Evaluation Of Quality Improvement Initiative Research Articles

Evaluation of a team-based quality improvement initiative for influenza vaccination in an underserved population.

Influenza vaccine is the most effective way to prevent influenza. However, low vaccination rates continue especially in underserved populations. To increase influenza vaccinations in an underserved population and to evaluate the impact of influenza vaccinations compared to previous year influenza vaccinations. Federally-Qualified Health care Center for the Homeless, Richmond, Virginia PRACTICE INNOVATION: Team-based quality improvement initiative led by a pharmacist champion. Before and after evaluation of the quality improvement initiative was conducted by comparing the total number of vaccines administered to those administered the previous year. Influenza vaccinations increased by 42% over the prior influenza vaccination season (1269 vs. 895), respectively. From a population perspective, 31% of patients received an influenza vaccine in 2019-20 and 48% in 2020-21. During the 2019-20 influenza vaccine season, the majority of patients vaccinated were female 56% versus 50.9% in 2020-21. The average age increased from 2019-20 to 2020-21, 37.62 years of age versus 42.71 years of age, respectively. A team-based quality improvement initiative was successful in improving our influenza vaccination program for adults and has served as a foundation for the delivery of other vaccines. Lessons learned were used to implement a COVID-19 vaccine program.

A survey of patient-centered practices in perinatal quality collaboratives.

SynopsisPerinatal quality collaboratives must incorporate patient and community member preferences in the design and evaluation of quality improvement initiatives to achieve truly patient‐centered maternity care.

Safer Baby Bundle: study protocol for the economic evaluation of a quality improvement initiative to reduce stillbirths

IntroductionStillbirth continues to be a public health concern in high-income countries, and with mixed results from several stillbirth prevention interventions worldwide the need for an effective prevention method is ever...

Family Physician Quality Improvement Plans: A Realist Inquiry Into What Works, for Whom, Under What Circumstances.

Evaluation of quality improvement programs shows variable impact on physician performance often neglecting to examine how implementation varies across contexts and mechanisms that affect uptake. Realist evaluation enables the generation, refinement, and testing theories of change by unpacking what works for whom under what circumstances and why. This study used realist methods to explore relationships between outcomes, mechanisms (resources and reasoning), and context factors of a national multisource feedback (MSF) program. Linked data for 50 physicians were examined to determine relationships between action plan completion status (outcomes), MSF ratings, MSF comments and prescribing data (resource mechanisms), a report summarizing the conversation between a facilitator and physician (reasoning mechanism), and practice risk factors (context). Working backward from outcomes enabled exploration of similarities and differences in mechanisms and context. The derived model showed that the completion status of plans was influenced by interaction of resource and reasoning mechanisms with context mediating the relationships. Two patterns were emerged. Physicians who implemented all their plans within six months received feedback with consistent messaging, reviewed data ahead of facilitation, coconstructed plan(s) with the facilitator, and had fewer risks to competence (dyscompetence). Physicians who were unable to implement any plans had data with fewer repeated messages and did not incorporate these into plans, had difficult plans, or needed to involve others and were physician-led, and were at higher risk for dyscompetence. Evaluation of quality improvement initiatives should examine program outcomes taking into consideration the interplay of resources, reasoning, and risk factors for dyscompetence.

Quality improvement in neurology: Neurology Outcomes Quality Measurement Set.

One in 6 Americans live with a neurologic disease.1–3 Recent evidence suggests that the number of people dying from and affected by these disorders has increased substantially in the past 25 years, contributing to a higher health loss across the lifespan.2 The American Academy of Neurology's (AAN's) mission is in part to promote the highest-quality patient-centered neurologic care for these patients, and the AAN's leadership in quality improvement initiatives and developing outcome measures is a conveyance of this mission. Quality, as defined by the National Academy of Medicine, is “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.”4 Quality improvement is “systematic, data-guided activities designed to bring about immediate improvements in health care delivery” and is considered “an intrinsic part of normal health care operations.”5 Data from outcome measures can be effectively used to establish a baseline of care quality delivered within a given health care unit (e.g., multispecialty group)5,6 and guide the implementation and ongoing evaluation of quality improvement initiatives intended to improve care quality and delivery.6 Increasing demands to provide health care outcomes data from patients and payers and the need for neurologic providers to have these data available to assist in care planning necessitated the AAN's former Quality and Safety Subcommittee to recommend the seating of a small work group to develop neurologic outcome quality measures, which would be applicable broadly across major neurologic diseases.

