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González Mariño MA. Sentinel node in breast cancer as an indicator of quality in medical care: Evaluation of statistics in Colombia. Breast Dis 2024; 43:65-69. [PMID: 38607745 DOI: 10.3233/bd-230059] [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] [Indexed: 04/14/2024]
Abstract
BACKGROUND Sentinel lymph node biopsy in breast cancer is considered the standard of staging in cases of clinically negative lymph nodes. Its omission in favor of axillary dissection generates significant morbidity. OBJECTIVE To determine the total number of sentinel node biopsy procedures in breast cancer in Colombia from 2017 through 2020, model and analyze them as if they were performed only in stage I breast cancer patients, and integrate their results into the concepts of quality of medical care. METHODS Search in a database of the Ministry of Health and Social Protection of Colombia with sentinel lymph node biopsy codes, and filters of breast cancer and year. Their results are contrasted with the number of cases in stage I of breast cancer. RESULTS Breast cancer TNM staging was reported in 22154 cases, 3648 stage I. In the same time frame, the number of sentinel lymph node biopsies for breast cancer in Colombia was 1045, 28.64% of the total cases reported in stage I. CONCLUSIONS Colombia is far from complying with the standard indicator of sentinel lymph node biopsy. It is recommended to concentrate breast cancer cases in hospitals that provide the conditions for its performance.
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Affiliation(s)
- Mario Arturo González Mariño
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universidad Nacional de Colombia, Bogotá D.C, Colombia
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Leung K, McLeod M, Torode J, Ilbawi A, Chakowa J, Bourbeau B, Sengar M, Booth CM, Gralow JR, Sullivan R, Aggarwal A. Quality indicators for systemic anticancer therapy services: a systematic review of metrics used to compare quality across healthcare facilities. Eur J Cancer 2023; 195:113389. [PMID: 37924649 DOI: 10.1016/j.ejca.2023.113389] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/08/2023] [Accepted: 10/11/2023] [Indexed: 11/06/2023]
Abstract
PURPOSE The number of systemic anticancer therapy (SACT) regimens has expanded rapidly over the last decade. There is a need to ensure quality of SACT delivery across cancer services and systems in different resource settings to reduce morbidity, mortality, and detrimental economic impact at individual and systems level. Existing literature on SACT focuses on treatment efficacy with few studies on quality or how SACT is delivered within routine care in comparison to radiation and surgical oncology. METHODS Systematic review was conducted following PRISMA guidelines. EMBASE and MEDLINE were searched and handsearching was undertaken to identify literature on existing quality indicators (QIs) that detect meaningful variations in the quality of SACT delivery across different healthcare facilities, regions, or countries. Data extraction was undertaken by two independent reviewers. RESULTS This review identified 63 distinct QIs from 15 papers. The majority were process QIs (n = 55, 87.3%) relating to appropriateness of treatment and guideline adherence (n = 28, 44.4%). There were few outcome QIs (n = 7, 11.1%) and only one structural QI (n = 1, 1.6%). Included studies solely focused on breast, colorectal, lung, and skin cancer. All but one studies were conducted in high-income countries. CONCLUSIONS The results of this review highlight a significant lack of research on SACT QIs particularly those appropriate for resource-constrained settings in low- and middle-income countries. This review should form the basis for future work in transforming performance measurement of SACT provision, through context-specific QI SACT development, validation, and implementation.
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Affiliation(s)
- Kari Leung
- Department of Oncology, Guy's & St Thomas' NHS Foundation Trust, London, UK.
