1
|
Stephens TJ, Beckingham IJ, Bamber JR, Peden CJ. What Influences the Effectiveness of Quality Improvement in Perioperative Care: Learning From Large Multicenter Studies in Emergency General Surgery? Anesth Analg 2022; 134:559-563. [PMID: 35180173 DOI: 10.1213/ane.0000000000005879] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Timothy J Stephens
- From the William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,Adult Critical Care Unit, The Royal London Hospital, Surgery and Critical Care, Barts Health NHS Trust, London, United Kingdom
| | - Ian J Beckingham
- Department of Hepatico-Pancreatico-Biliary Surgery, Nottingham University Hospitals NHS Foundation Trust, Nottingham, United Kingdom
| | - Jonathan Riddell Bamber
- Department of Medicine, Faculty of Medical Sciences, University College London, London, United Kingdom
| | - Carol J Peden
- Department of Anesthesiology, Keck School of Medicine, University of Southern California, Los Angeles, California.,Department of Anesthesiology, University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|
2
|
Surgical site infection prevention through bundled interventions in hip replacement surgery: A systematic review. Int J Surg 2021; 95:106149. [PMID: 34687953 DOI: 10.1016/j.ijsu.2021.106149] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/30/2021] [Accepted: 10/18/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Bundles have shown to improve patient outcomes in several settings. Surgical site infections (SSIs) following joint replacement surgery are associated with severe outcomes. We aimed to determine the effectiveness of non-pathogen specific bundled interventions in reducing SSIs after hip arthroplasty procedures. MATERIALS AND METHODS A systematic review and meta-analysis were conducted according to the PRISMA statement guidelines (PROSPERO registration number CRD42020203031). PubMed, Embase and Cochrane databases were searched for studies evaluating SSI prevention bundles in hip replacement surgery, excluding studies evaluating pathogen-specific bundles. Records were independently screened by two authors. The primary outcome was the SSI rate in intervention and control groups or before and after bundle implementation. Secondary outcomes of interest were bundle compliance and the number and type of bundle components. A meta-analysis was conducted using raw data, by calculating pooled relative risk (RR) SSI estimates to assess the impact of bundled interventions on SSI reduction. RESULTS Eleven studies were included in the qualitative review and four studies comprising over 20 000 patients were included in the quantitative synthesis. All included studies found bundles were associated with reduced SSI rates. The pooled RR estimated from the fixed-effects model was 0.76 (95% confidence interval 0.61-0.96, p 0.022) with 49.8% heterogeneity. CONCLUSIONS Results support the effectiveness of non-pathogen specific bundled interventions in preventing SSIs following hip arthroplasty. A "core" group of evidence-based elements for bundle development were identified.
Collapse
|
3
|
Standardized aseptic dressing change procedure: Optimizations and adherence in a prospective pre- and postintervention cohort study. Infect Control Hosp Epidemiol 2021; 43:736-741. [PMID: 34027842 DOI: 10.1017/ice.2021.200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The "HygArzt" project investigated the effectiveness of hygiene measures introduced by an infection prevention link physician (PLP). OBJECTIVE To investigate whether the introduction of a standardized aseptic dressing change concept (ADCC) by a PLP can increase hand hygiene adherence and adherence to specific process steps during an aseptic dressing change (ADC) in a trauma surgery and orthopedic department. METHODS We defined 4 required hand disinfection indications: (1) before the preparation of ADC equipment, (2) immediately before the ADC, (3) before the clean phase, and (4) after the ADC. A process analysis of the preintervention phase (331 ADCs) was used to develop a standardized ADCC. The ADCC was introduced and iteratively adopted during the intervention phase. The effect was evaluated during the postintervention phase (374 ADCs). RESULTS Hand hygiene adherence was significantly increased by the introduction of the ADCC for all indications: (1) before the preparation of the ADC equipment (from 34% before to 85% after, P <.001), (2) immediately before an ADC (from 32% before to 85% after; P < .001), (3) before the clean phase (from 42% before to 96% after; P < .001), and (4) after an ADC (from 74% before to 99% after; P < .001). Overall hand hygiene adherence was analyzed before the indications for an ADC (from 9.6% before to 74% after; P < .001). The same strategy was applied to the following process parameters: use of a clean work surface, clean withdrawal of equipment from the dressing trolley, and appropriate waste disposal. CONCLUSIONS A PLP sufficiently implemented a standardized concept for aseptic dressing change during an iterative improvement process, which resulted in a significant improvement in hand hygiene and adherence to other specific ADCC process steps.
