Continuous Quality Improvement Data Research Articles

ConnectShareCare builds connections among care partners of people with serious illness

AbstractPeople living with chronic illnesses naturally turn to peers and community members to address the need for emotional support, practical advice, and quick help with emergent problems. Health systems have been slower to incorporate the expertise that comes from patients and caregivers/ care partners’ lived experience into the design and delivery of care. A coproduction learning health system model aims to draw on the expertise of all to deliver optimal “whole person” care and to capture learning for improvement in the process of care delivery. This model harnesses naturally occurring peer‐to‐peer connections outside the traditional healthcare system into facilitated support networks, which extend the scope of services offered by the health system to support lay care partners, thereby improving their resiliency and inviting them to share their expertise with others. With patients and care partners, we co‐designed and piloted an online facilitated support network, connectsharecare.org, to help persons providing care or support to an adult with a serious illness better prepare to cope with surprises that arise post diagnosis and/or during bereavement. The team prioritized two network functions (1) connecting care partners to information and (2) facilitating emotional support. Between its launch in April 2021 and January 2023 the network has grown to more than 200 members with more than 3,500 posts over 21‐months. Most members report satisfaction with the support and information received, and say that the network helps them find meaning and purpose by supporting others. The most frequently used discussion threads focus on well‐being, emotions, and sources of joy and hope. The network is being adapted and improved as we learn from the data generated. It is feasible to engage a multi‐stakeholder team to co‐design an online peer‐to‐peer facilitated support network for care partners of people with serious illness. ConnectShareCare is valued by care partners. This work has the potential to contribute to a coproduction learning health system for people living with Alzheimer’s disease and other dementias by (1) prioritizing and addressing potentially unique needs of their care partners, (2) generating data for continuous quality improvement, and (3) contributing to scientific knowledge.

ConnectShareCare builds connections among care partners of people with serious illness

AbstractPeople living with chronic illnesses naturally turn to peers and community members to address the need for emotional support, practical advice, and quick help with emergent problems. Health systems have been slower to incorporate the expertise that comes from patients and caregivers/ care partners’ lived experience into the design and delivery of care.A coproduction learning health system model aims to draw on the expertise of all to deliver optimal “whole person” care and to capture learning for improvement in the process of care delivery. This model harnesses naturally occurring peer‐to‐peer connections outside the traditional healthcare system into facilitated support networks, which extend the scope of services offered by the health system to support lay care partners, thereby improving their resiliency and inviting them to share their expertise with others.With patients and care partners, we co‐designed and piloted an online facilitated support network, connectsharecare.org, to help persons providing care or support to an adult with a serious illness better prepare to cope with surprises that arise post diagnosis and/or during bereavement. The team prioritized two network functions (1) connecting care partners to information and (2) facilitating emotional support.Between its launch in April 2021 and January 2023 the network has grown to more than 200 members with more than 3,500 posts over 21‐months. Most members report satisfaction with the support and information received, and say that the network helps them find meaning and purpose by supporting others. The most frequently used discussion threads focus on well‐being, emotions, and sources of joy and hope. The network is being adapted and improved as we learn from the data generated.It is feasible to engage a multi‐stakeholder team to co‐design an online peer‐to‐peer facilitated support network for care partners of people with serious illness. ConnectShareCare is valued by care partners. This work has the potential to contribute to a coproduction learning health system for people living with Alzheimer’s disease and other dementias by (1) prioritizing and addressing potentially unique needs of their care partners, (2) generating data for continuous quality improvement, and (3) contributing to scientific knowledge.

Assessing the impact of adaptations to the clinical workflow in radiotherapy using transit in vivo dosimetry.

