Quality Improvement Success Research Articles

Diabetes Centers’ Participation in the T1D Exchange Quality Improvement Collaborative Advances Health Equity and Clinical Outcomes

As the learning health network known as the T1D Exchange Quality Improvement Collaborative (T1DX-QI) has expanded on a significant scale to provide care for more than 120,000 people since its inception in 2016, assessing the quality improvement (QI) culture and monitoring clinical outcome improvements of participating centers has become vital to understanding the network’s progress and success. Centers participating in the T1DX-QI complete regular QI culture self-assessments to quantify four evidence-based areas of culture: QI team structure, QI foundation, QI capacity, and QI success. This study builds on a previous baseline analysis to demonstrate self-reported improvements in T1DX-QI centers’ QI culture from 2021 to 2022 and summarizes QI successes experienced by participating centers.

Strategies to Increase the Use of Connected Insulin Pens Through Shared Decision-Making: A Quality Improvement Success Story.

Quality Improvement Success Stories are published by the American Diabetes Association in collaboration with the American College of Physicians and the National Diabetes Education Program. This series is intended to highlight best practices and strategies from programs and clinics that have successfully improved the quality of care for people with diabetes or related conditions. Each article in the series is reviewed and follows a standard format developed by the editors of Clinical Diabetes. The following article is part of a special article collection from the T1D Exchange Quality Improvement Collaborative. It describes an initiative to reduce inequities in diabetes technology access and use and increase the use of connected insulin pens at an academic endocrinology practice in Chicago, IL.

Partnering With Families Through Shared Decision-Making to Increase Connected Pen Use: A Quality Improvement Success Story.

Quality Improvement Success Stories are published by the American Diabetes Association in collaboration with the American College of Physicians and the National Diabetes Education Program. This series is intended to highlight best practices and strategies from programs and clinics that have successfully improved the quality of care for people with diabetes or related conditions. Each article in the series is reviewed and follows a standard format developed by the editors of Clinical Diabetes. The following article is part of a special article collection from the T1D Exchange Quality Improvement Collaborative. It describes efforts at an academic pediatric diabetes clinic in Memphis, TN, to increase both the use of connected insulin pens (CIPs) and shared decision-making around diabetes technology aided by patient information and self-reflection handouts.

Increasing Awareness and Uptake of Connected Insulin Pens for Eligible Patients With Diabetes: A Quality Improvement Success Story.

Quality Improvement Success Stories are published by the American Diabetes Association in collaboration with the American College of Physicians and the National Diabetes Education Program. This series is intended to highlight best practices and strategies from programs and clinics that have successfully improved the quality of care for people with diabetes or related conditions. Each article in the series is reviewed and follows a standard format developed by the editors of Clinical Diabetes. The following article is part of a special article collection from the T1D Exchange Quality Improvement Collaborative. It describes an initiative to increase the use of connected insulin pens in two primary care clinics and one endocrinology clinic serving diverse populations within the Stanford Health Care system in the San Francisco Bay area of California.

Quality improvement in public–private partnerships in low- and middle-income countries: a systematic review

BackgroundPublic–private partnerships (PPP) are often how health improvement programs are implemented in low-and-middle-income countries (LMICs). We therefore aimed to systematically review the literature about the aim and impacts of quality improvement (QI) approaches in PPP in LMICs.MethodsWe searched SCOPUS and grey literature for studies published before March 2022. One reviewer screened abstracts and full-text studies for inclusion. The study characteristics, setting, design, outcomes, and lessons learned were abstracted using a standard tool and reviewed in detail by a second author.ResultsWe identified 9,457 citations, of which 144 met the inclusion criteria and underwent full-text abstraction. We identified five key themes for successful QI projects in LMICs: 1) leadership support and alignment with overarching priorities, 2) local ownership and engagement of frontline teams, 3) shared authentic learning across teams, 4) resilience in managing external challenges, and 5) robust data and data visualization to track progress. We found great heterogeneity in QI tools, study designs, participants, and outcome measures. Most studies had diffuse aims and poor descriptions of the intervention components and their follow-up. Few papers formally reported on actual deployment of private-sector capital, and either provided insufficient information or did not follow the formal PPP model, which involves capital investment for a explicit return on investment. Few studies discussed the response to their findings and the organizational willingness to change.ConclusionsMany of the same factors that impact the success of QI in healthcare in high-income countries are relevant for PPP in LMICs. Vague descriptions of the structure and financial arrangements of the PPPs, and the roles of public and private entities made it difficult to draw meaningful conclusions about the impacts of the organizational governance on the outcomes of QI programs in LMICs. While we found many articles in the published literature on PPP-funded QI partnerships in LMICs, there is a dire need for research that more clearly describes the intervention details, implementation challenges, contextual factors, leadership and organizational structures. These details are needed to better align incentives to support the kinds of collaboration needed for guiding accountability in advancing global health. More ownership and power needs to be shifted to local leaders and researchers to improve research equity and sustainability.

