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Kornelsen J, Cameron A, Stoll K, Skinner T, Humber N, Williams K, Ebert S. A mixed-methods descriptive study on the role of continuous quality improvement in rural surgical and obstetrical stability: Considering enablers, challenges and impact. PLoS One 2024; 19:e0300977. [PMID: 38843178 PMCID: PMC11156343 DOI: 10.1371/journal.pone.0300977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 03/07/2024] [Indexed: 06/09/2024] Open
Abstract
INTRODUCTION The Rural Surgical Obstetrical Networks (RSON) initiative in BC was developed to stabilize and grow low volume rural surgical and obstetrical services. One of the wrap-around supportive interventions was funding for Continuous Quality Improvement (CQI) initiatives, done through a local provider-driven lens. This paper reviews mixed-methods findings on providers' experiences with CQI and the implications for service stability. BACKGROUND Small, rural hospitals face barriers in implementing quality improvement initiatives due primarily to lack of resource capacity and the need to prioritize clinical care when allocating limited health human resources. Given this, funding and resources for CQI were key enablers of the RSON initiative and seen as an essential part of a response to assuaging concerns of specialists at higher volume sites regarding quality in lower volume settings. METHODS Data were derived from two datasets: in-depth, qualitative interviews with rural health care providers and administrators over the course of the RSON initiative and through a survey administered at RSON sites in 2023. FINDINGS Qualitative findings revealed participants' perceptions of the value of CQI (including developing expanded skillsets and improved team function and culture), enablers (the organizational infrastructure for CQI projects), challenges in implementation (complications in protecting/prioritizing CQI time and difficulty with staff engagement) and the importance of local leadership. Survey findings showed high ratings for elements of team function that relate directly to CQI (team process and relationships). CONCLUSION Attention to effective mechanisms of CQI through a rural lens is essential to ensure that initiatives meet the contextual realities of low-volume sites. Instituting pathways for locally-driven quality improvement initiatives enhances team function at rural hospitals through creating opportunities for trust building and goal setting, improving communication and increasing individual and team-wide motivation to improve patient care.
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Affiliation(s)
- Jude Kornelsen
- Centre for Rural Health Research, Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Audrey Cameron
- Centre for Rural Health Research, Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kathrin Stoll
- Centre for Rural Health Research, Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tom Skinner
- Rural Coordination Centre of British Columbia, Vancouver, British Columbia, Canada
| | - Nancy Humber
- Rural Coordination Centre of British Columbia, Vancouver, British Columbia, Canada
| | - Kim Williams
- Rural Coordination Centre of British Columbia, Vancouver, British Columbia, Canada
| | - Sean Ebert
- Rural Coordination Centre of British Columbia, Vancouver, British Columbia, Canada
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Dias T, MacKay D, Canuto K, Boyle JA, D’Antoine H, Hampton D, Martin K, Phillips J, Bartlett N, Mcintyre HD, Graham S, Corpus S, Connors C, McCarthy L, Kirkham R, Maple-Brown LJ. Supporting healthy lifestyles for First Nations women and communities through co-design: lessons and early findings from remote Northern Australia. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2024; 5:1356060. [PMID: 38863516 PMCID: PMC11165116 DOI: 10.3389/fcdhc.2024.1356060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 04/24/2024] [Indexed: 06/13/2024]
Abstract
Background The period before, during, and after pregnancy presents an opportunity to reduce diabetes-related risks, which in Australia disproportionately impact Aboriginal and Torres Strait Islander women. Collaboration with Aboriginal and Torres Strait Islander women/communities is essential to ensure acceptability and sustainability of lifestyle modifications. Using a novel co-design approach, we aimed to identify shared priorities and potential lifestyle strategies. We also reflected on learnings from this approach. Methods We conducted 11 workshops and 8 interviews at two sites in Australia's Northern Territory (Central Australia and Top End), using experience-based co-design (EBCD) and incorporating principles of First Nations participatory research. Workshops/interviews explored participant' experiences and understanding of diabetes in pregnancy, contextual issues, and potential lifestyle strategies. Participants included three groups: 1) Aboriginal and Torres Strait Islander women of reproductive age (defined as aged 16-45 years); 2) Aboriginal and Torres Strait Islander community members; and 3) health/community services professionals. The study methodology sought to amplify the voices of Aboriginal women. Findings Participants included 23 women between ages 16-45 years (9 with known lived experience of diabetes in pregnancy), 5 community members and 23 health professionals. Key findings related to identified priority issues, strategies to address priorities, and reflections on use of EBCD methodology. Priorities were largely consistent across study regions: access to healthy foods and physical activity; connection to traditional practices and culture; communication regarding diabetes and related risks; and the difficulty for women of prioritising their health among competing priorities. Strategies included implementation of a holistic women's program in Central Australia, while Top End participants expressed the desire to improve nutrition, peer support and community awareness of diabetes. EBCD provided a useful structure to explore participants' experiences and collectively determine priorities, while allowing for modifications to ensure co-design methods were contextually appropriate. Challenges included the resource-intensive nature of stakeholder engagement, and collaborating effectively with services and communities when researchers were "outsiders". Conclusions A hybrid methodology using EBCD and First Nations participatory research principles enabled collaboration between Aboriginal women, communities and health services to identify shared priorities and solutions to reduce diabetes-related health risks. Genuine co-design processes support self-determination and enhance acceptability and sustainability of health strategies.
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Affiliation(s)
- Tara Dias
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Diana MacKay
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
- Department of Endocrinology, Royal Darwin Hospital, Darwin, NT, Australia
| | - Karla Canuto
- College of Medicine and Public Health, Flinders University , Melbourne, VIC, Australia
| | - Jacqueline A. Boyle
- Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Heather D’Antoine
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
- School of Public Health, University of Queensland, Brisbane, QLD, Australia
| | - Denella Hampton
- Central Australian Aboriginal Congress, Alice Springs, NT, Australia
- Aboriginal and Torres Strait Islander Advisory Group, Diabetes Across the Lifecourse: Northern Australia Partnership, Darwin, NT, Australia
| | - Kim Martin
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Jessica Phillips
- Women’s Cultural Hub, Mala’la Community Wellness Centre, Mala’la Aboriginal Health Corporation, Maningrida, NT, Australia
| | - Norlisha Bartlett
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - H. David Mcintyre
- Mater Research, The University of Queensland, Brisbane, QLD, Australia
| | - Sian Graham
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
- Aboriginal and Torres Strait Islander Advisory Group, Diabetes Across the Lifecourse: Northern Australia Partnership, Darwin, NT, Australia
| | - Sumaria Corpus
- Aboriginal and Torres Strait Islander Advisory Group, Diabetes Across the Lifecourse: Northern Australia Partnership, Darwin, NT, Australia
- Northern Territory Department of Health, Darwin, NT, Australia
| | | | - Leisa McCarthy
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
- Anyinginyi Health Aboriginal Corporation, Tennant Creek, NT, Australia
| | - Renae Kirkham
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Louise J. Maple-Brown
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
- Department of Endocrinology, Royal Darwin Hospital, Darwin, NT, Australia
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Oliver MJ, Abra G, Béchade C, Brown EA, Sanchez-Escuredo A, Johnson DW, Guedes AM, Graham J, Fernandes N, Jha V, Kabbali N, Knananjubach T, Kam-Tao Li P, Lundström UH, Salenger P, Lobbedez T. Assisted peritoneal dialysis: Position paper for the ISPD. Perit Dial Int 2024; 44:160-170. [PMID: 38712887 DOI: 10.1177/08968608241246447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024] Open