Currently in-vivo dosimetry (IVD) is primarily used to identify individual patient errors in radiotherapy. This study investigated possible correlations of observed trends in transit IVD results, with adaptations to the clinical workflow, aiming to demonstrate the possibility of using the bulk data for continuous quality improvement. In total 84,100 transit IVD measurements were analyzed of all patients treated between 2018 and 2022, divided into four yearly periods. Failed measurements (FM) were divided per pathology and into four categories of causes of failure: technical, planning and positioning problems, and anatomic changes. The number of FM due to patient related problems gradually decreased from 9.5% to 6.6%, 6.1% and 5.6% over the study period. FM attributed to positioning problems decreased from 10.0% to 4.9% in boost breast cancer patients after introduction of extra imaging, from 9.1% to 3.9% in Head&Neck patients following education of radiation therapists on positioning of patients' shoulders, from 6.1% to 2.8% in breast cancer patients after introduction of ultrahypofractionated breast radiotherapy with daily online pre-treatment imaging and from 11.2% to 4.3% in extremities following introduction of immobilization with calculated couch parameters and a Surface Guided Radiation Therapy solution. FM related to anatomic changes decreased from 10.2% to 4.0% in rectum patients and from 6.7% to 3.3% in prostate patients following more patient education from dieticians. Our study suggests that IVD can be a powerful tool to assess the impact of adaptations to the clinical workflow and its use for continuous quality improvement.

Design and rationale of the Western Sydney Clinical Frailty Registry: A prospective observational long-term clinical cohort study

BackgroundFrail older adults are frequently admitted to hospital with complex care needs, however little is known about their clinical profile, inpatient management or outcomes. Aims(i) To establish a baseline clinical profile of patients with frailty; (ii) To obtain a representative cross-sectional view of patients with frailty and their acute inpatient clinical management; (iii) To determine the rate and clinical outcomes of frailty among hospitalised patients. MethodsThe study will be conducted in a Western Sydney tertiary teaching hospital (Blacktown and Mount Druitt Hospital), serving a large socio-economically diverse, multi-cultural community. A long-term, prospective observational clinical cohort of patients who are admitted under Rehabilitation and Aged Care Services over the next 5-year period (2020–25) will be conducted. Frailty will be assessed using the Clinical Frailty Scale, and the FI-ED frailty instrument, performance will be assessed using the Australian-modified Karnofsky Performance Status (AKPS). Participants will be followed-up at 3, 6, and 12 months by telephone, following their index hospitalisation. Outcomes of interest include all-cause rehospitalisation (including emergency department presentation), mortality and admission to residential aged care service over the period of 12 months. Data Linkage endpoint assessment will be undertaken at 1, 2, and 5 years. DiscussionFrailty is an emergent area of clinical and research interest. It is an important prognostic indicator of mortality, rehospitalisation and institutionalisation. ConclusionThis study will provide longitudinal data to demonstrate short, mid, or long-term outcomes of hospitalised frail older adults. Data will be used to inform future studies and quality improvement activities. ImpactIt is envisioned that the registry will act as a spine project for future multi-disciplinary research opportunities including interventional studies, data linkage studies and quality improvement projects, thus enabling robust medium – long term examination of outcomes of interest, such as mortality, rehospitalisation and admission to residential aged care within this area of growing concern. There are plans to engage more disciplines in the registry's research capacity-building endeavours and we have identified the need for greater consumer engagement and public involvement. The sustainability of the registry needs to be considered within the context of ongoing research funding and making better use of these data for continuous quality improvement. Registry registrationThe registry was registered with the Australian Register of Clinical Registries (Australian Commission on Safety and Quality in Healthcare) on 3rd August 2020.(Australian Commission on Safety and Quality in Healthcare, 2020) Reference ACSQHC-ARCR-095. Available via https://www.safetyandquality.gov.au/australian-register-clinical-registries

Policy and Kidney Community Engagement to Advance toward Greener Kidney Care.

Policy and Kidney Community Engagement to Advance toward Greener Kidney Care.

Achieving high coverage of Kangaroo mother care practice is possible: Lessons from implementation research for accelerating scale-up in Tigray Region, Ethiopia.