| | - Megan McLeod
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Julie Torode
- Institute of Cancer Policy, King's College London, London, UK
| | | | | | - Brian Bourbeau
- American Society of Clinical Oncology, Alexandria, Virginia, USA
| | - Manju Sengar
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - Christopher M Booth
- Division of Cancer Care and Epidemiology, Departments of Oncology and Public Health, Queen's Cancer Research Institute, Queen's University, Kingston, Ontario, Canada
| | - Julie R Gralow
- American Society of Clinical Oncology, Alexandria, Virginia, USA
| | | | - Ajay Aggarwal
- Department of Oncology, Guy's & St Thomas' NHS Foundation Trust, London, UK; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Philpot S, Youl PH, Harden H, Morris M, Furnival C, Dunn N, Moore J, Theile DE. Development and implementation of a population-based breast cancer quality index in Queensland, Australia. J Cancer Policy 2021; 29:100291. [DOI: 10.1016/j.jcpo.2021.100291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 05/16/2021] [Accepted: 05/26/2021] [Indexed: 11/28/2022]
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Imai S, Kiyomi A, Sugiura M, Fushimi K. Healthcare utilization associated with adherence to antibiotics for abdominal surgeries in Japan: cross-sectional analysis of administrative database. Int J Qual Health Care 2021; 33:6106515. [PMID: 33480426 DOI: 10.1093/intqhc/mzab017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/16/2020] [Accepted: 01/22/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Since patients receiving surgery may experience surgical site infections, therapeutic guidelines for reducing hospitalization time and cost include appropriate antibiotic use. However, the association between adherence to therapeutic guidelines and healthcare utilization is currently unclear. OBJECTIVES This study aimed to confirm the positive association between the adherence to guidelines of antibiotic therapy and a reduction in the length of stay and cost of hospitalization, especially considering the high infection rates in abdominal surgery. METHODS This cross-sectional study used administrative data (diagnosis procedure combination data) collected using the case-mix system implemented in acute-care hospitals in Japan. We assessed the length of hospital stay and cost of hospitalization for patients who received prophylactic antibiotic for abdominal surgeries consistent with therapeutic guidelines. The data of patients aged 15 years or older who received appendectomy, laparoscopic cholecystectomy or inguinal hernia repair were extracted. The appropriateness of antibiotic prophylaxis was evaluated in terms of the Japanese guidelines for antibiotic selection and treatment duration. To assess the mean difference in antibiotic costs and length of stay, we performed the propensity score matching by confounding factors. Furthermore, we assessed the progress in healthcare utilization of this therapy over a decade. RESULTS Of the 302 233 patients who received single general surgery from April 2014 to March 2016, 198 885 were eligible for analysis after applying the exclusion criteria (143 975 in the adherence and 54 910 in the non-adherence group). Each group comprised 48 439 patients after propensity score matching. Inappropriate antibiotic selection and duration were observed in 9294 (9.8%) and 687 (0.7%) of inguinal hernia repairs, 6431 (25.3%) and 311 (1.2%) of appendectomies and 38 134 (48.5%) and 391 (0.5%) of laparoscopic cholecystectomy cases, respectively. After propensity score matching by operation type, average hospitalization length (6.5 [SD 3.8] and 7.3 [SD 4.8] days) and costs (536 000 [SD 167 000] JPY and 573 000 [SD 213 000] JPY) differed significantly between adherence and non-adherence groups. CONCLUSION The results revealed that unnecessary healthcare utilization was associated with failure to adhere to therapeutic guidelines for prophylactic antibiotic therapy in elective general surgeries. We concluded that the progress of reduction in length of hospitalization over the decade was successful. Notably, adherence to treatment duration was better than that was 10 years ago. In this decade, administrators in hospitals have attempted to reduce the duration of hospitalization by developing various clinical pathways for surgical procedures and quality indicators. However, 15 877 patients (8.7%) were prescribed oral antibiotics the day after surgery. These observations should be evaluated further.
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Affiliation(s)
- Shinobu Imai
- Department of Drug Safety and Risk Management, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, 1432-1, Horinouchi, Tokyo 192-0392, Japan.,Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo 113-8510, Japan
| | - Anna Kiyomi
- Department of Drug Safety and Risk Management, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, 1432-1, Horinouchi, Tokyo 192-0392, Japan
| | - Munetoshi Sugiura
- Department of Drug Safety and Risk Management, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, 1432-1, Horinouchi, Tokyo 192-0392, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo 113-8510, Japan