Affiliation(s)
- Matthew J Oliver
- Division of Nephrology, Department of Medicine, University of Toronto, ON, Canada
| | - Graham Abra
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Clémence Béchade
- Université Caen Normandie - UFR de Médecine, CAEN CEDEX, France
- Néphrologie, CHU CAEN, Avenue de la Côte de Nacre, Normandie Université, CAEN CEDEX, France
- ANTICIPE U1086 INSERM-UCN, Centre François Baclesse, Caen, France
| | - Edwina A Brown
- Imperial College Kidney and Transplant Centre, Imperial College Healthcare NHS Trust, London, UK
| | | | - David W Johnson
- Department of Kidney and Transplant Services, University of Queensland at Princess Alexandra Hospital, Brisbane, QLD, Australia
| | | | | | - Natalia Fernandes
- Department of Nephrology, Juiz de Fora University Hospital, Juiz de Fora, Minas Gerais, Brazil
| | - Vivekanand Jha
- George Institute for Global Health, UNSW, New Delhi, India
- School of Public Health, Imperial College, London, UK
- Manipal Academy of Higher Education, Manipal, India
| | - Nadia Kabbali
- Nephrology Department, Hassan II University Hospital, Fez, Morocco
| | - Talerngsak Knananjubach
- Division of Nephrology, Department of Medicine and Center of Excellence in Kidney Metabolic Disorders, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Philip Kam-Tao Li
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Ulrika Hahn Lundström
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | | | - Thierry Lobbedez
- Université Caen Normandie - UFR de Médecine, CAEN CEDEX, France
- Néphrologie, CHU CAEN, Avenue de la Côte de Nacre, Normandie Université, CAEN CEDEX, France
- ANTICIPE U1086 INSERM-UCN, Centre François Baclesse, Caen, France
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Endalamaw A, Khatri RB, Mengistu TS, Erku D, Wolka E, Zewdie A, Assefa Y. A scoping review of continuous quality improvement in healthcare system: conceptualization, models and tools, barriers and facilitators, and impact. BMC Health Serv Res 2024; 24:487. [PMID: 38641786 PMCID: PMC11031995 DOI: 10.1186/s12913-024-10828-0] [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: 12/27/2023] [Accepted: 03/05/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND The growing adoption of continuous quality improvement (CQI) initiatives in healthcare has generated a surge in research interest to gain a deeper understanding of CQI. However, comprehensive evidence regarding the diverse facets of CQI in healthcare has been limited. Our review sought to comprehensively grasp the conceptualization and principles of CQI, explore existing models and tools, analyze barriers and facilitators, and investigate its overall impacts. METHODS This qualitative scoping review was conducted using Arksey and O'Malley's methodological framework. We searched articles in PubMed, Web of Science, Scopus, and EMBASE databases. In addition, we accessed articles from Google Scholar. We used mixed-method analysis, including qualitative content analysis and quantitative descriptive for quantitative findings to summarize findings and PRISMA extension for scoping reviews (PRISMA-ScR) framework to report the overall works. RESULTS A total of 87 articles, which covered 14 CQI models, were included in the review. While 19 tools were used for CQI models and initiatives, Plan-Do-Study/Check-Act cycle was the commonly employed model to understand the CQI implementation process. The main reported purposes of using CQI, as its positive impact, are to improve the structure of the health system (e.g., leadership, health workforce, health technology use, supplies, and costs), enhance healthcare delivery processes and outputs (e.g., care coordination and linkages, satisfaction, accessibility, continuity of care, safety, and efficiency), and improve treatment outcome (reduce morbidity and mortality). The implementation of CQI is not without challenges. There are cultural (i.e., resistance/reluctance to quality-focused culture and fear of blame or punishment), technical, structural (related to organizational structure, processes, and systems), and strategic (inadequate planning and inappropriate goals) related barriers that were commonly reported during the implementation of CQI. CONCLUSIONS Implementing CQI initiatives necessitates thoroughly comprehending key principles such as teamwork and timeline. To effectively address challenges, it's crucial to identify obstacles and implement optimal interventions proactively. Healthcare professionals and leaders need to be mentally equipped and cognizant of the significant role CQI initiatives play in achieving purposes for quality of care.
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Affiliation(s)
- Aklilu Endalamaw
- School of Public Health, The University of Queensland, Brisbane, Australia.
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Resham B Khatri
- School of Public Health, The University of Queensland, Brisbane, Australia
- Health Social Science and Development Research Institute, Kathmandu, Nepal
| | - Tesfaye Setegn Mengistu
- School of Public Health, The University of Queensland, Brisbane, Australia
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Daniel Erku
- School of Public Health, The University of Queensland, Brisbane, Australia
- Centre for Applied Health Economics, School of Medicine, Grifth University, Brisbane, Australia
- Menzies Health Institute Queensland, Grifth University, Brisbane, Australia
| | - Eskinder Wolka
- International Institute for Primary Health Care in Ethiopia, Addis Ababa, Ethiopia
| | - Anteneh Zewdie
- International Institute for Primary Health Care in Ethiopia, Addis Ababa, Ethiopia
| | - Yibeltal Assefa
- School of Public Health, The University of Queensland, Brisbane, Australia
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Molima CEN, Karemere H, Makali S, Bisimwa G, Macq J. Is a bio-psychosocial approach model possible at the first level of health services in the Democratic Republic of Congo? An organizational analysis of six health centers in South Kivu. BMC Health Serv Res 2023; 23:1238. [PMID: 37951897 PMCID: PMC10638814 DOI: 10.1186/s12913-023-10216-0] [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: 10/26/2022] [Accepted: 10/26/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND The health system, in the Democratic Republic of Congo, is expected to move towards a more people-centered form of healthcare provision by implementing a biopsychosocial (BPS) approach. It's then important to examine how change is possible in providing healthcare at the first line of care. This study aims to analyze the organizational capacity of health centers to implement a BPS approach in the first line of care. METHODS A mixed descriptive and analytical study was conducted from November 2017 to February 2018. Six health centers from four Health Zones (South Kivu, Democratic Republic of Congo) were selected for this study. An organizational analysis of six health centers based on 15 organizational capacities using the Context and Capabilities for Integrating Care (CCIC) as a theoretical framework was conducted. Data were collected through observation, document review, and individual interviews with key stakeholders. The annual utilization rate of curative services was analyzed using trends for the six health centers. The organizational analysis presented three categories (Basic Structures, People and values, and Key Processes). RESULT This research describes three components in the organization of health services on a biopsychosocial model (Basic Structures, People and values, and Key processes). The current functioning of health centers in South Kivu shows strengths in the Basic Structures component. The health centers have physical characteristics and resources (financial, human) capable of operating health services. Weaknesses were noted in organizational governance through sharing of patient experience, valuing patient needs in Organizational/Network Culture, and Focus on Patient Centeredness & Engagement as well as partnering with other patient care channels. CONCLUSION This study highlighted the predisposition of health centers to implement a BPS approach to their organizational capacities. The study highlights how national policies could regulate the organization of health services on the front line by relying more on the culture of teamwork in the care structures and focusing on the needs of the patients. Paying particular attention to the values of the agents and specific key processes could enable the implementation of the BPS approach at the health center level.
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Affiliation(s)
- Christian Eboma Ndjangulu Molima
- École Régionale de Santé Publique, Université Catholique de Bukavu, Avenue Michombero N°2, Kadutu, Bukavu, Democratic Republic of Congo.
