Establishment of the T1D Exchange Quality Improvement Collaborative (T1DX-QI).
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ABSTRACT:
SUBMITTER: Alonso GT
PROVIDER: S-EPMC7164986 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:IntroductionPediatric residencies are expected to arm trainees with skills in quality improvement (QI) that allow trainees to systematically enhance their own practice. Simulation has been shown to be effective in teaching QI, but there are no published QI simulation tools that target pediatric learners.MethodsWe adapted a previously developed QI simulation to include a case relevant for pediatric residents. Participants devised interventions using basic QI principles with iterative feedback from facilitators with knowledge of QI methodology. Changes in resident knowledge, attitudes about the curriculum, and depth of engagement in QI were assessed using pre- and posttests, surveys, and assessment of independent QI activities performed prior to graduation, respectively.ResultsEighty-two residents completed the simulation. Of the 76 residents who completed both the pre- and posttests, which each had a total possible score of 28 points, 68% had improved posttest scores, with an average score increase of 2.6 points (SD = 0.6, p < .001). Improvements were most pronounced for residents that scored in the lowest quartile on the pretest. After the simulation, residents reported greater confidence in and likelihood of completing a QI initiative. There was no difference in the level of involvement in future independent QI activities completed by residents who were simulation participants compared with nonparticipants.DiscussionAdapting a previously published QI simulation for pediatric residents was feasible and effective, and the QI simulation was well-liked by learners. Those with lower baseline QI knowledge may have the most to gain from this simulation.
| S-EPMC7431186 | biostudies-literature
Project description:IntroductionIn recent years, undergraduate and graduate medical education has been rightfully emphasizing education in quality improvement and patient safety (QIPS). However, the best methods for teaching the foundational principles of QIPS and associated skills are unknown.MethodsIn collaboration with the Institute for Healthcare Improvement Open School, we developed an approachable simulation for teams of health care trainees at any level and any discipline. The simulation is based on the investigation of a case regarding a psychiatric patient admitted to a fictional hospital for medical treatment who has eloped. In teams, participants investigate the incident by collecting data and using basic QI principles to brainstorm and design interventions. Participants are guided through this paper-based simulation by QI facilitators who have working knowledge of basic QI principles and techniques.ResultsThe simulation has been successfully used with hundreds of medical students and other health professional trainees. While working in teams, participants gained exposure to patient-safety incident reporting and investigation, process mapping, plan-do-study-act cycles, run charts, intervention design, and interactions with hospital administrators. Surveyed participants reported that they had learned QI principles, gained confidence in their ability to do QI work, and increased their likelihood of leading a QI initiative in the future.DiscussionSimulation has become a standard way to teach many clinical topics in undergraduate and graduate medical education, and QIPS should be no exception. This simulation has been shown to be effective in increasing understanding of and interest in QIPS.
| S-EPMC6342354 | biostudies-literature
Project description:BACKGROUND: Assessing the effectiveness of quality improvement curricula is important to improving this area of resident education. OBJECTIVE: To assess the ability of the Quality Improvement Knowledge Application Tool (QIKAT) to differentiate between residents who were provided instruction in QI and those who were not, when scored by individuals not involved in designing the QIKAT, its scoring rubric, or QI curriculum instruction. METHODS: The QIKAT and a 9-item self-assessment of QI proficiency were administered to an intervention and a control group. The intervention was a longitudinal curriculum consisting of 8 hours of didactic QI training and 6 workshops providing just-in-time training for resident QI projects. Two uninvolved faculty scored the QIKAT. RESULTS: A total of 33 residents in the intervention group and 27 in the control group completed the baseline and postcurriculum QIKAT and self-assessment. QIKAT mean intervention group scores were significantly higher than mean control group scores postcurriculum (P < .001). Absolute QIKAT differences were small (of 15 points, intervention group improved from a mean score of 12.8 to 13.2). Interrater agreement as measured by kappa test was low (0.09). Baseline self-assessment showed no differences, and after instruction, the intervention group felt more proficient in QI knowledge than controls in 4 of 9 domains tested. CONCLUSIONS: The QIKAT detected a statistically significant improvement postintervention, but the absolute differences were small. Self-reported gain in QI knowledge and proficiency agreed with the results of the QIKAT. However, QIKAT limitations include poor interrater agreement and a scoring rubric that lacks specificity. Programs considering using QIKAT to assess curricula should understand these limitations.