Collapse
|
4
|
Impact of a bundle on surgical site infections after hip arthroplasty: A cohort study in Italy (2012–2019). Int J Surg 2020; 82:8-13. [DOI: 10.1016/j.ijsu.2020.07.064] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 07/30/2020] [Indexed: 12/13/2022]
|
5
|
Implementation methods of infection prevention measures in orthopedics and traumatology - a systematic review. Eur J Trauma Emerg Surg 2020; 47:1003-1013. [PMID: 32914198 PMCID: PMC8321980 DOI: 10.1007/s00068-020-01477-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 08/21/2020] [Indexed: 12/11/2022]
Abstract
Background Prevention of hospital-acquired infections, in the clinical field of orthopedics and traumatology especially surgical site infections, is one of the major concerns of patients and physicians alike. Many studies have been conducted proving effective infection prevention measures. The clinical setting, however, requires strategies to transform this knowledge into practice. Question/purpose As part of the HYGArzt-Project (“Proof Of Effectivity And Efficiency Of Implementation Of Infection Prevention (IP) Measures By The Physician Responsible For Infection Prevention Matters In Traumatology/Orthopedics”), the objective of this study was to identify effective implementation strategies for IP (infection prevention) measures in orthopedics and trauma surgery. Methods The systematic review was conducted following PRISMA guidelines. A review protocol was drafted prior to the literature search (not registered). Literature search was performed in MEDLINE, SCOPUS and COCHRANE between January 01, 1950 and June 01, 2019. We searched for all papers dealing with infection and infection control measures in orthopedics and traumatology, which were then scanned for implementation contents. All study designs were considered eligible. Exclusion criteria were language other than English or German and insufficient reporting of implementation methods. Analyzed outcome parameters were study design, patient cohort, infection prevention measure, implementation methods, involved personnel, reported outcome of the studies and study period. Results The literature search resulted in 8414 citations. 13 records were eligible for analysis (all published between 2001 and 2019). Studies were primarily prospective cohort studies featuring various designs and including single IP measures to multi-measure IP bundles. Described methods of implementation were heterogeneous. Main outcome parameters were increase of adherence (iA) to infection prevention (IP) measures or decrease in surgical site infection rate (dSSI%). Positive results were reported in 11 out of 13 studies. Successful implementation methods were building of a multidisciplinary team (considered in 8 out of 11 successful studies [concerning dSSI% in 5 studies, concerning iA in five studies]), standardization of guidelines (considered in 10/11 successful studies [concerning dSSI% in 5 studies, concerning iA in seven studies]), printed or electronic information material (for patient and/or staff; considered in 9/11 successful studies [concerning dSSI% 4/4, concerning iA 5/5]), audits and regular meetings, personal training and other interactive measures as well as regular feedback (considered in 7/11 successful studies each). Personnel most frequently involved were physicians (of those, most frequently surgeons) and nursing professions. Conclusion Although evidence was scarce and quality-inconsistent, we found that adhering to a set of implementation methods focusing on interdisciplinary and interactive /interpersonal work might be an advisable strategy when planning IP improvement interventions in orthopedics and traumatology. Electronic supplementary material The online version of this article (10.1007/s00068-020-01477-z) contains supplementary material, which is available to authorized users.