- Institute of Health and Society (IRSS), Université Catholique de Louvain, Brussels, Belgium.
| | - Hermès Karemere
- École Régionale de Santé Publique, Université Catholique de Bukavu, Avenue Michombero N°2, Kadutu, Bukavu, Democratic Republic of Congo
| | - Samuel Makali
- École Régionale de Santé Publique, Université Catholique de Bukavu, Avenue Michombero N°2, Kadutu, Bukavu, Democratic Republic of Congo
| | - Ghislain Bisimwa
- École Régionale de Santé Publique, Université Catholique de Bukavu, Avenue Michombero N°2, Kadutu, Bukavu, Democratic Republic of Congo
| | - Jean Macq
- Institute of Health and Society (IRSS), Université Catholique de Louvain, Brussels, Belgium
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Siddiqui MUH, Khafagy AA, Majeed F. Program Report: Improving Patient Experience at an Outpatient Clinic Using Continuous Improvement Tools. Healthcare (Basel) 2023; 11:2301. [PMID: 37628499 PMCID: PMC10454562 DOI: 10.3390/healthcare11162301] [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: 11/23/2022] [Revised: 06/04/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
Patient satisfaction with prompt and high-quality healthcare services plays a pivotal role in healthcare settings. The delivery of high-quality services within the healthcare sector is closely associated with continuous quality improvement (CQI), which is an incremental and progressive process that prioritizes the safety of all participants, favorable outcomes, systematic processes, and a regulated and improved working environment, particularly in later stages. Surprisingly, these aspects are less frequently explored in Middle Eastern countries. Thus, this research paper aims to assess the impact of quality services on patient satisfaction in tertiary care clinics located in the Middle East. To improve the quality of services in our clinic, we employed patient feedback as a valuable resource. We proactively reached out to all patients who had visited our hospital via mobile phone messages and requested their feedback on the services they received. Approximately 5% of all visitors responded and completed a comprehensive questionnaire. The majority of respondents expressed satisfaction with the services provided across various departments. However, they also offered valuable suggestions that helped us identify further areas for improvement and enhance the overall patient experience within our clinic. Drawing upon the feedback received, we meticulously considered the identified issues, redesigned our policies, and implemented strategic changes. Following the implementation of these new approaches, we once again sought patients' feedback on the quality of our services. Patient feedback highlighted the significant impact of optimized service delivery methods, resulting in a substantial increase in patient satisfaction. Overall, this study sheds light on the vital factors that can enhance patients' experience in outpatient clinics, emphasizing the importance of integrating patient feedback into continuous quality improvement initiatives. By utilizing this approach, healthcare providers, administrators, and researchers can effectively improve service quality and patient satisfaction. Consequently, this research paper serves as a valuable reference for public health stakeholders, administrators, and researchers in their pursuit of delivering exceptional healthcare experiences.
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Affiliation(s)
| | - Abdullah Ahmed Khafagy
- Department of Community Medicine and Pilgrims Healthcare, College of Medicine, Umm Al-Qura University, Mecca 24381, Saudi Arabia;
| | - Faisal Majeed
- Occupational Health & Safety Compliance at Reckitt USA, Parsippany, NJ 07054, USA;
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Aikins DA, Poku CA, Donkor E, Naab F. Practice environment determinants of job satisfaction among midwives at healthcare facilities in Accra Metropolis: A multicentre study. PLoS One 2023; 18:e0282251. [PMID: 36857327 PMCID: PMC9977032 DOI: 10.1371/journal.pone.0282251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 02/10/2023] [Indexed: 03/02/2023] Open
Abstract
INTRODUCTION Sustainable Development Goal 3 (SDG 3) has been one of the key goals for all partners of health globally. The health workforce especially midwives are among the principal skilled experts for achieving the goal. This is evidenced in the role they play in caring for pregnant women from the antenatal stages to the postpartum periods. However, very little has been reported about midwives' job satisfaction in Ghana. The study assessed the practice environment determinants of job satisfaction among registered midwives in Ghana. MATERIALS AND METHODS A cross-sectional design was adopted to recruit midwives from public and quasi-government hospitals in Accra Metropolis. Validated scales-'Measure of Job Satisfaction' and 'Practice Environment Scale of Nursing Work Index' were used for data collection. Data was analysed through descriptive statistics, Pearson correlation and linear regression. RESULTS Midwives had a positive perception of their work environment. They were generally satisfied with their job but were dissatisfied with their salaries. Key determinants of midwives' job satisfaction included years of work as a midwife, managers' leadership and support, and adequacy of human and material resources. CONCLUSION Improving midwives' job satisfaction through enabling the work environment will go a long way to improve healthcare provision in the healthcare delivery points in helping achieve SDG 3.
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Affiliation(s)
| | - Collins Atta Poku
- Department of Nursing, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- * E-mail: ,
| | - Ernestina Donkor
- School of Nursing and Midwifery, University of Health and Allied Science, Ho, Ghana
| | - Florence Naab
- School of Nursing and Midwifery, University of Ghana, Accra, Ghana
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Goyal N, Goldrich D, Hazard W, Stewart W, Ulinfun C, Soulier J, Fink G, Urich T, Bascom R. The need for systematic quality controls in implementing N95 reprocessing and sterilization. J Hosp Infect 2023; 133:38-45. [PMID: 36521581 PMCID: PMC9744483 DOI: 10.1016/j.jhin.2022.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/01/2022] [Accepted: 11/09/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Due to increased requirement for personal protective equipment during the coronavirus disease 2019 pandemic, many medical centres utilized sterilization systems approved under Food and Drug Administration Emergency Use Authorization for single-use N95 mask re-use. However, few studies have examined the real-world clinical challenges and the role of ongoing quality control measures in successful implementation. AIMS To demonstrate successful implementation of quality control measures in mask reprocessing, and the importance of continued quality assurance. METHODS A prospective quality improvement study was conducted at a tertiary care medical centre. In total, 982 3M 1860 masks and Kimberly-Clark Tecnol PFR95 masks worn by healthcare workers underwent sterilization using a vaporized hydrogen peroxide gas plasma-based reprocessing system. Post-processing qualitative fit testing (QFT) was performed on 265 masks. Mannequin testing at the National Institute for Occupational Safety and Health (NIOSH) laboratory was used to evaluate the impact of repeated sterilization on mask filtration efficacy and fit. A locally designed platform evaluated the filtration efficiency of clinically used and reprocessed masks. FINDINGS In total, 255 N95 masks underwent QFT. Of these, 240 masks underwent post-processing analysis: 205 were 3M 1860 masks and 35 were PFR95 masks. Twenty-five (12.2%) of the 3M masks and 10 (28.5%) of the PFR95 masks failed post-processing QFT. Characteristics of the failed masks included mask deformation (N=3, all 3M masks), soiled masks (N=3), weakened elastic bands (N=5, three PFR95 masks), and concern about mask shrinkage (N=3, two 3M masks). NIOSH testing demonstrated that while filter efficiency remained >98% after two cycles, mask strap elasticity decreased by 5.6% after reprocessing. CONCLUSIONS This study demonstrated successful quality control implementation for N95 mask disinfection, and highlights the importance of real-world clinical testing beyond laboratory conditions.
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Affiliation(s)
- N Goyal
- Department of Otolaryngology - Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA.