To evaluate coverage of effective Kangaroo mother care (KMC) by developing a model that would result in high coverage (≥80%) of KMC for newborn weighing less than 2000 g at birth in Tigray region, Ethiopia. The study used formative research and continuous programme learning in iterative cycles of model development and modification conducted in close collaboration with the Tigray Regional Health Bureau. Quantitative methods were used to evaluate the various models. All study facilities were enrolled simultaneously, and hospitals and health centres were considered to become KMC-providers. The final scalable model implemented in two rural districts and one special urban zone of Tigray region attained the desired objective, with coverage of effective KMC of 82.3% at discharge. Achieving high coverage of KMC is possible through the design of context-specific implementation strategies. The key factors for success were the commitment and strong leadership from the regional health bureau, strong linkages within the health system and between different departments within health facilities, improved health worker knowledge, skills and attitudes, hospitals and health centres that supported KMC performance, and systematic generation and use of data for continuous quality improvement.

UTILIZATION OF HEALTH MANAGEMENT INFORMATION SYSTEM AND ASSOCIATED FACTORS IN HEALTH INSTITUTIONS OF KEMBATA TEMBARO ZONE, SOUTHERN ETHIOPIA

Background: Health Management Information System (HMIS) is one of the six building blocks of a health system designed to provide important data for continuous quality improvement at all levels of health care administration. It is a major source of information for monitoring and adjusting policy implementation and resources use. Some studies have been conducted in health data collection and ways to improve data quality, but little is known about utilization of HMIS in health services organization. Therefore, this study aimed to assess the utilization of HMIS and associated factors in the study area.
 Methods: A facility-based cross-sectional study conducted in public health institutions of Kembata Tembaro zone from March 1 to March 30, 2018. The sample size was calculated using single population proportion formula,and a total of 317 heads of units/departments of district health offices and health facilities were included. Both quantitative and qualitative data were collected using structured questionnaires, observational check-lists and interview guide by trained data collectors. Multivariable logistic regressions were performed using Enter method to identify factors independently associated with dependent variable. Statistical significant variables were declared at P-value less than 0.05 and Odds ratio with 95% confidence interval were used for data interpretation.
 Result: In this study, overall data utilization was 131(41.59%) with 95% CI of 38.9-46.1%. The data utilization was found to be 98(38.73%) and 33(53.23%) in the health facilities and health administrative units respectively. Training for HMIS [AOR (95% CI)=3.06(2.15-6.75)], availability of procedure manuals [AOR (95% CI)=3.67(1.78-9.01)], and Supportive supervision[AOR (95% CI)=5.30(3.05-11.53)] were found to be significant with HMIS utilization.
 Conclusion: Utilization of HMIS in public health institution was lower compared to previous studies. HMIS training, supportive supervision and availability of procedure manuals were positively associated with utilization of HMIS. Health facilities and offices should avail HMIS manuals and capacity building of health workers through training and supportive supervision was recommended.
 
 Peer Review History: 
 Received: 7 March 2022; Revised: 11 April; Accepted: 27 April, Available online: 15 May 2022
 Academic Editor: Dr. Marwa A. A. Fayed, University of Sadat City, Egypt, maafayed@gmail.com
 UJPR follows the most transparent and toughest ‘Advanced OPEN peer review’ system. The identity of the authors and, reviewers will be known to each other. This transparent process will help to eradicate any possible malicious/purposeful interference by any person (publishing staff, reviewer, editor, author, etc) during peer review. As a result of this unique system, all reviewers will get their due recognition and respect, once their names are published in the papers. We expect that, by publishing peer review reports with published papers, will be helpful to many authors for drafting their article according to the specifications. Auhors will remove any error of their article and they will improve their article(s) according to the previous reports displayed with published article(s). The main purpose of it is ‘to improve the quality of a candidate manuscript’. Our reviewers check the ‘strength and weakness of a manuscript honestly’. There will increase in the perfection, and transparency. 
 Received file: Reviewer's Comments:
 Average Peer review marks at initial stage: 6.0/10
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 Reviewers:
 Dr. Awofisayo, O Abosede, University of Uyo, Nigeria, shalomgirl08@yahoo.com
 Dr. A.A. Mgbahurike, University of Port Harcourt, Nigeria, amaka_mgbahurike@yahoo.com
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 INVESTIGATING THE OBSTACLES OF IMPLEMENTING HEALTH INFORMATION SYSTEMS FROM VIEWPOINT OF PERSONNEL OF MEHRIZ HEALTHCARE SYSTEM IN 2017