Collapse
|
6
|
Michas M, Deuchar L, Leigh R, Bhutani M, Rowe BH, Stickland MK, Ospina MB. Factors influencing the implementation and uptake of a discharge care bundle for patients with acute exacerbation of chronic obstructive pulmonary disease: a qualitative focus group study. Implement Sci Commun 2020; 1:3. [PMID: 32924018 PMCID: PMC7477849 DOI: 10.1186/s43058-020-00017-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 01/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is one of the most common causes of mortality and morbidity in high-income countries. In addition to the high costs of initial hospitalization, COPD patients frequently return to the emergency department (ED) and are readmitted to hospital within 30 days of discharge. A COPD acute care discharge care bundle focused on optimizing care for patients with an acute exacerbation of COPD has been shown to reduce ED revisits and hospital readmissions. The aim of this study was to explore and understand factors influencing implementation and uptake of COPD discharge care bundle items in acute care facilities from the perspective of health care providers and patients. METHODS Qualitative methodology was adopted. Nine focus groups were conducted using a semi-structured guide: seven with acute and primary/community health care providers and two with patients/family members. Focus groups were audiotaped, transcribed verbatim, and coded and analyzed using a thematic approach. RESULTS Forty-six health care providers and 14 patients/family members participated in the focus groups. Health care providers and patients identified four factors that can challenge the implementation of COPD discharge care bundles: process of care complexities, human capacity in care settings, communication and engagement, and attitudes and perceptions towards change. Both health care providers and patients recognized process of care complexity as the most important determinant of the COPD discharge bundle uptake. Processes of care complexity include patient activities in seeking and receiving care, as well as practitioner activities in making a diagnosis and recommending or implementing treatment. Important issues linked to human capacity in care settings included time constraints, high patient volume, and limited staffing. Communication during transitions in care across settings and patient engagement were also broadly discussed. Other important issues were linked to patients', providers', and system attitudes towards change and level of involvement in COPD discharge bundle implementation. CONCLUSIONS Complexities in the process of care were perceived as the most important determinant of COPD discharge bundle implementation. Early engagement of health providers and patients in the uptake of COPD discharge bundle items as well as clear communication between acute and post-acute settings can contribute positively to bundle uptake and implementation success.
Collapse
Affiliation(s)
- Marta Michas
- Division of Pulmonary Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta Canada
| | | | - Richard Leigh
- Section of Respiratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada
| | - Mohit Bhutani
- Division of Pulmonary Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta Canada
| | - Brian H. Rowe
- Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta Canada
- School of Public Health, University of Alberta, Edmonton, Alberta Canada
| | - Michael K. Stickland
- Division of Pulmonary Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta Canada
- Alberta Health Services, Edmonton, Alberta Canada
| | - Maria B. Ospina
- School of Public Health, University of Alberta, Edmonton, Alberta Canada
- Department of Obstetrics & Gynecology and Medicine, Faculty of Medicine & Dentistry, University of Alberta, 220B Heritage Medical Research Centre, Edmonton, Alberta T6G 2S2 Canada
| |
Collapse
|
7
|
Morrell AT, Golladay GJ, Kates SL. Surgical selection criteria compliance is associated with a lower risk of periprosthetic joint infection in total hip arthroplasty. Arthroplast Today 2019; 5:521-524. [PMID: 31886401 PMCID: PMC6921180 DOI: 10.1016/j.artd.2019.10.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 10/24/2019] [Accepted: 10/26/2019] [Indexed: 12/17/2022] Open
Abstract
Background Periprosthetic joint infection (PJI) is a devastating complication of total hip arthroplasty (THA). Patient optimization represents an important target for PJI prevention. Unfortunately, best practice screening guidelines are not consistently followed by all surgeons. Our study aimed to determine both the degree and the effect that compliance with our institutional preoperative surgical selection criteria had on PJI rates for patients undergoing elective primary THA. Methods A retrospective review was conducted on 455 elective primary THA procedures performed at an academic tertiary care center over a 2-year period. Institutional preoperative surgical selection criteria included the following: body mass index ≤40 kg/m2, hemoglobin A1c ≤7.5%, hemoglobin ≥12 g/dL, albumin ≥3.5 g/dL, no smoking within 30 days prior to surgery, and completion of a decolonization protocol if a nasal polymerase chain reaction was positive for Staphylococcus aureus. PJI was assessed for a minimum 1-year follow-up using Musculoskeletal Infection Society criteria from 2011. Rates of compliance and PJI were compared using a chi-squared test. Results Surgeon compliance with institutional preoperative selection criteria was 62.4% and ranged from 0.0% to 83.9%. Five of 455 patients developed a PJI. The total PJI rate was 1.1%. The compliant patient cohort had a PJI rate of 0.0%, while the noncompliant cohort had a PJI rate of 2.9% (P = .0038). Conclusions This study identified a statistically significant decrease in PJI rates among patients who met all preoperative screening criteria.
