: 10.1055/s-0044-1787006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 03/27/2024] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVES There is limited research on suicide risk screening (SRS) among head and neck cancer (HNC) patients, a population at increased risk for suicide. To address this gap, this single-site mixed methods study assessed oncology professionals' perspectives about the feasibility, acceptability, and appropriateness of an electronic SRS program that was implemented as a part of routine care for HNC patients. METHODS Staff who assisted with SRS implementation completed (e.g., nurses, medical assistants, advanced practice providers, physicians, social workers) a one-time survey (N = 29) and interview (N = 25). Quantitative outcomes were assessed using previously validated feasibility, acceptability, and appropriateness measures. Additional qualitative data were collected to provide context for interpreting the scores. RESULTS Nurses and medical assistants, who were directly responsible for implementing SRS, reported low feasibility, acceptability, and appropriateness, compared with other team members (e.g., physicians, social workers, advanced practice providers). Team members identified potential improvements needed to optimize SRS, such as hiring additional staff, improving staff training, providing different modalities for screening completion among individuals with disabilities, and revising the patient-reported outcomes to improve suicide risk prediction. CONCLUSION Staff perspectives about implementing SRS as a part of routine cancer care for HNC patients varied widely. Before screening can be implemented on a larger scale for HNC and other cancer patients, additional implementation strategies may be needed that optimize workflow and reduce staff burden, such as staff training, multiple modalities for completion, and refined tools for identifying which patients are at greatest risk for suicide.
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Affiliation(s)
- Bhargav Kansara
- Department of Oncological Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida, United States
| | - Ameer Basta
- Department of Oncological Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida, United States
| | - Marian Mikhael
- Department of Oncological Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida, United States
| | - Randa Perkins
- Department of Internal and Hospital Medicine, Moffitt Cancer Center, Tampa, Florida, United States
- Department of Clinical Informatics, Center for Digital Health, Moffitt Cancer Center, Tampa, Florida, United States
| | - Phillip Reisman
- Department of Clinical Informatics, Center for Digital Health, Moffitt Cancer Center, Tampa, Florida, United States
| | - Julie Hallanger-Johnson
- Mayo Clinic College of Medicine and Science, Division of Endocrinology, Metabolism, Diabetes, and Nutrition, Rochester, Minnesota, United States
| | - Dana E. Rollison
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida, United States
| | - Oliver T. Nguyen
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, United States
| | - Sean Powell
- Department of Social Work, Moffitt Cancer Center, Tampa, Florida, United States
| | - Scott M. Gilbert
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida, United States
| | - Kea Turner
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, United States
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Florida, United States
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Sara SA, Schwarz A, Knopp MI, Warm EJ. Twelve tips for creating a longitudinal quality improvement and safety education for early health professions students. MEDICAL TEACHER 2024; 46:330-336. [PMID: 37917988 DOI: 10.1080/0142159x.2023.2274137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
Despite the numerous calls for integrating quality improvement and patient safety (QIPS) curricula into health professions education, there are limited examples of effective implementation for early learners. Typically, pre-clinical QIPS experiences involve lectures or lessons that are disconnected from the practice of medicine. Consequently, students often prioritize other content they consider more important. As a result, they may enter clinical settings without essential QIPS skills and struggle to incorporate these concepts into their early professional identity formation. In this paper, we present twelve tips aimed at assisting educators in developing QIPS education early in the curricula of health professions students. These tips address various key issues, including aligning incentives, providing longitudinal experiences, incorporating real-world care outcomes, optimizing learning environments, communicating successes, and continually enhancing education and care delivery processes.
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Affiliation(s)
- S Anthony Sara
- College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Anna Schwarz
- Department of Internal Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Michelle I Knopp
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Eric J Warm
- Department of Internal Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
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Desveaux L, Ivers N. Practice or perfect? Coaching for a growth mindset to improve the quality of healthcare. BMJ Qual Saf 2024:bmjqs-2023-016456. [PMID: 38355297 DOI: 10.1136/bmjqs-2023-016456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 01/28/2024] [Indexed: 02/16/2024]
Affiliation(s)
- Laura Desveaux
- Trillium Health Partners Institute for Better Health, Mississauga, Ontario, Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Noah Ivers
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada
- Department of Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada
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Turner K, McNett M, Potter C, Cramer E, Al Taweel M, Shorr RI, Mion LC. Alarm with care-a de-implementation strategy to reduce fall prevention alarm use in US hospitals: a study protocol for a hybrid 2 effectiveness-implementation trial. Implement Sci 2023; 18:70. [PMID: 38053114 PMCID: PMC10696656 DOI: 10.1186/s13012-023-01325-9] [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: 10/18/2023] [Accepted: 11/22/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Fall prevention alarms are commonly used among US hospitals as a fall prevention strategy despite limited evidence of effectiveness. Further, fall prevention alarms are harmful to healthcare staff (e.g., alarm fatigue) and patients (e.g., sleep disturbance, mobility restriction). There is a need for research to develop and test strategies for reducing use of fall prevention alarms in US hospitals. METHODS To address this gap, we propose testing the effectiveness and implementation of Alarm with Care, a de-implementation strategy to reduce fall prevention alarm use using a stepped-wedge randomized controlled trial among 30 adult medical or medical surgical units from nonfederal US acute care hospitals. Guided by the Choosing Wisely De-Implementation Framework, we will (1) identify barriers to fall prevention alarm de-implementation and develop tailored de-implementation strategies for each unit and (2) compare the implementation and effectiveness of high- versus low-intensity coaching to support site-specific de-implementation of fall prevention alarms. We will evaluate effectiveness and implementation outcomes and examine the effect of multi-level (e.g., hospital, unit, and patient) factors on effectiveness and implementation. Rate of fall prevention alarm use is the primary outcome. Balancing measures will include fall rates and fall-related injuries. Implementation outcomes will include feasibility, acceptability, appropriateness, and fidelity. DISCUSSION Findings from this line of research could be used to support scale-up of fall prevention alarm de-implementation in other healthcare settings. Further, research generated from this proposal will advance the field of de-implementation science by determining the extent to which low-intensity coaching is an effective and feasible de-implementation strategy. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT06089239 . Date of registration: October 17, 2023.
