Outpatient oxaliplatin desensitizations: A process improvement evaluation.
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ABSTRACT:
SUBMITTER: Barmettler S
PROVIDER: S-EPMC6878134 | biostudies-literature | 2019 Dec
REPOSITORIES: biostudies-literature
Publications
Outpatient oxaliplatin desensitizations: A process improvement evaluation.
Barmettler Sara S Wolfson Anna A Yang Nancy N Fu Xiaoqing X Blumenthal Kimberly K Banerji Aleena A
Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology 20190903 6
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Project description:We describe our experience implementing an intensive quality improvement cohort pilot focused on managing asymptomatic bacteriuria in 19 critical access hospitals. Participation in the pilot was high, and almost all sites identified an improvement goal and collected clinical data. Barriers to implementation included staffing shortages, turnover, and lack of bandwidth.
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Project description:PURPOSE AND OBJECTIVES:Quality improvement (QI) coaching improves human papillomavirus (HPV) vaccination coverage, but effects of coaching have been small, and little is known about how and when QI coaching works. To assess implementation outcomes and explore factors that might explain variation in outcomes, we conducted a process evaluation of a QI coaching intervention for HPV vaccination. INTERVENTION APPROACH:QI coaches received tools and training to support 4 core coaching competencies: 1) expertise in using clinic-level adolescent vaccination data to drive change, 2) knowledge of the evidence base to support change in HPV vaccination practice, 3) familiarity with improvement strategies and action planning, and 4) skill in building relationships. EVALUATION METHODS:Our mixed methods evaluation involved collecting quantitative data through effort-tracking logs and gathering qualitative data through in-depth interviews with QI coaches (N = 11) who worked with 89 clinics in 3 US states. Data were collected on implementation outcomes and on contextual factors that might explain variations in those outcomes. Implementation outcomes included adoption by clinics, reach to providers and staff (ie, participation in the coaching visit), and implementation fidelity. RESULTS:States achieved either high adoption or high reach, but not both. For example, state A had high adoption with 94% of clinics accepting a coaching visit, but low reach with a median of 1 participant per clinic. In contrast, state C had lower adoption (29%, P < .01) than state A but higher reach (median of 4 participants per clinic, P < .01). Generally, states had high coaching protocol fidelity with the exception of advising on strategies and action planning. QI coaches described factors that might explain these variations, including strength of relationships with clinic staff and whether they recruited clinics directly or through large clinic networks. IMPLICATIONS FOR PUBLIC HEALTH:Our findings have implications for the design of future QI coaching initiatives, including how coaches recruit clinics to ensure full clinic engagement, refinements to coaching visits, and how QI coaches can effectively engage with clinic networks. Findings could inform future QI coaching interventions to strengthen their impact on public health.
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Project description:BackgroundInadequate assessment of the severity and urgency of medical problems is one of the factors contributing to unnecessary emergency department (ED) visits. The implementation of a software-based instrument for standardized initial assessment-Standardisierte medizinische Ersteinschätzung in Deutschland (SmED) (Standardized medical Initial Assessment in Germany in English)-aims to support health care professionals and steer patients toward the right health care provider. This study aimed to explore the implementation process of SmED from a user perspective.ObjectiveThis study aims to evaluate the overall perception of SmED by health care professionals using the software, to examine to what extent SmED influences the workload and work routines of health care professionals, and to determine which factors are associated with the use of SmED.MethodsAn early qualitative process evaluation on the basis of interviews was carried out alongside the implementation of SmED in 26 outpatient emergency care services within 11 federal states in Germany. Participants were 30 health care professionals who work with SmED either at the joint central contact points of the outpatient emergency care service and the EDs of hospitals (ie, the Joint Counter; Gemeinsamer Tresen in German) or at the initial telephone contact points of the outpatient emergency care service (phone number 116117). Matrix-based framework analysis was applied to analyze the interview data.ResultsHealth care professionals perceived that workload increased initially, due to additional time needed per patient. When using SmED more frequently and over a longer time period, its use became more routine and the time needed per call, per patient, decreased. SmED was perceived to support decision making regarding urgency for medical treatment, but not all types of patients were eligible. Technical problems, lack of integration with other software, and lack of practicability during peak times affected the implementation of SmED.ConclusionsInitial experiences with SmED were positive, in general, but also highlighted organizational issues that need to be addressed to enhance sustainability.Trial registrationGerman Clinical Trials Register DRKS00017014; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00017014.
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Project description:Tennessee registered the second-highest drug overdose mortality rate of any state in 2022; such deaths have grown by 90% from 2019 to 2022. Tennessee has participated in the State Unintentional Drug Overdose Reporting System (SUDORS) since 2018. An abstraction team synthesizes data for SUDORS from death certificates, autopsies, and other sources. The purpose of this study was to engage in a comprehensive qualitative evaluation of our SUDORS process to distill insights that could improve abstraction speed and quality while reducing abstractor burnout. We conducted 2 rounds of interviews and focus groups with all 7 members of the Tennessee abstraction team in late 2023 and early 2024. The researcher asked questions regarding the adequacy of the current project management approach and team communication level, abstractors' stress levels, the need for further training, and whether additional data science-based tools could be deployed to increase the speed and accuracy of abstraction. The study yielded several actionable insights for improving abstraction capacity and lessening stress burdens. Accordingly, we made changes to our project management, team communication, and training approaches; worked to better integrate our extant data science tools; and took steps to improve mental well-being. As a result, the average time it takes for an abstractor to enter a case into the NVDRS platform dropped from 12.2 to 6.5 minutes, and all team members noted a decrease in stress levels. The changes made as a result of the findings of this study will help the State keep pace with a high case load and will support abstractors' mental well-being.
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Project description:BackgroundInadequate assessment of the severity and urgency of health problems is one of the factors contributing to unnecessary emergency department visits. A software-based instrument for standardized initial assessment (SmED) aims to support healthcare professionals and steer patients to the appropriate source of care. The aim of this study was to evaluate the implementation process of SmED based on the point of view of users in order to facilitate sustainable implementation.MethodsA quantitative process evaluation on the basis of a paper-based questionnaire was carried out alongside the implementation of SmED in 26 outpatient emergency care services within 11 federal states in Germany. Healthcare professionals who worked with SmED either at the joint contact points of the outpatient emergency care service and the emergency departments of hospitals ("Joint Counter", German "Gemeinsamer Tresen") or at the initial telephone contact points of the outpatient emergency care service (116117) were invited to participate in the survey.Results200 users of SmED completed the questionnaire comprising the five scales: Intervention effectiveness/efficacy, Interprofessional context/occupational Interest, Individual Context, Organisational Framework Conditions, and Medical Context. Several individual characteristics were related to the implementation process of SmED. Female and younger healthcare professionals and participants with less than five years of professional experience tended to evaluate the implementation process as more positive. Factors related to the Individual Context and to the Medical Context were associated with the reported use of SmED (p = 0.004 and 0.041, respectively).ConclusionThe involvement of healthcare professionals, particularly more experienced professionals, in the implementation of SmED may help to facilitate sustainable implementation. In addition, training of potential user prior and during the implementation process and the adaption of Organisational Context factors are crucial. Trial registration The study was registered at the German Clinical Trials Register prior to the start of the study (DRKS00017014).
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