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Ferranti M, Pinnarelli L, Rosa A, Pastorino R, D’Ovidio M, Fusco D, Davoli M. Evaluation of the breast cancer care network within the Lazio Region (Central Italy). PLoS One 2020; 15:e0238562. [PMID: 32881971 PMCID: PMC7470269 DOI: 10.1371/journal.pone.0238562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 08/14/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND OBJECTIVES A summary indicator for evaluating the breast cancer network has never been measured at the regional level. The aim is to design treemaps providing a summary description of hospitals (including breast units) and Local Health Units (LHUs) in terms of their levels of performance within the breast cancer network of the Lazio region (central Italy). The treemap structure has an intuitive design and displays information from both general and specific analyses. METHODS Patients admitted to the regional hospitals for malignant breast cancer (MBC) surgery in 2010-2017 were selected in a population-based cohort study. These quality indicators were calculated based on the international guidelines (EUSOMA, ESMO) to assess the performance in terms of volume of activity, surgery procedure, post-surgery assistance and timeliness of medical therapy or radiotherapy beginning. The quality indicators were calculated using administrative health data systematically collected at the regional level and were included in the treemap to represent the surgery or the post-surgery areas of the breast cancer clinical pathway. In order to allow aggregation of scores for different indicators belonging to the same clinical area, up to five evaluation classes were defined using the "Jenks Natural Breaks" algorithm. A score and a colour were assigned to each clinical area based on the ranking of the indicators involved. The analyses were performed on an annual basis, by the LHU of residence and by the hospital which performed the surgical intervention. RESULTS In 2017, 6218 surgical interventions for MBC were performed in the hospitals of Lazio. The results showed a continuous increase of the level of performance over the years. Hospitals showed higher variability in the levels of performance than the LHUs. 36% of the evaluated hospitals reached a high level of performance. An audit of the S. Filippo Neri breast unit revealed incorrect coding of the input data. For this reason, the score for the indicator for the volume of wards was re-calculated and re-evaluated, with a subsequent improvement of the level of performance. Most LHUs achieved at least an average overall level of performance, with 20% of the LHUs reaching a high level of performance. CONCLUSIONS This is the first attempt to apply the treemap logic to a single clinical network, in order to obtain a summary indicator for the evaluation of the breast cancer care network. Our results supply decision makers with a transparent instrument of governance for heterogeneous users, directing efforts improving and promoting equity of care. The treemaps could be reproduced and adapted for other local contexts, in order to limit inappropriateness and ensure uniform levels of breast cancer care within local areas. The next step is the evaluation of audit and feedback interventions to improve the quality of care and to guarantee homogeneous levels of care throughout the region.
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Affiliation(s)
- Margherita Ferranti
- Department of Epidemiology of Lazio Regional Health Service, Rome, Italy
- Department of Woman and Child Health and Public Health—Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
- * E-mail:
| | - Luigi Pinnarelli
- Department of Epidemiology of Lazio Regional Health Service, Rome, Italy
| | - Alessandro Rosa
- Department of Epidemiology of Lazio Regional Health Service, Rome, Italy
| | - Roberta Pastorino
- Department of Woman and Child Health and Public Health—Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | | | - Danilo Fusco
- Lazio Regional Health Service, Department of Health Information Systems, Rome, Italy
| | - Marina Davoli
- Department of Epidemiology of Lazio Regional Health Service, Rome, Italy
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Matsumura S, Ozaki M, Iwamoto M, Kamitani S, Toyama M, Waza K, Higashi T, Bito S. Development and Pilot Testing of Quality Indicators for Primary Care in Japan. JMA J 2019; 2:131-138. [PMID: 33615023 PMCID: PMC7889691 DOI: 10.31662/jmaj.2018-0053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 02/22/2019] [Indexed: 11/09/2022] Open
Abstract
Introduction: To the best of our knowledge, no quality indicators (QIs) for primary care provided by local clinics have yet been developed in Japan. We aimed to develop valid and applicable QIs to evaluate primary care in Japan. Methods: Two focus group interviews were held to identify conceptual categories. Existing indicators for these categories were identified, and initial sets of potential QIs were developed. Using a modified Delphi appropriateness method, a multidisciplinary expert panel then developed and selected the QIs. Feasibility and applicability of these QIs were then confirmed in pilot testing at six local clinics in Hokkaido, Japan. To determine patient acceptance of these quality improvement activities, the survey asked two questions, “Do you think it is preferable that the patients of this clinic be periodically surveyed?” and “Do you think it is preferable that this clinic periodically undergo an external quality review by an independent body?” Results: Seven categories emerged from the focus group discussions as key components of primary care in Japan. Thirty-nine QIs under five categories (Comprehensive care/Standardized care, Access, Communication, Co-ordination, and Understanding of patient background) were finally selected and named the QIs for Primary Care Practice in Japan. In pilot testing at six primary care clinics in 2015, 65.4% of patients answered favorably to the idea that clinics should conduct regular patient surveys, and 71.8% answered favorably to the idea that clinics should undergo periodic external quality review by an independent body. Conclusions: We developed QIs to assess primary care services provided by clinics in Japan, for the first time. Although further refinement is required, establishment of these QIs is the first step in quality improvement for primary care practices in Japan.