| | - D Goldrich
- Department of Otolaryngology - Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - W Hazard
- Department of Anesthesiology and Perioperative Medicine and Neurosurgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - W Stewart
- Operational Excellence Program, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - C Ulinfun
- Department of Facilities, Administration, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - J Soulier
- Department of Nursing, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - G Fink
- Facilities Infrastructure and Energy, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - T Urich
- Department of Environmental Systems, Facilities Maintenance, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - R Bascom
- Department of Pulmonary Medicine, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
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Saunders V, McCalman J, Tsey S, Askew D, Campbell S, Jongen C, Angelo C, Spurling G, Cadet-James Y. Counting what counts: a systematic scoping review of instruments used in primary healthcare services to measure the wellbeing of Indigenous children and youth. BMC PRIMARY CARE 2023; 24:51. [PMID: 36803458 PMCID: PMC9936129 DOI: 10.1186/s12875-023-02001-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 02/02/2023] [Indexed: 02/19/2023]
Abstract
BACKGROUND Primary healthcare services have principal responsibility for providing child and youth wellbeing and mental health services, but have lacked appropriate measurement instruments to assess the wellbeing of Indigenous children and youth or to evaluate the effectiveness of programs and services designed to meet their needs. This review assesses the availability and characteristics of measurement instruments that have been applied in primary healthcare services in Canada, Australia, New Zealand and the United States (CANZUS countries) to assess the wellbeing of Indigenous children and youth. METHODS Fifteen databases and 12 websites were searched in December 2017 and again in October 2021. Pre-defined search terms pertained to Indigenous children and youth, CANZUS country names, and wellbeing or mental health measures. PRISMA guidelines were followed, with eligibility criteria guiding screening of titles and abstracts, and selected full-text papers. Results are presented based on the characteristics of documented measurement instruments assessed according to five desirability criteria: development for Indigenous youth populations, adherence to relational strength-based constructs, administration by child and or youth self-report, reliability and validity, and usefulness for identifying wellbeing or risk levels. RESULTS Twenty-one publications were found that described the development and or use by primary healthcare services of 14 measurement instruments, employed across 30 applications. Four of the 14 measurement instruments were developed specifically for Indigenous youth populations, four focused solely on strength-based wellbeing concepts but none included all Indigenous wellbeing domains. CONCLUSION There is a diversity of measurement instruments available, but few fit our desirability criteria. Although it is possible that we missed relevant papers and reports, this review clearly supports the need for further research to develop, refine or adapt instruments cross-culturally to measure the wellbeing of Indigenous children and youth.
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Affiliation(s)
- Vicki Saunders
- Jawun Research Centre, Central Queensland University, Cnr Shields and Aplin St, Cairns, QLD, 4870, Australia.
| | - Janya McCalman
- grid.1023.00000 0001 2193 0854Jawun Research Centre, Central Queensland University, Cnr Shields and Aplin St, Cairns, QLD 4870 Australia
| | - Sena Tsey
- grid.1023.00000 0001 2193 0854Jawun Research Centre, Central Queensland University, Cnr Shields and Aplin St, Cairns, QLD 4870 Australia
| | - Deborah Askew
- grid.1003.20000 0000 9320 7537General Practice Clinical Unit and School of Public Health, Faculty of Medicine, University of Queensland, Level 2, Public Health Building, 288 Herston Road, Brisbane, QLD 4006 Australia
| | - Sandy Campbell
- grid.1043.60000 0001 2157 559XMolly Wardaguga Research Centre, Charles Darwin University, Level 11, 410 Ann St, Brisbane, QLD 4000 Australia
| | - Crystal Jongen
- grid.1023.00000 0001 2193 0854Jawun Research Centre, Central Queensland University, Cnr Shields and Aplin St, Cairns, QLD 4870 Australia
| | - Candace Angelo
- grid.1013.30000 0004 1936 834XAboriginal and Torres Strait Islander Public Health, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Edward Ford Building, Fisher Road, Sydney, NSW 2006 Australia
| | - Geoff Spurling
- grid.1003.20000 0000 9320 7537General Practice Clinical Unit and School of Public Health, Faculty of Medicine, University of Queensland, Level 2, Public Health Building, 288 Herston Road, Brisbane, QLD 4006 Australia
| | - Yvonne Cadet-James
- Yvonne Cadet-James, Apunipima Cape York Health Council, 186 McCoombe St, Cairns, QLD 4870 Australia
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Eljiz K, Greenfield D, Hogden A, Agaliotis M, Taylor R, Siddiqui N. Implementing health system improvement: resources and strategies for interprofessional teams. BMJ Open Qual 2023; 12:bmjoq-2022-001896. [PMID: 36707126 PMCID: PMC9884892 DOI: 10.1136/bmjoq-2022-001896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 11/20/2022] [Indexed: 01/28/2023] Open
Abstract
Health system improvement (HSI) is focused on systematic changes to organisational processes and practices to improve the efficient delivery of safe care and quality outcomes. Guidelines that specify how interprofessional teams conduct HSI and knowledge translation are needed. We address this urgent requirement providing health professional teams with resources and strategies to investigate, analyse and implement system-level improvements. HSI encompasses similar, yet different, inter-related activities across a continuum. The continuum spans three categories of activities, such as quality improvement, health management research and translational health management research. A HSI decision making guide and checklist, comprising six-steps, is presented that can be used to select and plan projects. This resource comprises six interconnected steps including, defining the activity, project outcome, aim, use of evidence, appropriate methodology and implementation plan. Each step has been developed focusing on an objective, actions and resources. HSI activities provide a foundation for interprofessional collaboration, allowing multiple professions to create, share and disseminate knowledge for improved healthcare. When planned and executed well, HSI projects assist clinical and corporate staff to make evidence-informed decisions and directions for the benefit of the service, organisation and sector.
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Affiliation(s)
- Kathy Eljiz
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - David Greenfield
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Anne Hogden
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia,Australian Institute of Health Services Management, University of Tasmania Tasmanian School of Business and Economics, Sydney, NSW, Australia
| | - Maria Agaliotis
- Australian Institute of Health Services Management, University of Tasmania Tasmanian School of Business and Economics, Sydney, NSW, Australia
| | - Robyn Taylor
- Australian Institute of Health Services Management, University of Tasmania Tasmanian School of Business and Economics, Sydney, NSW, Australia
| | - Nazlee Siddiqui
- Australian Institute of Health Services Management, University of Tasmania Tasmanian School of Business and Economics, Sydney, NSW, Australia
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11
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Improving Primary Care Quality Through Supportive Supervision and Mentoring: Lessons From the African Health Initiative in Ethiopia, Ghana, and Mozambique. GLOBAL HEALTH: SCIENCE AND PRACTICE 2022; 10:GHSP-D-21-00667. [PMID: 36109059 PMCID: PMC9476486 DOI: 10.9745/ghsp-d-21-00667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 02/07/2022] [Indexed: 11/15/2022]
Abstract
Systematic approaches to positioning technical support, enhancing systems, and promoting sustainment are crucial to strengthening supportive supervision and mentoring in primary health care systems. The African Health Initiative projects in Ethiopia, Ghana, and Mozambique have lessons to share from such experiences that stakeholders can apply to similar efforts in other countries. Introduction: Supportive supervision and mentoring (SSM) is crucial to primary care quality and effectiveness. Yet, there is little clarity on how to design and implement SSM and make it sustainable in primary health care (PHC) systems. The 3 African Health Initiative partnership projects introduced strategies to do this in Ethiopia, Ghana, and Mozambique. We describe: (1) how each partnership adapted SSM implementation strategies, (2) the dynamics of implementation and change that ensued after intervening within PHC systems, and (3) insights on the SSM sustainability as a mainstay of PHC. Methods: Researchers from each project collaboratively wrote a cross-country protocol based on those objectives. For this, they adapted implementation science frameworks—the Exploration, Preparation, Implementation, and Sustainment model and the Consolidated Framework for Implementation Research—through a qualitative theme reduction process. This resulted in harmonized lines of inquiry on the design, implementation, and potential sustainability of each project’s SSM strategy. In-depth interviews and focus group discussions were conducted with stakeholders from PHC systems in each country and thematic analyses ensued. Results: Across the projects, SSM strategies acquired multiple components to address individual, systems, and process-related determinants. Benefits arose from efforts that addressed worker-level attitudes and barriers, promoted a wider learning environment, and enhanced collaborative structures and tools for monitoring performance. Peer exchanges and embedded implementation research were critical to the perceived effectiveness of SSM strategies. Discussion: Despite differences in their approach to SSM implementation, there are common crucial ingredients across the SSM strategies of the 3 AHI partner projects from which important lessons arise: (1) positioning learning and adaptation opportunities within the routine workings of PHC systems, facilitation, and technical support to reflect and utilize new knowledge; (2) multisectoral collaboration, particularly with academic organizations; and (3) building PHC decision-makers’ and implementation teams’ capacity for evidence-informed change.