Tracking metrics that matter for scaling up employment outcomes

BACKGROUND: Supporting employment consultants in their work with job seekers is critical for increasing the employment outcomes of people with disabilities. OBJECTIVE: To better understand how to leverage data for supporting employment consultants, including what metrics to track, what to do with the data, and what can be improved. METHODS: A panel of three directors of employment programs addressed these questions as part of the Association of People Supporting Employment First (APSE) 2020 conference. RESULTS: Most employment service providers collect data for billing and compliance reporting. Innovative providers leverage data for quality improvement. CONCLUSIONS: Tracking metrics designed specifically for monitoring the implementation of effective employment supports is key for leveraging data for continuous quality improvement and thus improving job seekers’ employment outcomes.

Administration and Evaluation of the American Association of Colleges of Pharmacy Curriculum Quality Surveys in Pharmacy Schools

Objective. To evaluate how pharmacy programs administer and evaluate American Association of Colleges of Pharmacy (AACP) curriculum quality perception surveys for continuous quality improvement, and to compare usage across the academy to the Principles of Good Use: AACP Quality Perception Surveys document.Methods. A 27-item survey instrument examining how schools used the curriculum quality survey was created and administered between March and June 2019 to assessment contacts of accredited schools and colleges of pharmacy. Descriptive statistics were performed for each survey item.Results. Of the 140 programs invited to participate, 88 (62.8%) responded. Curriculum quality survey data were triangulated with additional existing data (39.8%) or additional data sources were collected for triangulation with the survey data (54.5%). Programs reported on modifications made in the following areas: curriculum (85.2%), communication (75.0%), student services (68.2%), policy and process (61.4%), and professional development (53.4%). Most programs reported the assessment lead was responsible for oversight of the curriculum quality survey.Conclusion. Of respondents, 66% were familiar with the AACP Principles of Good Use document, and results indicate that institutions are generally following the recommendations. Survey analysis revealed that a significant number of programs are utilizing curriculum quality survey data for making meaningful programmatic improvements. Future work should center on further development of best practices for schools and colleges of pharmacy to effectively use the CQS data for continuous quality improvement.

Teachers’ Pedagogical Practices and Students’ Learning Experiences in an Ethiopian University Setting

There is a growing interest among higher education (HE) researchers regarding the relevance of measuring quality via the lived experiences of teachers and students. However, relatively few studies have examined more broadly the pedagogical practices and student learning experiences in HE. In addition, there is a minimal study that compared students’ perceptions of learning behaviors with that of their teachers. The current study explores students’ and teachers’ perceptions about the existing pedagogical practices and learning experiences by analyzing each group’s responses and examining similarities and differences between their perspectives. For this, undergraduate students (n = 536) and teachers (n =89) at Jimma University, Ethiopia voluntarily participated in filling out two separate questionnaires. The findings show that university teaching and student learning in Ethiopia face considerable challenges that originated from different sources of influences, including input, process, and outcome dimensions. As the study participants reported, they faced high challenges in teaching and learning mainly due to the shortage of required inputs and processes. The role of pedagogical practices and learning experiences within universities' quality measurement and developing strategies to use such data for continuous quality improvement are discussed.

Characterization of first-line use of cyclin dependent kinase 4/6 (CDK4/6) inhibitors in metastatic breast cancer among Florida health care systems.