Collapse
Affiliation(s)
- Aidan T Morrell
- School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Gregory J Golladay
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Stephen L Kates
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA, USA
| |
Collapse
|
8
|
Stephens T, Johnston C, Hare S. Quality improvement and emergency laparotomy care: what have we learnt from recent major QI efforts? Clin Med (Lond) 2019; 19:454-457. [PMID: 31732584 PMCID: PMC6899256 DOI: 10.7861/clinmed.2019.0251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
More than 1.53 million adults undergo inpatient surgery in the UK NHS. Patients undergoing emergency abdominal surgery have a much greater risk of death than patients admitted for elective surgery. Widespread variations in key standards of care between hospitals exist and are associated with differences in mortality rates.Recently there have been three large-scale initiatives to improve quality of care for emergency laparotomy patients: the National Emergency Laparotomy Audit, the enhanced perioperative care for high-risk patients trial and the Emergency Laparotomy Collaborative. Here we provide a critical review of what we currently know about the use of structured methods for improving the quality of healthcare services, with reference to the three initiatives. We find that using structured methods to improve care is the hallmark of quality improvement but attention must too be paid to the context in which these methods are used.
Collapse
Affiliation(s)
- Tim Stephens
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Carolyn Johnston
- St Georges University Hospital NHS Trust, London, UK and quality improvement lead, National Emergency Laparotomy Audit, Royal College of Anaesthetists, London, UK
| | - Sarah Hare
- Medway Maritime Hospital, Kent, UK and clinical lead, National Emergency Laparotomy Audit, Royal College of Anaesthetists, London, UK
| |
Collapse
|
9
|
Stephens TJ, Bamber JR, Beckingham IJ, Duncan E, Quiney NF, Abercrombie JF, Martin G. Understanding the influences on successful quality improvement in emergency general surgery: learning from the RCS Chole-QuIC project. Implement Sci 2019; 14:84. [PMID: 31443689 PMCID: PMC6708165 DOI: 10.1186/s13012-019-0932-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 04/05/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Acute gallstone disease is the highest volume Emergency General Surgical presentation in the UK. Recent data indicate wide variations in the quality of care provided across the country, with national guidance for care delivery not implemented in most UK hospitals. Against this backdrop, the Royal College of Surgeons of England set up a 13-hospital quality improvement collaborative (Chole-QuIC) to support clinical teams to reduce time to surgery for patients with acute gallstone disease requiring emergency cholecystectomy. METHODS Prospective, mixed-methods process evaluation to answer the following: (1) how was the collaborative delivered by the faculty and received, understood and enacted by the participants; (2) what influenced teams' ability to improve care for patients requiring emergency cholecystectomy? We collected and analysed a range of data including field notes, ethnographic observations of meetings, and project documentation. Analysis was based on the framework approach, informed by Normalisation Process Theory, and involved the creation of comparative case studies based on hospital performance during the project. RESULTS Chole-QuIC was delivered as planned and was well received and understood by participants. Four hospitals were identified as highly successful, based upon a substantial increase in the number of patients having surgery in line with national guidance. Conversely, four hospitals were identified as challenged, achieving no significant improvement. The comparative analysis indicate that six inter-related influences appeared most associated with improvement: (1) achieving clarity of purpose amongst site leads and key stakeholders; (2) capacity to lead and effective project support; (3) ideas to action; (4) learning from own and others' experience; (5) creating additional capacity to do emergency cholecystectomies; and (6) coordinating/managing the patient pathway. CONCLUSION Collaborative-based quality improvement is a viable strategy for emergency surgery but success requires the deployment of effective clinical strategies in conjunction with improvement strategies. In particular, achieving clarity of purpose about proposed changes amongst key stakeholders was a vital precursor to improvement, enabling the creation of additional surgical capacity and new pathways to be implemented effectively. Protected time, testing ideas, and the ability to learn quickly from data and experience were associated with greater impact within this cohort.