Motivational drivers for health professionals in a large quality improvement collaborative project in Brazil: a qualitative study

BackgroundThe success of collaborative quality improvement (QI) projects in healthcare depends on the context and engagement of health teams; however, the factors that modulate teams’ motivation to participate in these projects are still unclear. The objective of the current study was to explore the barriers to and facilitators of motivation; the perspective was health professionals in a large project aiming to implement evidence-based infection prevention practices in intensive care units of Brazilian hospitals.MethodsThis qualitative study was based on content analysis of semistructured in-depth interviews held with health professionals who participated in a collaborative QI project named “Improving patient safety on a large scale in Brazil”. In accordance with the principle of saturation, we selected a final sample of 12 hospitals located throughout the five regions of Brazil that have implemented QI; then, we conducted videoconference interviews with 28 health professionals from those hospitals. We encoded the interview data with NVivo software, and the interrelations among the data were assessed with the COM-B model.ResultsThe key barriers identified were belief that improvement increases workload, lack of knowledge about quality improvement, resistance to change, minimal involvement of physicians, lack of supplies, lack support from senior managers and work overload. The primary driver of motivation was tangible outcomes, as evidenced by a decrease in infections. Additionally, factors such as the active participation of senior managers, teamwork, learning in practice and understanding the reason for changes played significant roles in fostering motivation.ConclusionThe motivation of health professionals to participate in collaborative QI projects is driven by a variety of barriers and facilitators. The interactions between the senior manager, quality improvement teams, and healthcare professionals generate attitudes that modulate motivation. Thus, these aspects should be considered during the implementation of such projects. Future research could explore the cost-effectiveness of motivational approaches.

New York Presbyterian-Brooklyn Methodist Hospital's Quality Improvement Project Targeting High A1C Levels.

Quality Improvement Success Stories are published by the American Diabetes Association in collaboration with the American College of Physicians and the National Diabetes Education Program. This series is intended to highlight best practices and strategies from programs and clinics that have successfully improved the quality of care for people with diabetes or related conditions. Each article in the series is reviewed and follows a standard format developed by the editors of Clinical Diabetes. The following article describes a Brooklyn, NY, hospital's initiative to reduce high A1C rates among its patients.

Improving Planning for Transition to Adult Care in a Pediatric Diabetes Clinic.

Quality Improvement Success Stories are published by the American Diabetes Association in collaboration with the American College of Physicians and the National Diabetes Education Program. This series is intended to highlight best practices and strategies from programs and clinics that have successfully improved the quality of care for people with diabetes or related conditions. Each article in the series is reviewed and follows a standard format developed by the editors of Clinical Diabetes. The following article describes efforts at a large midwestern pediatric health system to improve planning for patients' transition from pediatric to adult diabetes care settings.

Providing High-Quality Care During a Pandemic: Nursing Home Administrator Perspectives.

Nursing home administrators are responsible for promoting quality improvement (QI), a challenging task during a pandemic. In the current study, a convenience sample of 28 administrators of non-profit nursing homes was recruited for interviews regarding leadership during the coronavirus disease 2019 pandemic. The purpose was to elicit administrator insights into sustainable QI initiatives and factors contributing to QI success during a pandemic. Open-ended interview items focused on QI initiatives, pandemic-related advice to new administrators, and ways external parties can contribute to QI during a pandemic. Administrators highlighted QI initiatives in social connections, infection control, and innovative activities. Advice to new administrators included team development, maintaining a positive attitude, and extensive communication. Administrators recommended that external parties respect infection control measures, seek alternatives to restrictive regulations, and commend staff. Nurses may be better able to lead or assist in implementing nursing home QI initiatives informed by findings from this study. [Journal of Gerontological Nursing, 49(8), 14-18.].