e19347 Background: First-line treatment with a CDK4/6 inhibitor in combination with an aromatase inhibitor for HR+/HER2- postmenopausal metastatic breast cancer (mBC) is considered standard of care based on the compelling data across all landmark trials. Commission on Cancer (CoC) as well as the Quality Oncology Practice Initiative (QOPI) describe standards for cancer care; some of which include utilizing data for continuous quality improvement as well as using nationally recognized guidelines to drive treatment selection. Reducing unwarranted variations in care through tracking and reporting adherence to nationally-recognized guidelines can be one way to focus on improving quality metrics. We evaluate first-line real-world treatment patterns of HR+/HER2- mBC patients in three health care systems in south Florida and compare with national standards. Methods: A retrospective analysis utilizing pharmacy and medical claims data (commercial and governmental payers) was performed. The data source was the IQVIA anonymized patient longitudinal open claims data for patients treated at the south Florida health systems. Patients age ≥18 years with HR+/HER2- mBC were included. First-line treatment was defined as the first claim for a medication after the mBC diagnosis. Results: Characterization of treatment patterns in three cancer centers in south Florida showed an increased utilization of CDK4/6 inhibitors as compared to the national average across all groups (see table). Conclusions: These data provide a baseline assessment of the utilization of CDK4/6 inhibitors in the first-line treatment of HR+/HER2- mBC. These data are reassuring with respect to the appropriate treatment in south Florida patients. However, we anticipate that treatment patterns may vary in other geographic areas given the national data trends. We would recommend this data be evaluated in other systems to identify potential areas of improvement. Limitations of this evaluation are consistent with any methodology using claims data which include possible coding errors and missing data which may or may not be systematic. [Table: see text]

Using Technology to Support Expectant and Parenting Youth through Case Management: Lessons Learned in the Field

IntroductionThe Support. Empower. Learn. Parenting Health Initiative (SELPHI) provides expectant and parenting youth ages 16–24 in Philadelphia with supports to improve educational, social, and economic outcomes to shape their health and the health of their children. Phone, text, video-based, and social media communication technology is built in to SELPHI’s program design to facilitate case management and connect clients to a broad referral network. Given the novelty of using information and communication technology (ICT) in case management, the reported lessons learned seek to give providers a specific and nuanced picture of ICT in case management.MethodsIn its initial 6-month implementation period, SELPHI’s five case managers, called Navigators, served 59 clients. Data from feedback surveys and case records were collected from clients and Navigators. Data included client demographic characteristics, needs assessment, and contact records to inform continuous quality improvement (CQI).ResultsICT’s benefits included having multiple ways to connect to difficult-to-reach clients, the ability to be more responsive to clients, and the flexibility to address scheduling and transportation barriers. ICT’s challenges are related to Navigators’ boundary setting, limitations on rapport building, and data security considerations. CQI data are presented to illustrate the lessons learned. Text messages were the most prevalent ICT; phone calls were most successful in engaging clients. Clients’ ICT preferences differed by purpose of communication.DiscussionFindings suggest that programs should understand the nuances of client contact preferences. To maximize the benefits of ICT, programs must develop or adapt protocols based on preference and purpose of communication.

ABET Accreditation During and After COVID19 - Navigating the Digital Age.

Engineering accreditation agencies and governmental educational bodies worldwide require programs to evaluate specific learning outcomes information for attainment of student learning and establish accountability. Ranking and accreditation have resulted in programs adopting shortcut approaches to collate cohort information with minimally acceptable rigor for Continuous Quality Improvement (CQI). With tens of thousands of engineering programs seeking accreditation, qualifying program evaluations that are based on reliable and accurate cohort outcomes is becoming increasingly complex and is high stakes. Manual data collection processes and vague performance criteria assimilate inaccurate or insufficient learning outcomes information that cannot be used for effective CQI. Additionally, due to the COVID19 global pandemic, many accreditation bodies have cancelled onsite visits and either deferred or announced virtual audit visits for upcoming accreditation cycles. In this study, we examine a novel meta-framework to qualify state of the art digital Integrated Quality Management Systems for three engineering programs seeking accreditation. The digital quality systems utilize authentic OBE frameworks and assessment methodology to automate collection, evaluation and reporting of precision CQI data. A novel Remote Evaluator Module that enables successful virtual ABET accreditation audits is presented. A theory based mixed methods approach is applied for evaluations. Detailed results and discussions show how various phases of the meta-framework help to qualify the context, construct, causal links, processes, technology, data collection and outcomes of comprehensive CQI efforts. Key stakeholders such as accreditation agencies and universities can adopt this multi-dimensional approach for employing a holistic meta-framework to achieve accurate and credible remote accreditation of engineering programs.

Priorities for improved management of acute rheumatic fever and rheumatic heart disease: analysis of cross-sectional continuous quality improvement data in Aboriginal primary healthcare centres in Australia.