Evaluation of Quality Improvement Initiatives to Improve and Sustain Advance Care Planning Completion and Documentation.

Despite the established benefit of advance care planning (ACP), achieving and sustaining high rates of ACP completion continue to be a challenge in many health care settings. A palliative care champions committee has targeted improving the ACP process through quality improvement initiatives at an academic medical center. To understand the impact of multiyear efforts to improve ACP, surveys of registered nurses, care coordinators, and medical assistants from inpatient and outpatient settings were conducted in 2013 and 2017 to explore comfort level with ACP, barriers preventing completion of ACP in daily practice, and suggestions for overcoming these barriers. The findings suggest strategies to further integrate ACP through interdisciplinary teams, including outpatient staff education, inpatient and outpatient quality improvement initiatives, and dedicated staff for ACP.

Methodologies to evaluate the effectiveness of knowledge translation interventions

Knowledge translation (KT) promotes evidenced-based medicine but methods used to support related practices are often not evidence based [1,2]. Implementation research is complex, as it requires taking into account multiple levels (from patients, multidisciplinary healthcare teams and health facilities to local and national health care systems), which adds to the significant conceptual and methodological challenges that currently exist. These challenges are likely the reasons why the impact of implementation strategies has been modest and why conclusions that can be drawn from these approaches and how they should be applied to given settings are so limited. There is pressure to improve quality of care, but there is a lack of information about which interventions work and under what circumstances. Most studies registered in the Cochrane collaboration are RCTs (~350,000), but only 2,400 are experimental and quasi-experimental trials of interventions to improve health care delivery. There is a need to shift the focus from developing new treatments to developing approaches that deliver what is already known to work and to create and evaluate interventions from evidence-based knowledge. Given the limited evidence base to work from, people involved in quality improvement (QI) have a responsibility to evaluate the effectiveness of their efforts not only because many interventions are ineffective and may lead to a waste of resources, but also because evaluation creates knowledge that may benefit others. When considering how to evaluate the impact of an intervention, one should first consider whether the interest is in local knowledge (i.e., whether an intervention worked in the context in which it was implemented, which is of interest to managers responsible for QI within an institution) or generalizable knowledge (i.e., whether an intervention is likely to work in comparable settings which is of interest to KT researchers). Determining the need for local or generalizable knowledge and available resources drives most choices in KT intervention study designs. Evaluation study designs include randomized controlled trials (the gold standard for assessing causality and impact of interventions); and non-randomized or quasi-experimental designs (e.g., controlled/uncontrolled before-after, and interrupted time series designs), which are more subject to biases but require fewer resources. These designs vary in their ability to control for bias to increase internal validity, but even the perfectly valid study may not determine the degree to which the results can be generalized to real practice conditions. Pragmatic study designs can facilitate this by maximizing the relevance of the results for real world decision-making, often for a broad range of settings. Despite a large number of studies, many knowledge gaps still remain. Rigorous evaluation of QI initiatives (using both quantitative studies to better understand “if” something works supplemented by qualitative studies to understand “why”) are needed to increase our knowledge of KT and to improve quality of care.

Evaluation of Quality Improvement Initiative in Pediatric Oncology

Our goal was to improve the efficiency of chemotherapy administration for pediatric oncology patients. We identified prechemotherapy hydration as the process that most often delayed chemotherapy administration. An aggressive hydration protocol, supported by fluid order sets, was developed for patients receiving planned chemotherapy. The mean interval from admission to achieving adequate hydration status was reduced significantly from 4.9 to 1.4 hours with a minor reduction in the time to initiate chemotherapy from 9.6 to 8.6 hours. Chemotherapy availability became the new rate-limiting process.

Quality of Mental Health Care for Depressed Adolescents

Understanding the quality of routine care for adolescent depression constitutes the initial step in designing and implementing improvement strategies. This study assessed depression detection and type and duration of services for adolescents in mental health care settings. Medical record diagnosis and standardized research interview results were compared for youth seeking mental health treatment. The majority of depressed adolescents received care consistent with guidelines and evidence. However, only 51% received appropriate medication; fewer than half received at least 8 sessions of outpatient care or follow-up after hospitalization. Males received significantly fewer components of quality care compared with females. Depression diagnoses in routine care may be facilitated by using structured interviews or questionnaires. Quality monitoring and improvement initiatives may also increase rates of care components that are consistent with guidelines and evidence. Methods tested in this study may facilitate the evaluation of quality improvement initiatives for adolescent depression or other mental health disorders.