Collapse
Affiliation(s)
- Timothy J. Stephens
- William Harvey Research Institute, Queen Mary University of London, c/o ACCU RESEARCH TEAM, 4th Floor, Central Tower, The Royal London Hospital, LONDON, E1 1BB United Kingdom
| | | | - Ian J. Beckingham
- Department of Hepatobiliary and Pancreatic Surgery, The Queens Medical Centre, Nottingham, UK
| | - Ellie Duncan
- Department of Professional Standards, The Royal College of Surgeons of England, London, UK
| | - Nial F. Quiney
- Department of Anaesthesia, Royal Surrey County Hospital, Guildford, UK
| | | | - Graham Martin
- THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, UK
| |
Collapse
|
10
|
Calderwood MS, Yokoe DS, Murphy MV, DeBartolo KO, Duncan K, Chan C, Schneider EC, Parry G, Goldmann D, Huang S. Effectiveness of a multistate quality improvement campaign in reducing risk of surgical site infections following hip and knee arthroplasty. BMJ Qual Saf 2018; 28:374-381. [PMID: 30297375 DOI: 10.1136/bmjqs-2018-007982] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 08/05/2018] [Accepted: 08/26/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Quality improvement (QI) campaigns appear to increase use of evidence-based practices, but their effect on health outcomes is less well studied. OBJECTIVE To assess the effect of a multistate QI campaign (Project JOINTS, Joining Organizations IN Tackling SSIs) that used the Institute for Healthcare Improvement's Rapid Spread Network to promote adoption of evidence-based surgical site infection (SSI) prevention practices. METHODS We analysed rates of SSI among Medicare beneficiaries undergoing hip and knee arthroplasty during preintervention (May 2010 to April 2011) and postintervention (November 2011 to September 2013) periods in five states included in a multistate trial of the Project JOINTS campaign and five matched comparison states. We used generalised linear mixed effects models and a difference-in-differences approach to estimate changes in SSI outcomes. RESULTS 125 070 patients underwent hip arthroplasty in 405 hospitals in intervention states, compared with 131 787 in 525 hospitals in comparison states. 170 663 patients underwent knee arthroplasty in 397 hospitals in intervention states, compared with 196 064 in 518 hospitals in comparison states. After the campaign, patients in intervention states had a 15% lower odds of developing hip arthroplasty SSIs (OR=0.85, 95% CI 0.75 to 0.96, p=0.01) and a 12% lower odds of knee arthroplasty SSIs than patients in comparison states (OR=0.88, 95% CI 0.78 to 0.99, p=0.04). CONCLUSIONS A larger reduction of SSI rates following hip and knee arthroplasty was shown in intervention states than in matched control states.
Collapse
Affiliation(s)
- Michael S Calderwood
- Section of Infectious Disease and International Health, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Deborah S Yokoe
- Division of Infectious Diseases, University of California San Francisco, San Francisco, California, USA
| | - Michael V Murphy
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | | | - Kathy Duncan
- Institute for Healthcare Improvement, Boston, Massachusetts, USA
| | - Christina Chan
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | | | - Gareth Parry
- Institute for Healthcare Improvement, Boston, Massachusetts, USA
| | - Don Goldmann
- Institute for Healthcare Improvement, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Susan Huang
- Division of Infectious Diseases and Healthy Policy Research Institute, University of California Irvine School of Medicine, Irvine, California, USA
| |
Collapse
|
11
|
Khodyakov D, Sharif MZ, Jones F, Heller SM, Pulido E, Wells KB, Bromley E. Whole Person Care in Under-resourced Communities: Stakeholder Priorities at Long-Term Follow-Up in Community Partners in Care. Ethn Dis 2018; 28:371-380. [PMID: 30202190 DOI: 10.18865/ed.28.s2.371] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective Depressed individuals may require help from different agencies to address health and social needs, but how such coordination occurs in under-resourced communities is poorly understood. This study sought to identify priorities of Latino and African American depressed clients, explore whether service providers understand client priorities, and describe how providers address them. Methods Between October 2014 and February 2015, we interviewed 104 clients stratified by depression history and 50 representatives of different programs in health and social community agencies who participated in Community Partners in Care, a cluster-randomized trial of coalition-building approaches to delivering depression quality improvement programs. Clients were queried about their most pressing needs; program representatives identified their clients' needs and explained how they addressed them. Results Physical and mental health were clients' top priorities, followed by housing, caring for and building relationships with others, and employment. While persistently depressed clients prioritized mental health, those with improved depression prioritized relationships with others. Program representatives identified housing, employment, mental health, and improving relationships with others as clients' top priorities. Needs assessment, client-centered services, and linkages to other agencies were main strategies used to address client needs. Conclusion Depressed clients have multiple health and social needs, and program representatives in under-resourced communities understand the complexity of clients' needs. Agencies rely on needs assessment and referrals to meet their clients' needs, which enhances the importance of agency partnership in "whole person" initiatives. Our results illustrate agency capacity to adopt integrated care models that will address clients' multiple needs through multi-sector collaboration and describe potential strategies to help reach the goal of whole person care.