Objective This study investigated the delivery of guideline-recommended services for the management of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) in Australian primary healthcare centres participating in the Audit and Best Practice for Chronic Disease (ABCD) National Research Partnership project. Methods ARF and RHD clinical audit data were collected from 63 Aboriginal centres in four Australian jurisdictions using the ABCD ARF/RHD audit tool. Records of up to 30 patients treated for ARF and/or RHD were analysed per centre from the most recent audit conducted between 2009 and 2014. The main outcome measure was a quality of ARF and RHD care composite indicator consisting of nine best-practice service items. Results Of 1081 patients, most were Indigenous (96%), female (61%), from the Northern Territory and Queensland (97%) and <25 years of age (49%). The composite indicator was highest in the 0-14 year age group (77% vs 65-67% in other age groups). Timely injections and provision of client education are important specific areas for improvement. Multiple regression showed age >15 years to be a significant negative factor for several care indicators, particularly for the delivery of long-acting antibiotic injections and specialist services in the 15-24 year age group. Conclusions The results suggest that timely injection and patient education are priorities for managing ARF and RHD, particularly focusing on child-to-adult transition care. What is known about the topic? The burden of rheumatic fever and RHD in some Aboriginal communities is among the highest documented globally. Guideline-adherent RHD prevention and management in primary health care (PHC) settings are critically important to reduce this burden. Continuous quality improvement (CQI) is a proven strategy to improve guideline adherence, using audit cycles and proactive engagement of PHC end users with their own data. Previously, such CQI strategies using a systems approach were shown to improve delivery of ARF and RHD care in six Aboriginal health services (three government and three community controlled). What does this paper add? This paper focuses on the variation across age groups in the quality of ARF and/or RHD care according to nine quality of care indicators across 63 PHC centres serving the Aboriginal population in the Northern Territory, Queensland, South Australia and Western Australia. These new findings provide insight into difference in quality of care by life stage, indicating particular areas for improvement of the management of ARF and RHD at the PHC level, and can act as a baseline for monitoring of care quality for ARF and RHD into the future. What are the implications for practitioners? Management plans and innovative strategies or systems for improving adherence need to be developed as a matter of urgency. PHC professionals need to closely monitor adherence to secondary prophylaxis at both the clinic and individual level. RHD priority status needs to be assigned and recorded as a tool to guide management. Systems strengthening needs to particularly target child-to-adult transition care. Practitioners are urged to keep a quick link to the RHDAustralia website to access resources and guidelines pertaining to ARF and RHD (https://www.rhdaustralia.org.au/arf-rhd-guideline, accessed 3 October 2019). CQI strategies can assist PHC centres to improve the care they provide to patients.

Using Continuous Quality Improvement Tools to Promote Tobacco Cessation Among Primary Caregivers in a Home Visiting Program in Alabama.

Alabama's Maternal, Infant, and Early Childhood Home Visiting-funded program was one of 10 state teams accepted to participate in the first wave of the Federal Home Visiting Program State and Territory Continuous Quality Improvement Practicum. This article reports methods and results of Alabama's continuous quality improvement (CQI) project and lessons learned in developing CQI capabilities among state and local public health practitioners. The Alabama team tracked CQI data weekly for the duration of the practicum using an annotated run chart. Participants included 20 identified tobacco users in 2 participating LIAs. This article highlights specific CQI tools to achieve the project aim. On the basis of CQI interventions, Alabama reached its goal; 12 of 20 primary caregivers in 2 home visiting programs made quit attempts. Alabama utilized multiple CQI tools to reach an ambitious, behavior-based aim; these same concepts could be broadly applied to quality improvement initiatives in any federal or state public health program to guide process- and outcomes-based improvement efforts.

Wide-Scale Continuous Quality Improvement: A Study of Stakeholders' Use of Quality of Care Reports at Various System Levels, and Factors Mediating Use.

