Encouraging translation and assessing impact of the Centre for Research Excellence in Integrated Quality Improvement: rationale and protocol for a research impact assessment

IntroductionThere is growing recognition among health researchers and funders that the wider benefits of research such as economic, social and health impacts ought to be assessed and valued alongside academic outputs such as peer-reviewed papers. Research translation needs to increase and the pathways to impact ought to be more transparent. These processes are particularly pertinent to the Indigenous health sector given continued concerns that Indigenous communities are over-researched with little corresponding improvement in health outcomes. This paper describes the research protocol of a mixed methods study to apply FAIT (Framework to Assess the Impact from Translational health research) to the Centre for Research Excellence in Integrated Quality Improvement (CRE-IQI). FAIT will be applied to five selected CRE-IQI Flagship projects to encourage research translation and assess the wider impact of that research.Methods and analysisPhase I will develop a modified programme logic model for each Flagship project including identifying process, output and impact metrics so progress can be monitored. A scoping review will inform potential benefits. In phase II, programme logic models will be updated to account for changes in the research pathways over time. Audit and feedback will be used to encourage research translation and collect evidence of achievement of any process, output and interim impacts. In phase III, three proven methodologies for measuring research impact—Payback, economic assessment and narratives—will be applied. Data on the application of FAIT will be collected and analysed to inform and improve FAIT’s performance.Ethics and disseminationThis study is funded by a nationally competitive grant (ID 1078927) from the Australian National Health and Medical Research Council. Ethics approval was obtained from the University of Newcastle’s Human Research Ethics Committee (ID: H-2017–0026). The results from the study will be presented in several peer-reviewed publications, through conference presentations and via social media.

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Doctor Who? A Quality Improvement Project to Assess and Improve Patients' Knowledge of Their Inpatient Physicians

Journal of Graduate Medical Education ◽

10.4300/jgme-d-15-00067.1 ◽

2016 ◽

Vol 8 (2) ◽

pp. 197-201 ◽

Cited By ~ 1

Author(s):

Kathleen Broderick-Forsgren ◽

Wynn G Hunter ◽

Ryan D Schulteis ◽

Wen-Wei Liu ◽

Joel C Boggan ◽

...

Keyword(s):

Quality Improvement ◽

Audit And Feedback ◽

Quality Improvement Initiative ◽

Clinical Learning Environment ◽

Improvement Project ◽

Business Card ◽

Quality Patient Care ◽

White Board ◽

White Boards ◽

The Impact

ABSTRACT Patient-physician communication is an integral part of high-quality patient care and an expectation of the Clinical Learning Environment Review program.Background This quality improvement initiative evaluated the impact of an educational audit and feedback intervention on the frequency of use of 2 tools—business cards and white boards—to improve provider identification.Objective This before-after study utilized patient surveys to determine the ability of those patients to name and recognize their physicians. The before phase began in July 2013. From September 2013 to May 2014, physicians received education on business card and white board use.Methods We surveyed 378 patients. Our intervention improved white board utilization (72.2% postintervention versus 54.5% preintervention, P < .01) and slightly improved business card use (44.4% versus 33.7%, P = .07), but did not improve physician recognition. Only 20.3% (14 of 69) of patients could name their physician without use of the business card or white board. Data from all study phases showed the use of both tools improved patients' ability to name physicians (OR = 1.72 and OR = 2.12, respectively; OR = 3.68 for both; P < .05 for all), but had no effect on photograph recognition.Results Our educational intervention improved white board use, but did not result in improved patient ability to recognize physicians. Pooled data of business cards and white boards, alone or combined, improved name recognition, suggesting better use of these tools may increase identification. Future initiatives should target other barriers to usage of these types of tools.Conclusions

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“We Are Not Stray Leaves Blowing About In The Wind”: Summing Up The Impact of Family Wellbeing Empowerment Research, 1998-2021

10.21203/rs.3.rs-779109/v1 ◽

2021 ◽

Author(s):

Nirukshi Perera ◽

Komla Tsey ◽

Marion Heyeres ◽

Mary Whiteside ◽

Leslie Baird ◽

...