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12
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Bluestone J, Troncoso E, Fitzgerald L, Nagbe L, Tetteh G, Hellar A, Ernest E. Three Pivots for Improving Health Care Provider Performance. GLOBAL HEALTH: SCIENCE AND PRACTICE 2022; 10:GHSP-D-21-00625. [PMID: 35294392 PMCID: PMC8885343 DOI: 10.9745/ghsp-d-21-00625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/18/2022] [Indexed: 12/04/2022]
Abstract
We share recommendations on 3 important pivots away from longstanding approaches to continued professional development and in-service training programs that have demonstrated a measurable benefit across a diversity of health-related applications and projects.
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13
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Ramesh A, Juarez PD, Matthews-Juarez P. Response to a Reader's Letter "Medical School Training Can Improve Patient Care". J Prim Care Community Health 2022; 13:21501319211070639. [PMID: 35090353 PMCID: PMC8801636 DOI: 10.1177/21501319211070639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Li H, Mu D, Wang P, Li Y, Wang D. Prediction of Obstetric Patient Flow and Horizontal Allocation of Medical Resources Based on Time Series Analysis. Front Public Health 2021; 9:646157. [PMID: 34738002 PMCID: PMC8562385 DOI: 10.3389/fpubh.2021.646157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 09/08/2021] [Indexed: 11/26/2022] Open
Abstract
Objective: Given the ever-changing flow of obstetric patients in the hospital, how the government and hospital management plan and allocate medical resources has become an important problem that needs to be urgently solved. In this study a prediction method for calculating the monthly and daily flow of patients based on time series is proposed to provide decision support for government and hospital management. Methods: The historical patient flow data from the Department of Obstetrics and Gynecology of the First Hospital of Jilin University, China, from January 1, 2018, to February 29, 2020, were used as the training set. Seven models such as XGBoost, SVM, RF, and NNAR were used to predict the daily patient flow in the next 14 days. The HoltWinters model is then used to predict the monthly flow of patients over the next year. Results: The results of this analysis and prediction model showed that the obstetric inpatient flow was not a purely random process, and that patient flow was not only accompanied by the random patient flow but also showed a trend change and seasonal change rule. ACF,PACF,Ljung_box, and residual histogram were then used to verify the accuracy of the prediction model, and the results show that the Holtwiners model was optimal. R2, MAPE, and other indicators were used to measure the accuracy of the 14 day prediction model, and the results showed that HoltWinters and STL prediction models achieved high accuracy. Conclusion: In this paper, the time series model was used to analyze the trend and seasonal changes of obstetric patient flow and predict the patient flow in the next 14 days and 12 months. On this basis, combined with the trend and seasonal changes of obstetric patient flow, a more reasonable and fair horizontal allocation scheme of medical resources is proposed, combined with the prediction of patient flow.
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Affiliation(s)
- Hua Li
- Department of Abdominal Ultrasound, First Affiliated Hospital of Jilin University, Changchun, China.,School of Public Health, Jilin University, Changchun, China
| | - Dongmei Mu
- School of Public Health, Jilin University, Changchun, China.,Department of Clinical Laboratory, First Affiliated Hospital of Jilin University, Changchun, China
| | - Ping Wang
- School of Public Health, Jilin University, Changchun, China
| | - Yin Li
- School of Public Health, Jilin University, Changchun, China
| | - Dongxuan Wang
- Department of Abdominal Ultrasound, First Affiliated Hospital of Jilin University, Changchun, China
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15
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Mitchell P, Cribb A, Entwistle V, Singh G. Pushing poverty off limits: quality improvement and the architecture of healthcare values. BMC Med Ethics 2021; 22:91. [PMID: 34256744 PMCID: PMC8278597 DOI: 10.1186/s12910-021-00655-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 06/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Poverty and social deprivation have adverse effects on health outcomes and place a significant burden on healthcare systems. There are some actions that can be taken to tackle them from within healthcare institutions, but clinicians who seek to make frontline services more responsive to the social determinants of health and the social context of people's lives can face a range of ethical challenges. We summarise and consider a case in which clinicians introduced a poverty screening initiative (PSI) into paediatric practice using the discourse and methodology of healthcare quality improvement (QI). DISCUSSION Whilst suggesting that interventions like the PSI are a potentially valuable extension of clinical roles, which take advantage of the unique affordances of clinical settings, we argue that there is a tendency for such settings to continuously reproduce a narrower set of norms. We illustrate how the framing of an initiative as QI can help legitimate and secure funding for practical efforts to help address social ends from within clinical service, but also how it can constrain and disguise the value of this work. A combination of methodological emphases within QI and managerialism within healthcare institutions leads to the prioritisation, often implicitly, of a limited set of aims and governing values for healthcare. This can act as an obstacle to a genuine broadening of the clinical agenda, reinforcing norms of clinical practice that effectively push poverty 'off limits.' We set out the ethical dilemmas facing clinicians who seek to navigate this landscape in order to address poverty and the social determinants of health. CONCLUSIONS We suggest that reclaiming QI as a more deliberative tool that is sensitive to these ethical dilemmas can enable managers, clinicians and patients to pursue health-related values and ends, broadly conceived, as part of an expansive range of social and personal goods.
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Affiliation(s)
- Polly Mitchell
- Centre for Public Policy Research, School of Education, Communication and Society, King's College London, Waterloo Bridge Wing, Franklin-Wilkins Building, Waterloo Road, London, SE1 9NH, UK.
| | - Alan Cribb
- Centre for Public Policy Research, School of Education, Communication and Society, King's College London, Waterloo Bridge Wing, Franklin-Wilkins Building, Waterloo Road, London, SE1 9NH, UK
| | - Vikki Entwistle
- Health Services Research Unit and School of Divinity, History and Philosophy, University of Aberdeen, 3rd floor, Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Guddi Singh
- Mary Sheridan Centre for Child Health, Guy's and St. Thomas' NHS Foundation Trust, 5 Dugard Way, London, SE11 4TH, UK
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16
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Imtiaz W, Nasir KS, Kanwal F, Saqib S, Hafeez H. Improving Compliance of Physicians in Reporting and Documenting Critical Alerts in a Cancer Hospital. JOURNAL OF CANCER & ALLIED SPECIALTIES 2021; 7:e419. [PMID: 37197215 PMCID: PMC10166344 DOI: 10.37029/jcas.v7i2.419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Introduction A critical result of an investigation is considered a representation of a pathophysiological state deemed to be high risk or life threatening for the patient. Therefore, such results should be addressed in an appropriate and timely manner. Unfortunately, routine closed chart audits suggested that the compliance of physicians in documenting critical alerts in patient notes was poor. This prompted the hospital to conduct a continuous quality improvement (CQI) project to improve the physicians' compliance. Materials and Methods A cause-and-effect analysis was conducted using a fishbone diagram to identify the reasons for poor compliance. Based on the analysis, several modifications were made, including, but not limited to, hospital-wide educational sessions on the standard operating procedures of receiving and documenting critical alerts for the physicians, daily audit of critical alerts to review the appropriateness of documentation and introduction of a new module in the hospital electronic medical record to acknowledge and document receiving critical alerts. Results Before implementing the strategies to improve physicians' documentation compliance, the average compliance rate was 57% in April 2020, and the median compliance rate was 52% (January 2020-April 2020). However, afterward, within a couple of months of implementing changes, the average compliance rate increased to 88%. This improvement was sustained for the next 8 months (median of 89%). Conclusion This study found that CQI approach can be used to improve the compliance of the physicians for appropriately and timely documenting critical alerts, in this case, by continued education and training process and incorporating changes into the electronic hospital information system.
