Abstract
BackgroundA 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.MethodsProject 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.ResultsIn 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.ConclusionsWithin 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.
Highlights
A decade ago, the Institute for Healthcare Improvement pioneered a quality improvement (QI) campaign, leveraging organizational and personal social networks to disseminate new practices
Despite the state-level matched pairs, respondents in the campaign and non-campaign states differed in professional position, the length of time in specialty or profession, and the length of time working within the hospital and unit, but not in the proportions involved in pre-operative and peri-operative care or the number of hours worked in the hospital each week (Table 2)
Study hospitals in the campaign and non-campaign states were relatively similar on baseline characteristics including the average number of respondents per hospital, the volume of hip and knee arthroplasties for Medicare beneficiaries, ownership, affiliation with hospital networks, urban vs. rural location, teaching status, and number of beds (Table 3)
Summary
The Affordable Care Act of 2010 encourages the use of evidence-based practices and innovative delivery models to drive quality improvement (QI). Several methods, including academic detailing, activation of opinion leaders, and QI collaboratives, have been shown in the past to improve health care quality [1,2,3]. QI collaboratives may be inefficient for rapidly spreading new practices, and studies of collaboratives have produced mixed results about the components essential for success [3]. These uncertainties may give pause to organizations weighing whether to invest in a collaborative [4]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