Introduction: Increasing the use of evidence in healthcare policy and practice requires greater understanding of how stakeholders use evidence to inform policy, refine systems and change practice. Drawing on implementation theory, we have used system-focused participatory research to engage diverse stakeholders in using aggregated continuous quality improvement (CQI) data from Australian Indigenous primary health care settings to identify priority evidence-practice gaps, barriers/enablers and strategies for improvement. This article reports stakeholders' use or intended use of evidence at various levels of the system, and factors mediating use.Material and Methods: Interviews were undertaken with a purposeful sample of 30 healthcare stakeholders in different roles, organization types and settings in one Australian jurisdiction and with national participants, as part of the project's developmental evaluation. Qualitative data were analyzed to identify themes and categories relating to use of evidence.Results: Context-specific aggregated CQI data that were relatable to the diverse professional roles and practices provided an effective starting point for sharing perspectives, generating practice-based evidence and mobilizing evidence-use. Interviewees perceived the co-produced findings as applicable at different levels and useful for planning, policy development, supporting best practice and reflection, capacity strengthening and developing new research. Factors mediating use were commitment to best practice; the credibility of the evidence and its perceived relevance to work roles, contexts and decision needs; report format and language; facilitation and communication; competing work pressures and the organizational environment for change.Conclusions: This study found that primary health care stakeholders used evidence on quality of care for a variety of purposes. This could be linked to the interactive research processes used to engage stakeholders in different roles and settings in interpreting data, sharing and generating knowledge. Findings indicate that system-based participatory research using CQI data and iterative, interactive and systematic CQI-based methods can be applied at scale to support concurrent action for healthcare improvement at different system levels. Factors known to influence implementation should be addressed within the research design to optimize evidence use. Further research is needed to explore the utility of interactive dissemination for engaging healthcare stakeholders in informing policy and system change.

Application of the i-PARIHS framework for enhancing understanding of interactive dissemination to achieve wide-scale improvement in Indigenous primary healthcare

BackgroundParticipatory research approaches improve the use of evidence in policy, programmes and practice. Few studies have addressed ways to scale up participatory research for wider system improvement or the intensity of effort required. We used the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework to analyse implementation of an interactive dissemination process engaging stakeholders with continuous quality improvement (CQI) data from Australian Indigenous primary healthcare centres. This paper reports lessons learnt about scaling knowledge translation research, facilitating engagement at a system level and applying the i-PARIHS framework to a system-level intervention.MethodsDrawing on a developmental evaluation of our dissemination process, we conducted a post-hoc analysis of data from project records and interviews with 30 stakeholders working in Indigenous health in different roles, organisation types and settings in one Australian jurisdiction and with national participants. Content-analysed data were mapped onto the i-PARIHS framework constructs to examine factors contributing to the success (or otherwise) of the process.ResultsThe dissemination process achieved wide reach, with stakeholders using aggregated CQI data to identify system-wide priority evidence–practice gaps, barriers and strategies for improvement across the scope of care. Innovation characteristics influencing success were credible data, online dissemination and recruitment through established networks, research goals aligned with stakeholders’ interest in knowledge-sharing and motivation to improve care, and iterative phases of reporting and feedback. The policy environment and infrastructure for CQI, as well as manager support, influenced participation. Stakeholders who actively facilitated organisational- and local-level engagement were important for connecting others with the data and with the externally located research team. Developmental evaluation was facilitative in that it supported real-time adaptation and tailoring to stakeholders and context.ConclusionsA participatory research process was successfully implemented at scale without intense facilitation efforts. These findings broaden the notion of facilitation and support the utility of the i-PARIHS framework for planning participatory knowledge translation research at a system level. Researchers planning similar interventions should work through established networks and identify organisational- or local-level facilitators within the research design. Further research exploring facilitation in system-level interventions and the use of interactive dissemination processes in other settings is needed.

Identifying evidence-practice gaps and strategies for improvement in Aboriginal and Torres Strait Islander maternal health care.