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Affiliation(s)
- Kea Turner
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA.
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA.
- Department of Oncological Sciences, University of South Florida Morsani College of Medicine, MFC-EDU, 12902 USF Magnolia Drive, Tampa, FL, 33612-9416, USA.
| | - Molly McNett
- Helene Fuld Health Trust National Institute for Evidence-Based Practice, The Ohio State University, 760 Kinnear Road, Columbus, OH, 43212, USA
| | - Catima Potter
- Press Ganey Associates, 1173 Ignition Dr, South Bend, IN, 46601, USA
| | - Emily Cramer
- Department of Health Outcomes and Health Services Research, Children's Mercy Hospital and Clinics, 2401 Gilham Road, Kansas City, MO, 64108, USA
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, 2411 Holmes Street, Kansas City, MO, 64108, USA
| | - Mona Al Taweel
- College of Nursing, The Ohio State University, 1577 Neil Avenue, Columbus, OH, 43210, USA
| | - Ronald I Shorr
- Geriatric Research Education and Clinical Center, North Florida/South Georgia Veterans Health System, 1601 SW Archer Road, Gainesville, FL, 32608, USA
- Department of Epidemiology, College of Public Health and Health Professions, University of Florida, 1225 Center Drive, Gainesville, FL, 32611, USA
| | - Lorraine C Mion
- College of Nursing, The Ohio State University, 1577 Neil Avenue, Columbus, OH, 43210, USA
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Albers B, Auer R, Caci L, Nyantakyi E, Plys E, Podmore C, Riegel F, Selby K, Walder J, Clack L. Implementing organized colorectal cancer screening programs in Europe-protocol for a systematic review of determinants and strategies. Syst Rev 2023; 12:26. [PMID: 36849979 PMCID: PMC9969690 DOI: 10.1186/s13643-023-02193-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 02/16/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND With a high mortality of 12.6% of all cancer cases, colorectal cancer (CRC) accounts for substantial burden of disease in Europe. In the past decade, more and more countries have introduced organized colorectal cancer screening programs, making systematic screening available to entire segments of a population, typically based on routine stool tests and/or colonoscopy. While the effectiveness of organized screening in reducing CRC incidence and mortality has been confirmed, studies continuously report persistent program implementation challenges. This systematic review will synthesize the literature on organized CRC screening programs. Its aim is to understand what is currently known about the barriers and facilitators that influence the implementation of these programs and about the implementation strategies used to navigate these determinants. METHODS A systematic review of primary studies of any research design will be conducted. CENTRAL, CINAHL, EMBASE, International Clinical Trials Registry Platform, MEDLINE, PsycINFO, and Scopus will be searched. Websites of (non-)government health care organizations and websites of organizations affiliated with authors of included studies will be screened for unpublished evaluation reports. Existing organized CRC screening programs will be contacted with a request to share program-specific grey literature. Two researchers will independently screen each publication in two rounds for eligibility. Included studies will focus on adult populations involved in the implementation of organized CRC screening programs and contain information about implementation determinants/ strategies. Publications will be assessed for their risk of bias. Data extraction will include study aim, design, location, setting, sample, methods, and measures; program characteristics; implementation stage, framework, determinants, strategies, and outcomes; and service and other outcome information. Findings will be synthesized narratively using the three stages of thematic synthesis. DISCUSSION With its sole focus on the implementation of organized CRC screening programs, this review will help to fill a central knowledge gap in the literature on colorectal cancer screening. Its findings can inform the decision-making in policy and practice needed to prioritize resources for establishing new and maintaining existing programs in the future. SYSTEMATIC REVIEW REGISTRATION PROSPERO (CRD42022306580).