1044-P: Advancing Quality Improvement Culture among 27 Pediatric and Adult Diabetes Centers

Background: The T1D Exchange Quality Improvement Collaborative (T1DX-QI) is a learning health system of over fifty endocrinology centers working to improve diabetes outcomes through Quality Improvement (QI). Centers join T1DX-QI with varying levels of QI culture and are assigned a QI Coach to support practice transformation. This study summarizes the results of 27 endocrinology centers involved in the T1DX-QI for over 12 months. Method: Centers completed a 20-question self-assessment survey to measure QI culture over time in four evidence-based areas: QI Team Structure (team roles); QI Foundation (data collection and training); QI Capacity (use of QI tools); and QI Success (scaling up small tests). Data was collected in 2021 and 2022 for the same centers. The overall difference in QI Capacity was calculated using a Chi-Square test. Results: Overall, QI Culture increased from 67% to 75% from 2021 to 2022 (p-value = 0.005). Figure 1 demonstrates that improvements were seen in three of the four evidence-based areas for both pediatric and adult centers in this time. Conclusion: Even with as little as one year of involvement with the T1DX-QI, centers experience an improvement in their QI Capacity. Disclosure A.Mungmode: None. L.Chao: None. J.Ilkowitz: None. O.Ebekozien: Advisory Panel; Medtronic, Research Support; Eli Lilly and Company, Dexcom, Inc. T1dx-qi collaborative: n/a. O.Odugbesan: None. V.Elisha: None. D.W.Steenkamp: Research Support; Abbott Diabetes, Novo Nordisk. M.K.Kamboj: None. D.Desalvo: Consultant; Dexcom, Inc., Research Support; Insulet Corporation. R.Y.Sonabend: None. A.Neyman: None. P.M.Mathias: None. Funding The Leona M. and Harry B. Helmsley Charitable Trust

Expanding Diabetes Specialty Care in a Community Primary Care Practice Center.

Quality Improvement Success Stories are published by the American Diabetes Association in collaboration with the American College of Physicians and the National Diabetes Education Program. This series is intended to highlight best practices and strategies from programs and clinics that have successfully improved the quality of care for people with diabetes or related conditions. Each article in the series is reviewed and follows a standard format developed by the editors of Clinical Diabetes. The following article describes an effort to expand access to specialty diabetes care for underserved residents in southeastern Dallas County, TX.

A Pharmacist-Led Practice to Improve Perioperative Glycemic Control in Elective Surgery.

Quality Improvement Success Stories are published by the American Diabetes Association in collaboration with the American College of Physicians and the National Diabetes Education Program. This series is intended to highlight best practices and strategies from programs and clinics that have successfully improved the quality of care for people with diabetes or related conditions. Each article in the series is reviewed and follows a standard format developed by the editors of Clinical Diabetes. The following article describes an effort to facilitate the timely identification and treatment of pre- and postoperative hyperglycemia in people with diabetes having elective surgery at a tertiary care hospital in Calgary, Alberta, Canada.

Connecting From Afar: Implementation of Remote Data-Sharing for Patients With Type 1 Diabetes on Insulin Pump Therapy.

Quality Improvement Success Stories are published by the American Diabetes Association in collaboration with the American College of Physicians and the National Diabetes Education Program. This series is intended to highlight best practices and strategies from programs and clinics that have successfully improved the quality of care for people with diabetes or related conditions. Each article in the series is reviewed and follows a standard format developed by the editors of Clinical Diabetes. The following article describes an effort to improve the remote collection of insulin pump data in an academic center in South Florida.

Developing a model for primary care quality improvement success: a comparative case study in rural, urban and Kaupapa Māori organisations.

Introduction Primary care is under pressure to achieve accessible, equitable, quality health care, while being increasingly under resourced. There is a need to understand factors that influence quality improvement (QI) to support a high-performing primary care system. Literature highlights the impact of context on QI but there is little primary care research on this topic. Aim This qualitative case study research seeks to discover the contextual factors influencing QI in primary care, and how the relationships between contextual factors, the QI initiative, and the implementation process influence outcomes. Methods The Consolidated Framework for Implementation Research was used to frame this qualitative study exploring primary care experiences in depth. Six sites were selected to provide a sample of rural, urban and Kaupapa Māori settings. Qualitative data was collected via semi-structured interviews and compared and contrasted with the organisational documents and data provided by participants. Results Cases reported success in achieving improved outcomes for patients, practices, and staff. Strong internal cultures of 'Clan' and 'Adhocracy' typologies supported teamwork, distributed leadership, and a learning climate to facilitate iterative sensemaking activities. To varying degrees, external network relationships provided resources, knowledge, and support. Discussion Organisations were motivated by a combination of patient/community need and organisational culture. Network relationships assisted to varying degrees depending on need. Engaged and distributed leadership based on teamwork was observed, where leadership was shared and emerged at different levels and times as the need arose. A learning climate was supported to enable iterative sensemaking activities to achieve success.