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Affiliation(s)
- Wania Imtiaz
- Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Punjab, Pakistan
| | - Khawaja Shehryar Nasir
- Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Punjab, Pakistan
- Department of Quality and Patient Safety, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Punjab, Pakistan
| | - Fareeha Kanwal
- Department of Quality and Patient Safety, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Punjab, Pakistan
| | - Sheeba Saqib
- Department of Quality and Patient Safety, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Punjab, Pakistan
| | - Haroon Hafeez
- Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Punjab, Pakistan
- Department of Quality and Patient Safety, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Punjab, Pakistan
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17
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Khan N, Hafeez H, Khawaja SN. Improving the efficiency and reducing variability in patient flow in an outpatient parenteral antibiotic therapy unit of a tertiary care hospital. Future Healthc J 2021; 8:e263-e266. [PMID: 34286195 DOI: 10.7861/fhj.2020-0022] [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: 11/27/2022]
Abstract
Outpatient parenteral administration of medications and blood transfusions using an outpatient parenteral antibiotic therapy (OPAT) unit has gradually become a standard of care. We report a continuous quality improvement project that was conducted on an OPAT unit of a tertiary care cancer hospital in Lahore, Pakistan. Prior to the initiation of the project, it was identified that 52% of the patient encounters in the OPAT unit were being delayed by a median of 63.5 minutes. A cause-and-effect analysis was performed, using a fishbone diagram, to identify the reasons for the delay in appointments. Based on the findings, several modifications were made to the processes of the OPAT unit including, but not limited to, a computerised physician order entry (CPOE) system module for prescribing, dispensing, reviewing and dispensing medications, changes in the nursing and staffing roster, and assignment of additional duties to the ward clerks. These changes resulted in improvement of waiting time to a median of 24.5 minutes and percentage delay in patient meetings decreased to 18%. Likewise, in 2019, 5,399 (27%) more patient meetings took place compared with 2018, which would have otherwise costed the hospital between 21.28 to 45.85 million Pakistani rupees. The use of continuous quality improvement techniques in the OPAT unit can result in substantial and appropriate changes in the process of patient flow, leading to measurable and significant reductions in the variability of care, and optimisation of service.
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Affiliation(s)
- Nasir Khan
- Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Haroon Hafeez
- Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Shehryar N Khawaja
- Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
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18
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Bailie J, Potts BA, Laycock AF, Abimbola S, Bailie RS, Cunningham FC, Matthews V, Bainbridge RG, Conte KP, Passey ME, Peiris D. Collaboration and knowledge generation in an 18-year quality improvement research programme in Australian Indigenous primary healthcare: a coauthorship network analysis. BMJ Open 2021; 11:e045101. [PMID: 33958341 PMCID: PMC8103942 DOI: 10.1136/bmjopen-2020-045101] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Though multidisciplinary research networks support the practice and effectiveness of continuous quality improvement (CQI) programmes, their characteristics and development are poorly understood. In this study, we examine publication outputs from a research network in Australian Indigenous primary healthcare (PHC) to assess to what extent the research network changed over time. SETTING Australian CQI research network in Indigenous PHC from 2002 to 2019. PARTICIPANTS Authors from peer-reviewed journal articles and books published by the network. DESIGN Coauthor networks across four phases of the network (2002-2004; 2005-2009; 2010-2014; 2015-2019) were constructed based on author affiliations and examined using social network analysis methods. Descriptive characteristics included organisation types, Indigenous representation, gender, student authorship and thematic research trends. RESULTS We identified 128 publications written by 308 individual authors from 79 different organisations. Publications increased in number and diversity over each funding phase. During the final phase, publication outputs accelerated for organisations, students, project officers, Indigenous and female authors. Over time there was also a shift in research themes to encompass new clinical areas and social, environmental or behavioural determinants of health. Average degree (8.1), clustering (0.81) and diameter (3) indicated a well-connected network, with a core-periphery structure in each phase (p≤0.03) rather than a single central organisation (degree centralisation=0.55-0.65). Academic organisations dominated the core structure in all funding phases. CONCLUSION Collaboration in publications increased with network consolidation and expansion. Increased productivity was associated with increased authorship diversity and a decentralised network, suggesting these may be important factors in enhancing research impact and advancing the knowledge and practice of CQI in PHC. Publication diversity and growth occurred mainly in the fourth phase, suggesting long-term relationship building among diverse partners is required to facilitate participatory research in CQI. Despite improvements, further work is needed to address inequities in female authorship and Indigenous authorship.
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Affiliation(s)
- Jodie Bailie
- University Centre for Rural Health, The University of Sydney, Lismore, New South Wales, Australia
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Boyd Alexander Potts
- University Centre for Rural Health, The University of Sydney, Lismore, New South Wales, Australia
| | - Alison Frances Laycock
- University Centre for Rural Health, The University of Sydney, Lismore, New South Wales, Australia
| | - Seye Abimbola
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Ross Stewart Bailie
- University Centre for Rural Health, The University of Sydney, Lismore, New South Wales, Australia
| | | | - Veronica Matthews
- University Centre for Rural Health, The University of Sydney, Lismore, New South Wales, Australia
| | | | - Kathleen Parker Conte
- University Centre for Rural Health, The University of Sydney, Lismore, New South Wales, Australia
- School of Public Health, DePaul University, Chicago, Illinois, USA
| | - Megan Elizabeth Passey
- University Centre for Rural Health, The University of Sydney, Lismore, New South Wales, Australia
| | - David Peiris
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
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Castillo E, Patey A, MacDonald N. Vaccination in pregnancy: Challenges and evidence-based solutions. Best Pract Res Clin Obstet Gynaecol 2021; 76:83-95. [PMID: 34090801 DOI: 10.1016/j.bpobgyn.2021.03.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 03/09/2021] [Indexed: 01/31/2023]
Abstract
Vaccination in pregnancy (VIP) is dually beneficial - it protects the mother and the baby from tetanus, influenza, and pertussis. VIP uptake is low in many countries. Vaccine hesitancy, defined by the World Health Organization (WHO) as a "delay in acceptance or refusal of vaccination despite the availability of vaccination services" is one of WHO's ten threats to global health per 2019. According to extensive research, mostly from high-income countries (HIC) and limited to tetanus, influenza and pertussis vaccines, lack of provider recommendations, safety concerns, and limitations in access are the main barriers to VIP. Health care provider recommendation is the leading facilitator for VIP across various socioeconomic status groups. Data on strategies to overcome patient, provider, and system barriers to VIP are inconsistent, contradictory, or lacking. Patient-focused research on evidence-based strategies to overcome provider and system barriers is needed. Furthermore, VIP programs require embedded continuous quality improvement to ensure sustainability.
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Affiliation(s)
- Eliana Castillo
- Department of Medicine, University of Calgary, Canada; Department of Obstetrics and Gynaecology University of Calgary, Canada.
| | - Andrea Patey
- Centre for Implementation Research, Ottawa Hospital Research Institute, Canada; Faculty of Health Sciences, Queen's University, Canada
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Ghosh A, Halcomb E, McCarthy S, Ashley C. Structured yet simple approaches to primary care data quality improvements can indeed strike gold. Aust J Prim Health 2021; 27:143-151. [PMID: 33689677 DOI: 10.1071/py20247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 11/26/2020] [Indexed: 11/23/2022]
Abstract
General practice data provide important opportunities for both population health and within-practice initiatives to improve health. Despite its promise, a lack of accuracy affects the use of such data. The Sentinel Practices Data Sourcing (SPDS) project is a structured chronic disease surveillance and data quality improvement strategy in general practice. A mixed-methods approach was used to evaluate data quality improvement in 99 participating practices over 12 months. Quantitative data were obtained by measuring performance against 10 defined indicators, whereas 48 semi-structured interviews provided qualitative data. Aggregated scores demonstrated improvements in all indicators, ranging from minor to substantially significant improvements. Participants reported positively on levels of support provided, and acquisition of new knowledge and skills relating to data entry and cleansing. This evaluation provides evidence of the effectiveness of a structured approach to improve the quality of primary care data. Investing in this targeted intervention has the potential to create sustained improvements in data quality, which can drive clinical practice improvement.