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Affiliation(s)
- Bianca Albers
- Institute for Implementation Science in Health Care (IfIS), Medical Faculty, University of Zurich, Universitätstrasse 84, 8006, Zurich, Switzerland.
| | - Reto Auer
- Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
| | - Laura Caci
- Institute for Implementation Science in Health Care (IfIS), Medical Faculty, University of Zurich, Universitätstrasse 84, 8006, Zurich, Switzerland
| | - Emanuela Nyantakyi
- Institute for Implementation Science in Health Care (IfIS), Medical Faculty, University of Zurich, Universitätstrasse 84, 8006, Zurich, Switzerland
| | - Ekaterina Plys
- Center for primary care and public health (Unisanté), University of Lausanne, Rue de Bugnon 44, 1010, Lausanne, Switzerland
| | - Clara Podmore
- Center for primary care and public health (Unisanté), University of Lausanne, Rue de Bugnon 44, 1010, Lausanne, Switzerland
| | - Franziska Riegel
- Institute for Implementation Science in Health Care (IfIS), Medical Faculty, University of Zurich, Universitätstrasse 84, 8006, Zurich, Switzerland
| | - Kevin Selby
- Center for primary care and public health (Unisanté), University of Lausanne, Rue de Bugnon 44, 1010, Lausanne, Switzerland
| | - Joel Walder
- Institute for Implementation Science in Health Care (IfIS), Medical Faculty, University of Zurich, Universitätstrasse 84, 8006, Zurich, Switzerland
| | - Lauren Clack
- Institute for Implementation Science in Health Care (IfIS), Medical Faculty, University of Zurich, Universitätstrasse 84, 8006, Zurich, Switzerland.,Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
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Singh AN, Sanchez V, Kenzie ES, Sullivan E, McCormack JL, Hiebert Larson J, Robbins A, Weekley T, Hatch BA, Dickinson C, Elder NC, Muench JP, Davis MM. Improving screening, treatment, and intervention for unhealthy alcohol use in primary care through clinic, practice-based research network, and health plan partnerships: Protocol of the ANTECEDENT study. PLoS One 2022; 17:e0269635. [PMID: 35763485 PMCID: PMC9239445 DOI: 10.1371/journal.pone.0269635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 05/24/2022] [Indexed: 11/18/2022] Open
Abstract
Background Unhealthy alcohol use (UAU) is a leading cause of morbidity and mortality in the United States, contributing to 95,000 deaths annually. When offered in primary care, screening, brief intervention, referral to treatment (SBIRT), and medication-assisted treatment for alcohol use disorder (MAUD) can effectively address UAU. However, these interventions are not yet routine in primary care clinics. Therefore, our study evaluates tailored implementation support to increase SBIRT and MAUD in primary care. Methods ANTECEDENT is a pragmatic implementation study designed to support 150 primary care clinics in Oregon adopting and optimizing SBIRT and MAUD workflows to address UAU. The study is a partnership between the Oregon Health Authority Transformation Center—state leaders in Medicaid health system transformation—SBIRT Oregon and the Oregon Rural Practice-based Research Network. We recruited clinics providing primary care in Oregon and prioritized reaching clinics that were small to medium in size (<10 providers). All participating clinics receive foundational support (i.e., a baseline assessment, exit assessment, and access to the online SBIRT Oregon materials) and may opt to receive tailored implementation support delivered by a practice facilitator over 12 months. Tailored implementation support is designed to address identified needs and may include health information technology support, peer-to-peer learning, workflow mapping, or expert consultation via academic detailing. The study aims are to 1) engage, recruit, and conduct needs assessments with 150 primary care clinics and their regional Medicaid health plans called Coordinated Care Organizations within the state of Oregon, 2) implement and evaluate the impact of foundational and supplemental implementation support on clinic change in SBIRT and MAUD, and 3) describe how practice facilitators tailor implementation support based on context and personal expertise. Our convergent parallel mixed-methods analysis uses RE-AIM (reach, effectiveness, adoption, implementation, maintenance). It is informed by a hybrid of the i-PARIHS (integrated Promoting Action on Research Implementation in Health Services) and the Dynamic Sustainability Framework. Discussion This study will explore how primary care clinics implement SBIRT and MAUD in routine practice and how practice facilitators vary implementation support across diverse clinic settings. Findings will inform how to effectively align implementation support to context, advance our understanding of practice facilitator skill development over time, and ultimately improve detection and treatment of UAU across diverse primary care clinics.
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Affiliation(s)
- Amrita N. Singh
- Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Victoria Sanchez
- Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Erin S. Kenzie
- Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Eliana Sullivan
- Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, Oregon, United States of America
| | - James L. McCormack
- Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Jean Hiebert Larson
- Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Alissa Robbins
- Oregon Health Authority Transformation Center, Portland, Oregon, United States of America
| | - Tiffany Weekley
- Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Brigit A. Hatch
- Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, Oregon, United States of America
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Caitlin Dickinson
- Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Nancy C. Elder
- Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, Oregon, United States of America
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, United States of America
| | - John P. Muench
- Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, Oregon, United States of America
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Melinda M. Davis
- Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, Oregon, United States of America
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, United States of America
- Community Health, OHSU-PSU School of Public Health, Portland, Oregon, United States of America
- * E-mail:
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