Keyword(s):

Research Impact ◽

Theory Of Change ◽

Indigenous Australians ◽

Research Translation ◽

Emotional Wellbeing ◽

Social And Emotional ◽

Scoping Reviews ◽

The Impact ◽

Social And Emotional Wellbeing ◽

Family Wellbeing

Abstract Background: An Aboriginal-developed empowerment and social and emotional wellbeing program, known as Family Wellbeing (FWB), has been found to strengthen the protective factors that help Indigenous Australians to deal with the devastating legacy of colonisation and intergenerational trauma. This article reviews the research that has accompanied the implementation of FWB over a 23 year period to assess the long-term impact of FWB research and the strengths and limitations of the impact data. This will inform more comprehensive monitoring of research impact.Methods: The study took a theory of change approach, following the steps of a research program logic, to assess impact. A mixed methods evaluation of publicly available research outputs was conducted. We analysed FWB participation data and research funding using descriptive statistics. We conducted systematic scoping reviews of: 1) nine evaluative studies to show reported social and emotional wellbeing benefits of FWB; and 2) seven FWB research translation-related resources to show impact of research outputs on further reach and uptake. Results: The investment of $2.3 million in research-related activities over 23 years resulted in a range of research outputs that evidenced social and emotional wellbeing benefits arising from participation in FWB. This evidence, in part, facilitated more demand for FWB. Overall the FWB program, and accompanying research, had a direct positive impact on the social and emotional wellbeing of approximately 7,500 participants.Conclusions: The study raised a range of issues relevant to demonstrating research impact in the context of Indigenous health research including the value of a logic model that is informed by Indigenous research principles; the need to take a longer-term incremental approach to building evidence when dealing with complex or messy social health interventions; and the importance of collecting evidence, especially from the point of view of end users, about the extent to which research influenced their decisions and actions regarding the program. This lesson, and the impact logic, highlight that researchers need to create appropriate databases from the beginning and collect data well beyond the life of the project, even though we acknowledge that such endeavours are rarely funded.

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The impact of audit and feedback to support change behaviour in healthcare organisations - a cross-sectional qualitative study of primary care centre managers

BMC Health Services Research ◽

10.1186/s12913-021-06645-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Anna H. Glenngård ◽

Anders Anell

Keyword(s):

Primary Care ◽

Quality Improvement ◽

Audit And Feedback ◽

Primary Care Centre ◽

Research Approach ◽

Care Centre ◽

Bottom Up ◽

Complex Change ◽

Facilitators And Barriers ◽

The Impact

Abstract Background This article addresses the role of audit and feedback (A&F) to support change behaviour and quality improvement work in healthcare organisations. It contributes to the sparse literature on primary care centre (PCC) managers´ views on A&F practices, taking into account the broad scope of primary care. The purpose was to explore if and how different types of A&F support change behaviour by influencing different forms of motivation and learning, and what contextual facilitators and barriers enable or obstruct change behaviour in primary care. Methods A qualitative research approach was used. We explored views about the impact of A&F across managers of 27 PCCs, in five Swedish regions, through semi-structured interviews. A purposeful sampling was used to identify both regions and PCC managers, in order to explore multiple perspectives. We used the COM-B framework, which describes how Capability, Opportunity and Motivation interact and generate change behaviour and how different factors might act as facilitators or barriers, when collecting and analysing data. Results Existing forms of A&F were perceived as coercive top-down interventions to secure adherence to contractual obligations, financial targets and clinical guidelines. Support to bottom-up approaches and more complex change at team and organisational levels was perceived as limited. We identified five contextual factors that matter for the impact of A&F on change behaviour and quality improvement work: performance of organisations, continuity in staff, size of organisations, flexibility in leadership and management, and flexibility offered by the external environment. Conclusions External A&F, perceived as coercive by recipients of feedback, can have an impact on change behaviour through ‘know-what’ and ‘know-why’ types of knowledge and ‘have-to’ commitment but provide limited support to complex change. ‘Want-to’ commitment and bottom-up driven processes are important for more complex change. Similar to previous research, identified facilitators and barriers of change consisted of factors that are difficult to influence by A&F activities. Future research is needed on how to ensure co-development of A&F models that are perceived as legitimate by health care professionals and useful to support more complex change.

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A Physician-Driven Quality Improvement Stewardship Intervention Using Lean Six Sigma Improves Patient Care for Community-Acquired Pneumonia

Global Journal on Quality and Safety in Healthcare ◽

10.36401/jqsh-21-2 ◽

2021 ◽

Author(s):

Lea M. Monday ◽

Omid Yazdanpaneh ◽

Caleb Sokolowski ◽

Jane Chi ◽

Ryan Kuhn ◽

...