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Affiliation(s)
- Abhijeet Ghosh
- COORDINARE - South Eastern NSW PHN, PO Box 325, Fairy Meadow, NSW 2519, Australia; and Corresponding author
| | - Elizabeth Halcomb
- School of Nursing, Faculty of Science, Medicine and Health, Building 41, Northfields Avenue, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Sandra McCarthy
- School of Nursing, Faculty of Science, Medicine and Health, Building 41, Northfields Avenue, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Christine Ashley
- School of Nursing, Faculty of Science, Medicine and Health, Building 41, Northfields Avenue, University of Wollongong, Wollongong, NSW 2522, Australia
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21
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Simone JP, Hoyt MJ, Bogert L, Storm DS. A Nurse-Led Initiative to Improve Implementation of HIV Preconception Care Services. J Assoc Nurses AIDS Care 2021; 32:115-126. [PMID: 33347008 DOI: 10.1097/jnc.0000000000000212] [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: 11/27/2022]
Abstract
ABSTRACT United States guidelines recommend preconception care (PCC) as an integral part of primary care to improve maternal and fetal/newborn outcomes and promote planned pregnancies. Persons living with HIV have additional, specialized needs for PCC. However, PCC is not reliably integrated in HIV care, and few studies have examined strategies to improve the provision of PCC services. We describe a successful, nurse-led initiative that incorporated collaborative strategic planning in conjunction with staff education and continuous quality improvement to strengthen implementation of PCC in a small urban HIV care clinic. Key features of this project included consensus building, training, and action planning with clinic staff; addressing clinic-specific barriers; and providing ongoing support/technical assistance. Continuous quality improvement reviews at 12, 18, and 36 months demonstrated improved and sustained implementation of PCC services for women and men. Our experiences serve as a model for HIV primary care clinics working to advance implementation of PCC services.
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Affiliation(s)
- Joanne Phillips Simone
- Joanne Phillips Simone, MS, RN, is an Education Specialist, François-Xavier Bagnoud Center, School of Nursing, Rutgers, The State University of New Jersey, Newark, New Jersey, USA. Mary Jo Hoyt, MS, RN, is a Clinical Evaluator, HIV Services, City of Kansas City, Missouri Health Department, Kansas City, Missouri, USA. Laura Bogert, RN, is a Clinical Coordinator, François-Xavier Bagnoud Center, School of Nursing, Rutgers, The State University of New Jersey, Newark, New Jersey, USA. Deborah S. Storm, PhD, RN, was Director of Research and Evaluation, François-Xavier Bagnoud Center, School of Nursing, Rutgers, The State University of New Jersey, Newark, New Jersey, USA
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22
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McCalman J, Bainbridge R, James YC, Bailie R, Tsey K, Matthews V, Ungar M, Askew D, Fagan R, Visser H, Spurling G, Percival N, Blignault I, Doran C. Systems integration to promote the mental health of Aboriginal and Torres Strait Islander children: protocol for a community-driven continuous quality improvement approach. BMC Public Health 2020; 20:1810. [PMID: 33246445 PMCID: PMC7694265 DOI: 10.1186/s12889-020-09885-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 11/12/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Systems integration to promote the mental health of Aboriginal and Torres Strait Islander children works towards developing a spectrum of effective, community-based services and supports. These services and supports are organised into a coordinated network, build meaningful partnerships with families and address their cultural and linguistic needs, to help children to function better at home, in school, in the community, and throughout life. This study is conducted in partnership with primary healthcare (PHC) and other services in three diverse Indigenous Australian communities. It entails conceptualising, co-designing, implementing, and evaluating the effectiveness of systems integration to promote the mental health and wellbeing of Indigenous school-aged children (4-17 years). This paper outlines a protocol for implementing such complex community-driven research. METHODS/DESIGN Using continuous quality improvement processes, community co-designed strategies for improved systems integration will be informed by narratives from yarning circles with Indigenous children and service providers, and quantitative data from surveys of service providers and audits of PHC client records and intersectoral systems. Agreed strategies to improve the integration of community-based services and supports will be modelled using microsimulation software, with a preferred model implemented in each community. The evaluation will investigate changes in the: 1) availability of services that are community-driven, youth-informed and culturally competent; 2) extent of collaborative service networks; 3) identification by PHC services of children's social and emotional wellbeing concerns; and 4) ratio of children receiving services to identified need. Costs and benefits of improvements to systems integration will also be calculated. DISCUSSION The study will provide evidence-informed, community-driven, and tested models that can be used for implementing systems integration to promote the mental health and wellbeing of Indigenous children. It will identify the situational enablers and barriers that impact systems integration and determine the extent to which systems integration improves service availability, systems and child outcomes. Evidence for the cost effectiveness of systems-level integration will contribute to national mental health policy reform.
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Affiliation(s)
- Janya McCalman
- Centre for Indigenous Health Equity Research, Central Queensland University, cnr Abbott and Shield St, Cairns, QLD, 4870, Australia.
- School of Health, Medical and Applied Sciences, Central Queensland University, cnr Abbott and Shield St, Cairns, QLD, 4870, Australia.
| | - Roxanne Bainbridge
- School of Health, Medical and Applied Sciences, Central Queensland University, cnr Abbott and Shield St, Cairns, QLD, 4870, Australia
| | - Yvonne Cadet James
- Apunipima Cape York Health Council, 186 McCoombe St, Cairns, QLD, 4870, Australia
| | - Ross Bailie
- University Centre for Rural Health, The University of Sydney, 61 Uralba St, Lismore, NSW, 2480, Australia
| | - Komla Tsey
- The Cairns Institute, James Cook University, McGregor Rd, Cairns, QLD, 4878, Australia
| | - Veronica Matthews
- University Centre for Rural Health, The University of Sydney, 61 Uralba St, Lismore, NSW, 2480, Australia
| | - Michael Ungar
- Resilience Research Centre, Dalhousie University, 6420 Coburg Rd, Halifax, NS, B3H 4R2, Canada
| | - Deborah Askew
- Primary Care Clinical Unit, The University of Queensland, Brisbane, Qld, 4072, Australia
- Southern Queensland Health Centre of Excellence in Aboriginal and Torres Strait Islander Primary Healthcare, Building 2/37 Wirraway Parade, Inala, QLD, 4077, Australia
| | - Ruth Fagan
- Gurriny Yealamucka Health Service, Bukki Rd, Yarrabah, QLD, 4871, Australia
| | - Hannah Visser
- Bulgarr Ngaru Medical Aboriginal Corporation, 153 Canterbury St, Casino, NSW, 2470, Australia
| | - Geoffrey Spurling
- Primary Care Clinical Unit, The University of Queensland, Brisbane, Qld, 4072, Australia
- Southern Queensland Health Centre of Excellence in Aboriginal and Torres Strait Islander Primary Healthcare, Building 2/37 Wirraway Parade, Inala, QLD, 4077, Australia
| | - Nikki Percival
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, 235 Jones St, Ultimo, NSW, 2007, Australia
| | - Ilse Blignault
- Translational Health Research Institute, University of Western Sydney, School of Medicine, Campbelltown Campus, NSW, 2560, Australia
| | - Chris Doran
- Centre for Indigenous Health Equity Research, Central Queensland University, cnr Abbott and Shield St, Cairns, QLD, 4870, Australia
- School of Health, Medical and Applied Sciences, Central Queensland University, cnr Abbott and Shield St, Cairns, QLD, 4870, Australia
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23
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Turner NN, Taylor J, Larkins S, Carlisle K, Thompson S, Carter M, Redman-MacLaren M, Bailie R. Conceptualizing the Association Between Community Participation and CQI in Aboriginal and Torres Strait Islander PHC Services. QUALITATIVE HEALTH RESEARCH 2019; 29:1904-1915. [PMID: 31014184 DOI: 10.1177/1049732319843107] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Drawing from Australian Aboriginal and Torres Strait Islander perspectives, we conceptualize the association between community participation and continuous quality improvement (CQI) processes in Indigenous primary health care (PHC) services. Indigenous experiences of community participation were drawn from our study identifying contextual factors affecting CQI processes in high-improving PHC services. Using case study design, we collected quantitative and qualitative data at the micro-, meso-, and macro-health system level in 2014 and 2015 in six services in northern Australia. Analyzing qualitative data, we found community participation was an important contextual factor in five of the six services. Embedded in cultural foundations, cultural rules, and expectations, community participation involved interacting elements of trusting relationships in metaphorically safe spaces, and reciprocated learning about each other's perspectives. Foregrounding Indigenous perspectives on community participation might assist more effective participatory processes in Indigenous PHC including in CQI processes.