Collapse
Affiliation(s)
| | | | - Felica Jones
- Healthy African American Families II, Los Angeles, CA
| | - S Megan Heller
- Center for Health Services and Society, University of California, Los Angeles, CA
| | | | - Kenneth B Wells
- Center for Health Services and Society, University of California, Los Angeles, David Geffen School of Medicine, Department of Psychiatry & Biobehavioral Sciences; RAND Corporation; University of California, Los Angeles School of Public Health
| | - Elizabeth Bromley
- Center for Health Services and Society, University of California, Los Angeles, David Geffen School of Medicine, Department of Psychiatry & Biobehavioral Sciences; Desert Pacific MIRECC Health Services Unit, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| |
Collapse
|
12
|
Schneider EC, Sorbero ME, Haas A, Ridgely MS, Khodyakov D, Setodji CM, Parry G, Huang SS, Yokoe DS, Goldmann D. Does a quality improvement campaign accelerate take-up of new evidence? A ten-state cluster-randomized controlled trial of the IHI's Project JOINTS. Implement Sci 2017; 12:51. [PMID: 28412954 PMCID: PMC5393011 DOI: 10.1186/s13012-017-0579-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 03/28/2017] [Indexed: 11/25/2022] Open
Abstract
Background A decade ago, the Institute for Healthcare Improvement pioneered a quality improvement (QI) campaign, leveraging organizational and personal social networks to disseminate new practices. There have been few rigorous studies of the QI campaign approach. Methods Project JOINTS (Joining Organizations IN Tackling SSIs) engaged a network of state-based organizations and professionals in a 6-month QI campaign promoting adherence to three new evidence-based practices known to reduce the risk of infection after joint replacement. We conducted a cluster-randomized trial including ten states (five campaign states and five non-campaign states) with 188 hospitals providing joint replacement to Medicare. We measured adherence to the evidence-based practices before and after the campaign using a survey of surgical staff and a difference-in-difference design with multivariable adjustment to compare adherence to each of the relevant practices and an all-or-none composite measure of the three new practices. Results In the campaign states, there were statistically significant increases in adherence to the three new evidence-based practices promoted by the campaign. Compared to the non-campaign states, the relative increase in adherence to the three new practices in the campaign states ranged between 1.9 and 15.9 percentage points, but only one of these changes (pre-operative nasal screening for Staphylococcus aureus carriage and decolonization prior to surgery) was statistically significant (p < 0.05). On the all-or-none composite measure, adherence to all three evidence-based practices increased from 19.6 to 37.9% in the campaign states, but declined slightly in the comparison states, yielding a relative increase of 23 percentage points (p = 0.004). In the non-campaign states, changes in adherence were not statistically significant. Conclusions Within 6 months, in a cluster-randomized trial, a multi-state campaign targeting hospitals and professionals involved in surgical care and infection control was associated with an increase in adherence to evidence-based practices that can reduce surgical site infection. Electronic supplementary material The online version of this article (doi:10.1186/s13012-017-0579-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Eric C Schneider
- RAND Corporation, Santa Monica, CA, USA. .,Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA. .,Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA. .,The Commonwealth Fund, One East 75th Street, New York, NY, 10021, USA.
| | | | - Ann Haas
- RAND Corporation, Santa Monica, CA, USA
| | | | | | | | - Gareth Parry
- Institute for Healthcare Improvement and Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Susan S Huang
- Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Deborah S Yokoe
- Division of Infectious Diseases, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Don Goldmann
- Institute for Healthcare Improvement and Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
| |
Collapse
|