Keyword(s):

Quality Improvement ◽

Clinical Outcomes ◽

Antimicrobial Stewardship ◽

Six Sigma ◽

Intervention Group ◽

Community Acquired Pneumonia ◽

Lean Six Sigma ◽

Audit And Feedback ◽

Control Group ◽

The Impact

ABSTRACT Introduction The Infectious Diseases Society of America (IDSA) recommends a minimum of 5 days of antibiotic therapy in stable patients who have community-acquired pneumonia (CAP). However, excessive duration of therapy (DOT) is common. Define, measure, analyze, improve, and control (DMAIC) is a Lean Six Sigma methodology used in quality improvement efforts, including infection control; however, the utility of this approach for antimicrobial stewardship initiatives is unknown. To determine the impact of a prospective physician-driven stewardship intervention on excess antibiotic DOT and clinical outcomes of patients hospitalized with CAP. Our specific aim was to reduce excess DOT and to determine why some providers treat beyond the IDSA minimum DOT. Methods A single-center, quasi-experimental quality improvement study evaluating rates of excess antimicrobial DOT before and after implementing a DMAIC-based antimicrobial stewardship intervention that included education, prospective audit, and feedback from a physician peer, and daily tracking of excess DOT on a Kaizen board. The baseline period included retrospective CAP cases that occurred between October 2018 and February 2019 (control group). The intervention period included CAP cases between October 2019 and February 2020 (intervention group). Results A total of 123 CAP patients were included (57 control and 66 intervention). Median antibiotic DOT per patient decreased (8 versus 5 days; p < 0.001), and the proportion of patients treated for the IDSA minimum increased (5.3% versus 56%; p < 0.001) after the intervention. No differences in mortality, readmission, length of stay, or incidence of Clostridioides difficile infection were observed between groups. Almost half of the caregivers surveyed were aware that as few as 5 days of antibiotic treatment could be appropriate. Conclusions A physician-driven antimicrobial quality improvement initiative designed using DMAIC methodology led to reduced DOT and increased compliance with the IDSA treatment guidelines for hospitalized patients with CAP reduced without negatively affecting clinical outcomes.

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Post-discharge care following acute kidney injury: quality improvement in primary care

BMJ Open Quality ◽

10.1136/bmjoq-2019-000891 ◽

2020 ◽

Vol 9 (4) ◽

pp. e000891

Author(s):

Susan J Howard ◽

Rebecca Elvey ◽

Julius Ohrnberger ◽

Alex J Turner ◽

Laura Anselmi ◽

...

Keyword(s):

Primary Care ◽

Acute Kidney Injury ◽

Patient Safety ◽

Quality Improvement ◽

Health Outcomes ◽

Kidney Injury ◽

Audit And Feedback ◽

Improvement Project ◽

General Practices ◽

The Impact

BackgroundOver the past decade, targeting acute kidney injury (AKI) has become a priority to improve patient safety and health outcomes. Illness complicated by AKI is common and is associated with adverse outcomes including high rates of unplanned hospital readmission. Through national patient safety directives, NHS England has mandated the implementation of an AKI clinical decision support system in hospitals. In order to improve care following AKI, hospitals have also been incentivised to improve discharge summaries and general practices are recommended to establish registers of people who have had an episode of illness complicated by AKI. However, to date, there is limited evidence surrounding the development and impact of interventions following AKI.DesignWe conducted a quality improvement project in primary care aiming to improve the management of patients following an episode of hospital care complicated by AKI. All 31 general practices within a single NHS Clinical Commissioning Group were incentivised by a locally commissioned service to engage in audit and feedback, education training and to develop an action plan at each practice to improve management of AKI.ResultsAKI coding in general practice increased from 28% of cases in 2015/2016 to 50% in 2017/2018. Coding of AKI was associated with significant improvements in downstream patient management in terms of conducting a medication review within 1 month of hospital discharge, monitoring kidney function within 3 months and providing written information about AKI to patients. However, there was no effect on unplanned hospitalisation and mortality.ConclusionThe findings suggest that the quality improvement intervention successfully engaged a primary care workforce in AKI-related care, but that a higher intensity intervention is likely to be required to improve health outcomes. Development of a real-time audit tool is necessary to better understand and minimise the impact of the high mortality rate following AKI.

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A mixed-methods study to explore opinions of research translation held by researchers working in a Centre of Research Excellence in Australia

BMJ Open ◽

10.1136/bmjopen-2018-022357 ◽

2018 ◽

Vol 8 (9) ◽

pp. e022357 ◽

Cited By ~ 1

Author(s):

Elizabeth A Lynch ◽

Shanthi A Ramanathan ◽

Sandy Middleton ◽

Julie Bernhardt ◽

Michael Nilsson ◽

...