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Affiliation(s)
- Shinji Matsumura
- Division of Clinical Epidemiology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan.,Matsumura Clinic, Tokyo, Japan
| | - Makiko Ozaki
- Internal Medicine, Horikawa Hospital, Kyoto, Japan
| | - Momoko Iwamoto
- Center for Cancer Control and Information Services, Division of Health Service Research, National Cancer Center, Tokyo, Japan
| | - Satoru Kamitani
- Department of Public Health, University of Tokyo, Tokyo, Japan
| | | | | | - Takahiro Higashi
- Center for Cancer Control and Information Services, Division of Health Service Research, National Cancer Center, Tokyo, Japan
| | - Seiji Bito
- Division of Clinical Epidemiology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
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Ozaki M, Matsumura S, Iwamoto M, Kamitani S, Higashi T, Toyama M, Bito S, Waza K. Quality of primary care provided in community clinics in Japan. J Gen Fam Med 2019; 20:48-54. [PMID: 30873304 PMCID: PMC6399592 DOI: 10.1002/jgf2.229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 11/24/2018] [Accepted: 12/10/2018] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Quality indicators (QIs) for primary care are used worldwide. To date, however, the use of QIs to assess the quality of primary care in Japan has not been reported besides diabetes care. Here, we used QIs to evaluate the quality of primary care services provided by local clinics in Japan. METHODS Four primary care clinics participated in the retrospective medical chart review in 2015. To assess primary care quality, we used 18 process-oriented QIs from the Quality Indicators for Primary Care practice in Japan (QIPC-J) those we previously developed by using a modified Delphi appropriateness method, which comprises 39 QIs in five categories (Comprehensive care/Standardized care, Access, Communication, Coordination, and Understanding of patient's background). Adult subjects were selected from among patients who visited each clinic within the previous one year using medical claims data. We collected data by reviewing medical charts, and calculated the quality score for each QI and clinic. RESULTS A cumulative total of 4330 medical charts were reviewed. The overall quality score was 31.5%. Adherence to QIs ranged from 3.2% to 85.6%. Some quality scores varied substantially between clinics but the overall quality of care among clinics varied less, from 29.2% to 34.0%. CONCLUSIONS The quality of primary care services provided by local clinics in Japan varies by both QI and clinic. Strategies to improve the quality of care are warranted.
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Affiliation(s)
| | - Shinji Matsumura
- Division of Clinical EpidemiologyNational Hospital Organization Tokyo Medical leftTokyoJapan
- Matsumura ClinicTokyoJapan
| | - Momoko Iwamoto
- Division of Health Service Researchleft for Cancer Control and Information ServicesNational Cancer CenterTokyoJapan
| | | | - Takahiro Higashi
- Division of Health Service Researchleft for Cancer Control and Information ServicesNational Cancer CenterTokyoJapan
| | | | - Seiji Bito
- Division of Clinical EpidemiologyNational Hospital Organization Tokyo Medical leftTokyoJapan
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Ueda K, Kaso M, Ohtera S, Nakayama T. Updating quality indicators for low-risk labour care in Japan using current clinical practice guidelines: a modified Delphi method. BMJ Open 2019; 9:e023595. [PMID: 30819701 PMCID: PMC6398654 DOI: 10.1136/bmjopen-2018-023595] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 10/17/2018] [Accepted: 12/12/2018] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES Quality indicators are measurable elements widely used to assess the quality of care. They are often developed from the results of systematic reviews or clinical practice guidelines. These sources are regularly updated in line with new clinical evidence, but there are few articles on updating quality indicators based on clinical practice guidelines. This study aimed to update the quality indicators developed for low-risk labour care in Japan in 2012, mainly drawing on new or updated clinical practice guidelines, and making the process clearly visible and assessable. DESIGN AND SETTING We used a modified Delphi method for the update. The procedure included four steps: (1) updating the definition of low-risk labour; (2) reviewing the literature published between June 2012 and December 2015 using five guidelines and two quality indicator databases to extract potential candidate indicators; (3) formation of a multidisciplinary panel including mothers and (4) panel ratings (two rounds between February and April 2016) on the validity of the candidate indicators, and judging the validity of the previous quality indicators drawing on the new evidence. PARTICIPANTS A multidisciplinary panel of 13 clinicians, including obstetricians, paediatricians and midwives, plus 3 non-clinician mothers. RESULTS The literature review identified 276 new recommendations from 27 clinical practice guidelines including 2 published in Japan and 21 quality indicators. We developed 13 new candidate indicators from these sources and panel recommendations, 12 of which were approved by the multidisciplinary panel. The panel also accepted all 23 existing quality indicators as still valid, resulting in a total of 35 quality indicators for low-risk labour. CONCLUSIONS We successfully updated the quality indicators for low-risk labour care in Japan. The procedure developed may be useful for updating other quality indicators based on new clinical practice guidelines.