Common characteristics of successful water quality improvement through point source pollution management

Ocean pollution from land-based sources, such as terrestrial runoff and wastewater discharge, has significant environmental, social and economic repercussions. Despite the importance of good water quality for coastal ecosystem health, there is limited information about the key management characteristics present in places where there has been successful water quality management and subsequent improvement in marine ecosystem health. In this study, we evaluated several well-known successful examples of point source pollution management that achieved a notable improvement in water quality and coastal and marine ecosystems recovery, using principles of effective management collated from several existing theoretical Integrated Coastal Zone Management (ICZM) frameworks. Principles related to strong legislation, nested level of governance, stakeholder engagement and coordination among involved entities were determined as key factors to achieve water quality improvement. Understanding consistent themes present in successful management of water quality enhances our ability to better design management strategies that protect marine ecosystems, biodiversity, and human well-being. • Success in marine water quality improvement is scarce. • Six large-scale water quality management have succeeded, measured by improvements in coastal and marine biodiversity. • Strong legislation in place and nested levels of governance were present in all water quality management projects. • Stakeholder engagement and participation in water quality management plan was also a prevalent theme. • The common themes across successful case studies can inform new and ongoing water quality management initiatives.

Parkland Diabetes Clinic.

Quality Improvement Success Stories are published by the American Diabetes Association in collaboration with the American College of Physicians and the National Diabetes Education Program. This series is intended to highlight best practices and strategies from programs and clinics that have successfully improved the quality of care for people with diabetes or related conditions. Each article in the series is reviewed and follows a standard format developed by the editors of Clinical Diabetes. The following article describes an initiative to reduce the no-show rate for appointments at the Parkland Diabetes Clinic in Dallas, TX.

Effect of a Type 2 Diabetes-Focused Visit Improvement Initiative on Therapeutic Inertia and Glycemic Control in Primary Care.

Quality Improvement Success Stories are published by the American Diabetes Association in collaboration with the American College of Physicians and the National Diabetes Education Program. This series is intended to highlight best practices and strategies from programs and clinics that have successfully improved the quality of care for people with diabetes or related conditions. Each article in the series is reviewed and follows a standard format developed by the editors of Clinical Diabetes. The following article describes a multicomponent quality improvement initiative in the Chicago, IL, area that used a diabetes-focused clinic visit to overcome barriers that lead to clinical inertia for type 2 diabetes.

Benefits of Electronic Consultations in Improving Diabetes Care Within a Safety-Net Health System.

Quality Improvement Success Stories are published by the American Diabetes Association in collaboration with the American College of Physicians and the National Diabetes Education Program. This series is intended to highlight best practices and strategies from programs and clinics that have successfully improved the quality of care for people with diabetes or related conditions. Each article in the series is reviewed and follows a standard format developed by the editors of Clinical Diabetes. The following article describes an initiative aimed at improving access to diabetes specialty care for patients within a safety-net health system in Dallas County, TX, through the implementation of electronic consultations.

MOVE! Enhanced: A Virtual Multidisciplinary Weight and Diabetes Management Program for High-Risk Veterans. A Feasibility Pilot.

Quality Improvement Success Stories are published by the American Diabetes Association in collaboration with the American College of Physicians and the National Diabetes Education Program. This series is intended to highlight best practices and strategies from programs and clinics that have successfully improved the quality of care for people with diabetes or related conditions. Each article in the series is reviewed and follows a standard format developed by the editors of Clinical Diabetes. The following article describes a feasibility study assessing a multidisciplinary, virtual weight and diabetes management program aimed at high-risk veterans with obesity and diabetes in Milwaukee, WI.

Improving Knowledge of Active Safety and QI Projects Amongst Practitioners in a Pediatric ICU.

Introduction:The success of quality improvement (QI) projects depends on many factors, with communication and knowledge of project-specific practice change being fundamental. This project aimed to improve the knowledge of active safety and QI projects.Methods:Two interventions were trialed to improve knowledge: paired email and meeting announcements followed by a daily huddle to review ongoing projects. Knowledge, measured as the ability to recall a project and its practice change, was the primary outcome. The frequency and duration of the Huddle were process and balancing measures, respectively.Results:Seven days after a meeting/email announcement, 3 of 13 (23%) faculty and fellows recalled the announced practice change. Investigators then tested the effects of the Huddle by assessing practitioners’ knowledge of safety and QI project-related practice changes on the first and last day of a service week. The average percentage of items recalled increased from the beginning to end of a service week by 33% [46% to 79%, 95% confidence interval (CI) 12–53] for faculty and 27% (51% to 77%, 95% CI 13–40) for fellows. The Huddle occurred in four of seven (interquartile range 2–5) days/wk with a mean duration of 4.5 (SD 2) minutes. Follow-up assessment 2 years after Huddle implementation demonstrate sustained increase in item recall [faculty +36% (95% CI +13% to 40%); fellows +35% (95% CI +23% to 47%)].Conclusions:A daily huddle to discuss safety and QI project-related practice change is an effective and time-efficient communication method to increase knowledge of active projects.