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Affiliation(s)
| | - Judy Taylor
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Sarah Larkins
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Karen Carlisle
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Sandra Thompson
- Western Australian Centre for Rural Health, Geraldton, Western Australia, Australia
| | - Maureen Carter
- Nindilingarri Cultural Health Services, Fitzroy Crossing, Western Australia, Australia
| | | | - Ross Bailie
- The University of Sydney, University Centre for Rural Health, Lismore, New South Wales, Australia
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24
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Lestari T, Graham S, van den Boogard C, Triasih R, Poespoprodjo JR, Ubra RR, Kenangalem E, Mahendradhata Y, Anstey NM, Bailie RS, Ralph AP. Bridging the knowledge-practice gap in tuberculosis contact management in a high-burden setting: a mixed-methods protocol for a multicenter health system strengthening study. Implement Sci 2019; 14:31. [PMID: 30890160 PMCID: PMC6425655 DOI: 10.1186/s13012-019-0870-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 02/12/2019] [Indexed: 01/12/2023] Open
Abstract
Background People in close contact with tuberculosis should have screening and appropriate management, as an opportunity for active case detection and prevention. However, implementation of tuberculosis contact screening and management is limited in high-burden settings. Behaviour change is needed across three levels of the healthcare system—policymakers, healthcare providers, and patients. To bridge the wide policy-practice gap, this study draws on the Consolidated Framework for Implementation Research, the Behaviour Change Wheel, and the RE-AIM model (Reach, Effectiveness, Adoption, Implementation, Maintenance) to respectively understand barriers, implement change, and evaluate process and outcome. Methods This methods paper describes a mixed-methods intervention study in Eastern Indonesia. Quantitative data will be collected during baseline, intervention, and sustainability periods and analyzed using time series analysis. The primary outcome is the number of individuals completing tuberculosis preventive therapy by the end of the two-year intervention phase. Of an estimated 10,000 contacts during this period, we anticipate that a minimum of 416 will be found to have active TB or will complete preventive therapy. Qualitative data (semi-structured interviews, focus group discussions, and observations) will be collected from consenting healthcare providers, patients, and contacts. Activities to promote policy implementation include healthcare provider training, quarterly continuous quality improvement workshops, a social media discussion forum, and promotional materials. The Consolidated Framework for Implementation Research will be used to identify reasons for limited policy implementation at baseline. The Behaviour Change Wheel will be used to ensure that a suitable range of activities are implemented to facilitate change. The RE-AIM model will be used as the evaluation framework. Discussion Use of theoretical frameworks in combination can ensure a comprehensive understanding of, and robust response to, health policy underimplementation. The selected frameworks are highly applicable to this pragmatic intervention study, in a setting where End TB Strategy targets will not be met without substantial behavior change within health systems. Continuous quality improvement cycles will provide a way to engage staff and stakeholders in understanding local data to motivate behavior change. If successful, up to 500 people could be prevented from developing complications of tuberculosis through early case-finding or receiving preventive therapy over a two-year period. Study registration Australian New Zealand Clinical Trials Register 375803.
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Affiliation(s)
- Trisasi Lestari
- Global and Tropical Health, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia. .,Center for Tropical Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
| | - Steve Graham
- Centre for International Child Health, Department of Paediatrics and Murdoch Children's Research Institute, University of Melbourne, Melbourne, Australia.,Burnet Institute, Melbourne, Australia
| | - Christel van den Boogard
- Global and Tropical Health, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Rina Triasih
- Center for Tropical Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Jeanne Rini Poespoprodjo
- Center for Tropical Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.,Papuan Health and Community Development Foundation, Papua, Indonesia
| | | | - Enny Kenangalem
- Papuan Health and Community Development Foundation, Papua, Indonesia
| | - Yodi Mahendradhata
- Center for Tropical Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Nicholas M Anstey
- Global and Tropical Health, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Division of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Ross S Bailie
- University Centre for Rural Health, School of Medicine, University of Sydney, Lismore, Australia
| | - Anna P Ralph
- Global and Tropical Health, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Division of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
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25
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Read C, Mitchell AG, de Dassel JL, Scrine C, Hendrickx D, Bailie RS, Johnston V, Maguire GP, Schultz R, Carapetis JR, Ralph AP. Qualitative Evaluation of a Complex Intervention to Improve Rheumatic Heart Disease Secondary Prophylaxis. J Am Heart Assoc 2018; 7:e009376. [PMID: 30018166 PMCID: PMC6064865 DOI: 10.1161/jaha.118.009376] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 06/14/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Rheumatic heart disease is a high-burden condition in Australian Aboriginal communities. We evaluated a stepped-wedge, community, randomized trial at 10 Aboriginal communities from 2013 to 2015. A multifaceted intervention was implemented using quality improvement and chronic care model approaches to improve delivery of penicillin prophylaxis for rheumatic heart disease. The trial did not improve penicillin adherence. This mixed-methods evaluation, designed a priori, aimed to determine the association between methodological approaches and outcomes. METHODS AND RESULTS An evaluation framework was developed to measure the success of project implementation and of the underlying program theory. The program theory posited that penicillin delivery would be improved through activities implemented at clinics that addressed elements of the chronic care model. Qualitative data were derived from interviews with health-center staff, informants, and clients; participant observation; and project officer reports. Quantitative data comprised numbers and types of "action items," which were developed by participating clinic staff with project officers to improve delivery of penicillin injections. Interview data from 121 health-center staff, 22 informants, and 72 clients revealed barriers to achieving the trial's aims, including project-level factors (short trial duration), implementation factors (types of activities implemented), and contextual factors (high staff turnover and the complex sociocultural environment). Insufficient actions were implemented addressing "self-management support" and "community linkage" streams of the chronic care model. Increased momentum was evident in later stages of the study. CONCLUSIONS The program theory underpinning the study was sound. The limited impact made by the study on adherence was attributable to complex implementation challenges.
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Affiliation(s)
- Clancy Read
- Telethon Kids Institute, University of Western Australia, Western Australia, Australia
| | | | | | - Clair Scrine
- Telethon Kids Institute, University of Western Australia, Western Australia, Australia
| | - David Hendrickx
- Telethon Kids Institute, University of Western Australia, Western Australia, Australia
| | - Ross S Bailie
- University of Sydney University Centre for Rural Health, Lismore, New South Wales, Australia
| | - Vanessa Johnston
- Menzies School of Health Research, Darwin, Northern Territory, Australia
- Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Graeme P Maguire
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Rosalie Schultz
- Centre For Remote Health, Alice Springs, Northern Territory, Australia
| | - Jonathan R Carapetis
- Telethon Kids Institute, University of Western Australia, Western Australia, Australia
- Perth Children's Hospital, Perth, Western Australia, Australia
| | - Anna P Ralph
- Charles Darwin University, Darwin, Northern Territory, Australia
- Menzies School of Health Research, Darwin, Northern Territory, Australia
- Royal Darwin Hospital, Darwin, Northern Territory, Australia
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