| S-EPMC4054728 | biostudies-other
Project description:ObjectiveValid, reliable critical appraisal tools advance quality improvement (QI) intervention impacts by helping stakeholders identify higher quality studies. QI approaches are diverse and differ from clinical interventions. Widely used critical appraisal instruments do not take unique QI features into account and existing QI tools (eg, Standards for QI Reporting Excellence) are intended for publication guidance rather than critical appraisal. This study developed and psychometrically tested a critical appraisal instrument, the QI Minimum Quality Criteria Set (QI-MQCS) for assessing QI-specific features of QI publications.MethodsApproaches to developing the tool and ensuring validity included a literature review, in-person and online survey expert panel input, and application to empirical examples. We investigated psychometric properties in a set of diverse QI publications (N=54) by analysing reliability measures and item endorsement rates and explored sources of disagreement between reviewers.ResultsThe QI-MQCS includes 16 content domains to evaluate QI intervention publications: Organisational Motivation, Intervention Rationale, Intervention Description, Organisational Characteristics, Implementation, Study Design, Comparator Description, Data Sources, Timing, Adherence/Fidelity, Health Outcomes, Organisational Readiness, Penetration/Reach, Sustainability, Spread and Limitations. Median inter-rater agreement for QI-MQCS items was κ 0.57 (83% agreement). Item statistics indicated sufficient ability to differentiate between publications (median quality criteria met 67%). Internal consistency measures indicated coherence without excessive conceptual overlap (absolute mean interitem correlation=0.19). The critical appraisal instrument is accompanied by a user manual detailing What to consider, Where to look and How to rate.ConclusionsWe developed a ready-to-use, valid and reliable critical appraisal instrument applicable to healthcare QI intervention publications, but recognise scope for continuing refinement.
| S-EPMC4680162 | biostudies-literature
Project description:BackgroundThe American College of Surgeons National Surgical Quality Improvement Program (NSQIP) collaborative in Ontario, the Ontario Surgical Quality Improvement Network (ON-SQIN), was launched in January 2015. We describe its approaches to support surgical quality improvement and examine its early impact on member hospitals.MethodsAll Ontario hospitals that participated in the ON-SQIN and NSQIP were included in this quality-improvement study. The primary intervention was the introduction of the ON-SQIN, and the secondary interventions included a community of practice and access to quality-improvement resources and tools. Outcome measures included the level of quality-improvement capacity, collaborative-wide aggregate data on postoperative complications, and self-reported rates of surgical site and urinary tract infections.ResultsEighteen hospitals that enrolled in the ON-SQIN in 2015 reported an increase in their capacity for quality improvement after 18 months. Analysis of the collaborative-wide aggregate data in a 6-month period (14 748 surgical cases) revealed a substantial reduction of acute renal failure (relative risk 0.48, 95% confidence interval 0.25-0.95) and urinary tract infection (relative risk 0.77, 95% confidence interval 0.61-0.97). Most hospitals that targeted prevention of surgical site infection and urinary tract infection reported reduction of these occurrences during a 1-year period.InterpretationThe ON-SQIN supported the uptake of the NSQIP in Ontario hospitals and promoted targeted surgical quality-improvement initiatives, resulting in increased quality-improvement capacity and development of the community of practice. Furthermore, our early experience suggests that improvements in surgical care are being realized.
| S-EPMC6182121 | biostudies-literature
Project description:BackgroundFew studies have rigorously evaluated the associations between organizational characteristics and intervention activities of health care organizations participating in quality improvement collaboratives (QICs).ObjectiveTo examine the relationship between clinic characteristics and intervention activities by primary care clinics that provide HIV care and that participated in a QIC.DesignCross-sectional study of Ryan White CARE Act (now called Ryan White HIV/AIDS Treatment Modernization Act) funded clinics that participated in a QIC over 16 months in 2000 and 2001. The QIC was originally planned to be a more typical 12 months long, but was extended to increase the likelihood of success. Data were collected using surveys of clinicians and administrators in participating clinics and monthly reports of clinic improvement activities.MeasuresNumber of interventions attempted, percent of interventions repeated, percent of interventions evaluated, and organizational characteristics.ResultsClinics varied significantly in their intervention choices. Organizations with a more open culture and a greater emphasis on quality improvement attempted more interventions (P < 0.01, P < 0.05) and interventions that were more comprehensive (P < 0.01, P < 0.10). Presence of multidisciplinary teams and measurement of progress toward quantifiable goals also were associated with comprehensiveness of interventions (P < 0.01, P < 0.05).ConclusionClinic characteristics predicted intervention activities during a QIC. Further research is needed on how these organizational characteristics affect quality of care through their influence on intervention activities.
