Effect of a Multifaceted Quality Improvement Intervention on Hospital Personnel Adherence to Performance Measures in Patients With Acute Ischemic Stroke in China

Abstract Background Over a decade of implementing a global strategy to eliminate lymphatic filariasis in Ghana through mass drug administration, the disease is still being transmitted in 11 districts out of an initial 98 endemic districts identified in 2000. A context-specific evidence-based quality improvement intervention was implemented in the Bole District of Northern Ghana after an initial needs assessment to improve the lymphatic filariasis mass drug administration towards eliminating the disease. Therefore, this study aimed to evaluate the process and impact of the lymphatic filariasis context-specific evidence-based quality improvement intervention in the Bole District of Northern Ghana. Method A cross-sectional mixed methods study using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework to evaluate the context-specific evidence-based quality improvement intervention was employed. Quantitative secondary data was extracted from the neglected tropical diseases database. A community survey was conducted with 446 randomly selected participants. Qualitative data were collected from 42 purposively selected health workers, chiefs/opinion leaders and community drug distributors in the study area. Results The evaluation findings showed an improvement in social mobilisation and sensitisation, knowledge about lymphatic filariasis and mass drug administration process, willingness to ingest the medication and adherence to the direct observation treatment strategy. We observed an increase in coverage ranging from 0.1 to 12.3% after implementing the intervention at the sub-district level and reducing self-reported adverse drug reaction. The level of reach, effectiveness and adoption at the district, sub-district and individual participants’ level suggest that the context-specific evidence-based quality improvement intervention is feasible to implement in lymphatic filariasis hotspot districts based on initial context-specific needs assessment. Conclusion The study provided the groundwork for future application of the RE-AIM framework to evaluate the implementation of context-specific evidence-based quality improvement intervention to improve lymphatic filariasis mass drug administration towards eliminating the disease as a public health problem.

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Nursing Home Staff Perceptions of Barriers and Facilitators to Implementing a Quality Improvement Intervention

Journal of the American Medical Directors Association ◽

10.1016/j.jamda.2019.01.139 ◽

2019 ◽

Vol 20 (7) ◽

pp. 810-815 ◽

Cited By ~ 4

Author(s):

Whitney L. Mills ◽

Camilla B. Pimentel ◽

A. Lynn Snow ◽

Rebecca S. Allen ◽

Nancy J. Wewiorski ◽

...

Keyword(s):

Quality Improvement ◽

Nursing Home ◽

Barriers And Facilitators ◽

Quality Improvement Intervention ◽

Staff Perceptions ◽

Nursing Home Staff ◽

Improvement Intervention

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The effect of a quality improvement intervention on sleep and delirium in critically ill patients in a surgical intensive care unit

CHEST Journal ◽

10.1016/j.chest.2021.03.030 ◽

2021 ◽

Author(s):

Joseph E. Tonna ◽

Anna Dalton ◽

Angela P. Presson ◽

Chong Zhang ◽

Elizabeth Colantuoni ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Quality Improvement ◽

Critically Ill ◽

Critically Ill Patients ◽

Quality Improvement Intervention ◽

Surgical Intensive Care Unit ◽

Surgical Intensive Care ◽

Improvement Intervention

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A quality improvement intervention to reduce emergency department radiography for bronchiolitis

Respiratory Medicine ◽

10.1016/j.rmed.2018.02.014 ◽

2018 ◽

Vol 137 ◽

pp. 1-5 ◽

Cited By ~ 3

Author(s):

Joel Reiter ◽

Adin Breuer ◽

Oded Breuer ◽

Saar Hashavya ◽

David Rekhtman ◽

...

Keyword(s):

Emergency Department ◽

Quality Improvement ◽

Quality Improvement Intervention ◽

Improvement Intervention

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Achieving More Rapid Door-to-Needle Times and Improved Outcomes in Acute Ischemic Stroke in a Nationwide Quality Improvement Intervention

Stroke ◽

10.1161/strokeaha.121.035853 ◽

2021 ◽

Author(s):

Ying Xian ◽

Haolin Xu ◽

Eric E. Smith ◽

Jeffrey L. Saver ◽

Mathew J. Reeves ◽

...

Keyword(s):

United States ◽

Quality Improvement ◽

Ischemic Stroke ◽

Thrombolytic Therapy ◽

Phase I ◽

Acute Ischemic Stroke ◽

Symptom Onset ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

The United States

Background and Purpose: The benefits of tPA (tissue-type plasminogen activator) in acute ischemic stroke are time-dependent. However, delivery of thrombolytic therapy rapidly after hospital arrival was initially occurring infrequently in hospitals in the United States, discrepant with national guidelines. Methods: We evaluated door-to-needle (DTN) times and clinical outcomes among patients with acute ischemic stroke receiving tPA before and after initiation of 2 successive nationwide quality improvement initiatives: Target: Stroke Phase I (2010–2013) and Target: Stroke Phase II (2014–2018) from 913 Get With The Guidelines-Stroke hospitals in the United States between April 2003 and September 2018. Results: Among 154 221 patients receiving tPA within 3 hours of stroke symptom onset (median age 72 years, 50.1% female), median DTN times decreased from 78 minutes (interquartile range, 60–98) preintervention, to 66 minutes (51–87) during Phase I, and 50 minutes (37–66) during Phase II ( P <0.001). Proportions of patients with DTN ≤60 minutes increased from 26.4% to 42.7% to 68.6% ( P <0.001). Proportions of patients with DTN ≤45 minutes increased from 10.1% to 17.7% to 41.4% ( P <0.001). By the end of the second intervention, 75.4% and 51.7% patients achieved 60-minute and 45-minute DTN goals. Compared with the preintervention period, hospitals during the second intervention period (2014–2018) achieved higher rates of tPA use (11.7% versus 5.6%; adjusted odds ratio, 2.43 [95% CI, 2.31–2.56]), lower in-hospital mortality (6.0% versus 10.0%; adjusted odds ratio, 0.69 [0.64–0.73]), fewer bleeding complication (3.4% versus 5.5%; adjusted odds ratio, 0.68 [0.62–0.74]), and higher rates of discharge to home (49.6% versus 35.7%; adjusted odds ratio, 1.43 [1.38–1.50]). Similar findings were found in sensitivity analyses of 185 501 patients receiving tPA within 4.5 hours of symptom onset. Conclusions: A nationwide quality improvement program for acute ischemic stroke was associated with substantial improvement in the timeliness of thrombolytic therapy start, increased thrombolytic treatment, and improved clinical outcomes.

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