IntroductionAdverse pregnancy outcomes are more common among Aboriginal and Torres Strait Islander populations than non-Indigenous populations in Australia. Later in life, most of the difference in life expectancy between Aboriginal and Torres Strait Islander women and non-Indigenous women is due to non-communicable diseases (NCDs). Most Aboriginal and Torres Strait Islander women attend health services regularly during pregnancy. Providing high-quality care within these appointments has an important role to play in improving the current and future health of women and babies.AimThis study engaged stakeholders in a theory-informed process to use aggregated continuous quality improvement (CQI) data to identify 1) priority evidence-practice gaps in Aboriginal and Torres Strait Islander maternal health care, 2) barriers and enablers to high-quality care, and 3) strategies to address identified priorities.MethodsThree phases of reporting and feedback were implemented using de-identified CQI data from 91 health services between 2007 and 2014 (4,402 client records). Stakeholders (n = 172) from a range of professions and organisations participated.ResultsStakeholders identified four priority areas relating to NCDs: smoking, alcohol, psychosocial wellbeing and nutrition. Barriers or enablers to high-quality care included workforce support, professional development, teamwork, woman-centred care, decision support, equipment and community engagement. Strategies to address the priorities included upskilling staff to provide best practice care in priority areas, advocating for availability of healthy food, housing and local referral options, partnering with communities on health promotion projects, systems to facilitate continuity of care and clear referral pathways.ConclusionsThis novel use of large-scale aggregate CQI data facilitated stakeholder input on priority evidence-practice gaps in maternal health care in Australia. Evidence-practice gaps relating to NCD risk factors and social determinants of health were prioritised, and stakeholders suggested both healthcare-focussed initiatives and approaches involving the community and the wider health sector. The findings can inform health service planning, advocacy, inter-agency strategies, and future research.

Quality of Cardiac Care in Canada: Recommendations for Building a Sustainable Future

Cardiovascular (CV) disease continues to present a significant disease and economic burden in Canada. To improve the quality of care and ensure sustainability of services, a national quality improvement initiative is required. The purpose of this analysis was to review the evidence for public reporting (PR) and external benchmarking (EB) to improve patient outcomes, and to recommend a strategy to improve CV care in Canada. To incorporate recent literature, the Canadian Cardiovascular Society (CCS) commissioned the Institute of Health Economics to provide a rapid update on the literature of PR and EB. The review showed that EB is more likely to promote positive effects, such as improved mortality, morbidity, and evidence-based clinical practice, and to limit negative effects, such as access restrictions or unintended provider behaviour associated with some forms of “top-down” PR. On the basis of these findings, this we recommend the following: (1) secure funding for the provincial collection of CV quality indicators and the creation of annual National CV Quality Reports; (2) enhance the culture of using CV quality indicator data for continuous quality improvement and opportunities for national or regional EB and sharing best practices; and (3) implement ongoing evaluation and revision of CCS clinical practice guidelines incorporating key quality indicators. This is already under way to a limited extent by the CCS with its Quality Project, but intentional, sustained support needs to be secured to enhance this ongoing effort and improve the quality of CV care for all Canadians.

Wireless Smart Infusion Pumps: A Descriptive Analysis of the Continuous Quality Improvement Data

Errors associated with the use of infusion pumps can cause serious harm or death in hospitalized patients and increased costs to the health care system. Our study reviewed the continuous quality improvement (CQI) data collected from a wireless smart infusion pump device implemented at one of the largest Canadian teaching hospitals. We reviewed the CQI summary data usage between February and December 2016 to assess dose error reduction software (DERS) compliance with the infusion pump’s master drug library and measure the frequency of monthly soft and hard limit events by clinical care area (CCA). In addition, we identified drugs that were most prone to alerts. The CQI data indicated that DERS compliance with the infusion pump ranged from 85.6 to 99.7% depending on the CCAs. The total number of soft limit double-confirmations was 35,174, and dexamethasone, oxytocin, and PACLitaxel had the highest frequency of double-confirmations. The total number of hard limits attempted observed was 13,188, and vancomycin, IV fluids, and potassium phosphate were more prone to hard limit alerts compared with other drugs during the study period. The study findings provided information on patterns of use and risk reduction opportunities to inform the hospital’s goal to enhance the delivery of quality care and patient safety. A CQI data analysis that incorporates open communication and detailed coordination in numerous departments across the hospital would help to increase the effectiveness of the new technology among the patient population.