| S-EPMC3748716 | biostudies-literature
Project description:BackgroundEvidence-based Practice for Improving Quality (EPIQ) is a collaborative quality improvement method adopted by the Canadian Neonatal Network that led to decreased mortality and morbidity in very preterm neonates. The Alberta Collaborative Quality Improvement Strategies to Improve Outcomes of Moderate and Late Preterm Infants (ABC-QI) Trial aims to evaluate the impact of EPIQ collaborative quality improvement strategies in moderate and late preterm neonates in Alberta, Canada.MethodsIn a 4-year, multicentre, stepped-wedge cluster randomized trial involving 12 neonatal intensive care units (NICUs), we will collect baseline data with the current practices in the first year (all NICUs in the control arm). Four NICUs will transition to the intervention arm at the end of each year, with 1 year of follow-up after the last group transitions to the intervention arm. Neonates born at 32 + 0 to 36 + 6 weeks' gestation with primary admission to NICUs or postpartum units will be included. The intervention includes implementation of respiratory and nutritional care bundles using EPIQ strategies, including quality improvement team building, quality improvement education, bundle implementation, quality improvement mentoring and collaborative networking. The primary outcome is length of hospital stay; secondary outcomes include health care costs and short-term clinical outcomes. Neonatal intensive care unit staff will complete a survey in the first year to assess quality improvement culture in each unit, and a sample will be interviewed 1 year after implementation in each unit to evaluate the implementation process.InterpretationThe ABC-QI Trial will assess whether collaborative quality improvement strategies affect length of stay in moderate and late preterm neonates. It will provide detailed population-based data to support future research, benchmarking and quality improvement.Trial registrationClinicalTrials.gov, no. NCT05231200.
| S-EPMC10158756 | biostudies-literature
Project description:BackgroundThe ABCDEF bundle (Assess, prevent, and manage pain and Delirium; Both spontaneous awakening and breathing trials; Choice of analgesia/sedation; Early mobility; and Family engagement) improves intensive care unit outcomes, but adoption into practice is poor.ObjectiveTo assess the effect of quality improvement collaborative participation on ABCDEF bundle performance.MethodsThis interrupted time series analysis included 20 months of bundle performance data from 15 226 adults admitted to 68 US intensive care units. Segmented regression models were used to quantify complete and individual bundle element performance changes over time and compare performance patterns before (6 months) and after (14 months) collaborative initiation.ResultsComplete bundle performance rates were very low at baseline (<4%) but increased to 12% by the end. Complete bundle performance increased by 2 percentage points (SE, 0.9; P = .06) immediately after collaborative initiation. Each subsequent month was associated with an increase of 0.6 percentage points (SE, 0.2; P = .04). Performance rates increased significantly immediately after initiation for pain assessment (7.6% [SE, 2.0%], P = .002), sedation assessment (9.1% [SE, 3.7%], P = .02), and family engagement (7.8% [SE, 3%], P = .02) and then increased monthly at the same speed as the trend in the baseline period. Performance rates were lowest for spontaneous awakening/breathing trials and early mobility.ConclusionsQuality improvement collaborative participation resulted in clinically meaningful, but small and variable, improvements in bundle performance. Opportunities remain to improve adoption of sedation, mechanical ventilation, and early mobility practices.
| S-EPMC9972543 | biostudies-literature
Project description:Experienced endoscopists will perform endoscopy during the study period and the detection rate of gastric premalignant lesion, correlation between endoscopic and serologic diagnosis of premalignant lesions and inter-observer agreement rate will be analyzed before and after the education.
| 2191050 | ecrin-mdr-crc
Project description:BackgroundMeaningful resident engagement in quality improvement (QI) remains challenging. Barriers include a lack of time and of faculty with QI expertise. We leveraged our internal medicine (IM) residency program's adoption of an "X" (inpatient rotations) plus "Y" (ambulatory block) schedule to implement a QI curriculum for all residents during their ambulatory block.ObjectiveWe sought to engage residents in interprofessional QI, improve residents' QI confidence and knowledge and application to practice, and create opportunities for QI scholarship.MethodsIn July 2015, the program provided dedicated time for QI in the ambulatory block. All categorical IM residents and 11 voluntary faculty mentors were divided into 10 teams based on clinic site and "Y" block schedule. Teams participated in resident-led, interprofessional ambulatory QI projects. Resident QI knowledge and confidence were assessed before the curriculum and 11 months after using the Quality Improvement Knowledge Application Tool-Revised (QIKAT-R) and surveys. QI project implementation and scholarship were tracked.ResultsAll categorical residents (N = 81) participated. Residents reported increased confidence in all QI skills, and they demonstrated increased knowledge, with mean QIKAT-R paired scores improving from 15.8 ± 4.6 to 19.1 ± 5.9 (n = 45 pairs, P < .001). A total of 9 of 10 teams implemented process changes, and 6 team project improvements have been sustained.ConclusionsThis ongoing curriculum engaged IM and IM-psychiatry residents in QI during their ambulatory block using volunteer clinic faculty mentors. Residents demonstrated improved QI confidence and knowledge. The majority of resident projects were sustained and generated scholarship.
| S-EPMC6008036 | biostudies-literature