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Affiliation(s)
- Kayo Ueda
- Department of Health Informatics in the School of Public Health, Kyoto University, Kyoto, Japan
- Graduate School of Nursing Women’s Health & Midwifery, School of Medicine Faculty of Nursing Department of Maternal Nursing, Nara Medical University, Kashihara, Japan
| | - Misato Kaso
- Department of Health Informatics in the School of Public Health, Kyoto University, Kyoto, Japan
| | - Shosuke Ohtera
- Department of Health Informatics in the School of Public Health, Kyoto University, Kyoto, Japan
| | - Takeo Nakayama
- Department of Health Informatics in the School of Public Health, Kyoto University, Kyoto, Japan
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Berian JR, Thomas JM, Minami CA, Farrell PR, O'Leary KJ, Williams MV, Prachand VN, Halverson AL, Bilimoria KY, Johnson JK. Evaluation of a novel mentor program to improve surgical care for US hospitals. Int J Qual Health Care 2017; 29:234-242. [PMID: 28453822 DOI: 10.1093/intqhc/mzx005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 01/12/2017] [Indexed: 01/22/2023] Open
Abstract
Objective To evaluate a novel mentor program for 27 US surgeons, charged with improving quality at their respective hospitals, having been paired 1:1 with 27 surgeon mentors through a state-wide quality improvement (QI) initiative. Design Mixed-methods utilizing quantitative surveys and in-depth semi-structured interviews. Setting The Illinois Surgical Quality Improvement Collaborative (ISQIC) utilized a novel Mentor Program to guide surgeons new to QI. Participants All mentor-mentee pairs received the survey (n = 27). Purposive sampling identified a subset of mentors (n = 8) and mentees (n = 4) for in-depth semi-structured interviews. Intervention Surgeons with expertise in QI mentored surgeons new to QI. Main outcome measures (i) Quantitative: self-reported satisfaction with the mentor program; (ii) Qualitative: key themes suggesting actions and strategies to facilitate mentorship in QI. Results Mentees expressed satisfaction with the mentor program (n = 24, 88.9%) and agreed that mentorship is vital to ISQIC (n = 24, 88.9%). Analysis of interview data revealed four key themes: (i) nuances of data management, (ii) culture of quality and safety, (iii) mentor-mentee relationship and (iv) logistics. Strategies from these key themes include: utilize raw data for in-depth QI understanding, facilitate presentations to build QI support, identify opportunities for in-person meetings and establish scheduled conference calls. The mentor's role required sharing experiences and acting as a resource. The mentee's role required actively bringing questions and identifying barriers. Conclusions Mentorship plays a vital role in advancing surgeon knowledge and engagement with QI in ISQIC. Key themes in mentorship reflect strategies to best facilitate mentorship, which may serve as a guide to other collaboratives.
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Affiliation(s)
- Julia R Berian
- Illinois Surgical Quality Improvement Collaborative (ISQIC), 633 N. St Clair St., 20th Floor, Chicago, IL 60611, USA
| | - Juliana M Thomas
- Illinois Surgical Quality Improvement Collaborative (ISQIC), 633 N. St Clair St., 20th Floor, Chicago, IL 60611, USA
| | - Christina A Minami
- Illinois Surgical Quality Improvement Collaborative (ISQIC), 633 N. St Clair St., 20th Floor, Chicago, IL 60611, USA
| | - Paula R Farrell
- Illinois Surgical Quality Improvement Collaborative (ISQIC), 633 N. St Clair St., 20th Floor, Chicago, IL 60611, USA
| | - Kevin J O'Leary
- Illinois Surgical Quality Improvement Collaborative (ISQIC), 633 N. St Clair St., 20th Floor, Chicago, IL 60611, USA
| | - Mark V Williams
- Illinois Surgical Quality Improvement Collaborative (ISQIC), 633 N. St Clair St., 20th Floor, Chicago, IL 60611, USA
| | - Vivek N Prachand
- Illinois Surgical Quality Improvement Collaborative (ISQIC), 633 N. St Clair St., 20th Floor, Chicago, IL 60611, USA
| | - Amy L Halverson
- Illinois Surgical Quality Improvement Collaborative (ISQIC), 633 N. St Clair St., 20th Floor, Chicago, IL 60611, USA
| | - Karl Y Bilimoria
- Illinois Surgical Quality Improvement Collaborative (ISQIC), 633 N. St Clair St., 20th Floor, Chicago, IL 60611, USA
| | - Julie K Johnson
- Illinois Surgical Quality Improvement Collaborative (ISQIC), 633 N. St Clair St., 20th Floor, Chicago, IL 60611, USA
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