Keyword(s):

Clinical Practice ◽

Mixed Methods ◽

Stroke Rehabilitation ◽

Research Impact ◽

Interview Data ◽

Mixed Methods Study ◽

Research Translation ◽

Stroke Research ◽

Semistructured Interviews ◽

Research Excellence

ObjectiveThere is a growing need for researchers to demonstrate impact, which is reliant on successful research translation. The Australian National Health and Medical Research Council funded a Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery (CRE-Stroke) to enhance collaborations between researchers conducting different types of stroke rehabilitation research. The purpose of this study was to explore opinions about research translation held by CRE-Stroke researchers conducting preclinical and clinical research, in terms of scope, importance, responsibility and perceived skills and knowledge.DesignMixed-methods study, comprising a paper-based survey and semistructured interviews. Interview data were inductively coded and thematically analysed. Survey and interview data were compared and synthesised.Participants55 (7 preclinical, 48 clinical) researchers attending a CRE-Stroke research forum completed a paper-based survey. Semistructured interviews with 22 CRE-Stroke (5 preclinical, 17 clinical) researchers were conducted.ResultsResearch translation was described as translating to other research and translating to clinical practice and policy. Most researchers (n=54, 98%) reported that research translation was important, particularly in terms of generating research impact, but the most common sign of project completion reported by researchers (n=7, 100% preclinical; n=37, 77% clinical) was publication. Most researchers (preclinical n=4, 57%; clinical n=37, 77%) reported having responsibility for translating research, but less than half reported having the necessary skills (n=1, 14% preclinical; n=17, 35% clinical) and knowledge (n=3, 43% preclinical; n=19, 40% clinical). Differing opinions about who should be responsible for translating findings to clinical practice were expressed.ConclusionsStroke rehabilitation researchers appear confident to translate their research via the traditional mechanism of publications. To optimise impact, clarity is needed regarding who is best placed to translate research findings to clinical practice and policy. Education and skills development to apply broader translation processes are needed to maximise the use of research at all stages.

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75. Less is More: A Physician-Driven Quality Improvement Stewardship Initiative to Reduce Excessive Duration of Antibiotic Therapy in Veterans Hospitalized with Community-Acquired Pneumonia

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.120 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S55-S56

Author(s):

Lea M Monday ◽

Omid Yazdanpanah ◽

Caleb Sokolowski ◽

Joseph Sebastian ◽

Ryan Kuhn ◽

...

Keyword(s):

Quality Improvement ◽

Clinical Outcomes ◽

Intervention Group ◽

Community Acquired Pneumonia ◽

Audit And Feedback ◽

Patient Specific ◽

Control Group ◽

Less Is More ◽

Historic Control ◽

The Impact

Abstract Background The IDSA and American Thoracic Society (IDSA/ATS) Community Acquired Pneumonia (CAP) guidelines recommend 5 days of therapy for clinically stable patients that defervesce, however, duration of therapy (DOT) is often longer. Pharmacists curb this via antimicrobial stewardship (AMS), but budgetary constraints are barriers to robust AMS programs in some hospitals. Physicians are increasingly encouraged to participate in quality improvement (QI) and are a potential resource to improve AMS. We sought to determine the impact of a prospective, physician-driven stewardship intervention on DOT and clinical outcomes in hospitalized veterans with CAP, with the goal to reduce the median DOT by at least 1 day within 5 months. Methods This single center, quasi-experimental QI study evaluated two concurrent physician-driven interventions over a 5-month period in an inner-city Veterans Affairs Hospital. Using DMAIC (Define, measure, analyze, improve, and control) methodology, the Chief Resident in Quality and Safety (CRQS) provided monthly education and daily audit and feedback with patient-specific DOT recommendations. Clinical outcomes were followed until 30 days post discharge. Results A total of 123 patients with CAP were included (57 in the historic control group and 66 in the AMS intervention group). The AMS intervention significantly increased the proportion of CAP patients treated with a 5-day treatment course (56% versus 5.3%, p< 0.0001), and reduced the proportion of patients treated beyond 7 days (12.1% versus 70.2%, p< 0.0001). Median DOT per patient was reduced significantly (5 versus 8 days, p< 0.0001). Median excess antibiotic days were significantly reduced (0 versus 3, p< 0.0001) and 118 days of unnecessary antibiotics were avoided (62 versus 180). 30-day all-cause mortality, all-cause readmission, and Clostridium difficile infection were similar between groups. Median LOS was similar between groups (p=0.246). DOT in the Historic Control Group Versus Stewardship Intervention Group Conclusion A physician driven QI stewardship intervention in hospitalized CAP patients significantly reduced the total antibiotic DOT and excess antibiotic days without adversely affecting patient outcomes. Providers can be educated through physician driven interventions resulting in substantial improvements in appropriate antibiotic use. Disclosures All Authors: No reported disclosures

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Thought Space Wānanga—A Kaupapa Māori Decolonizing Approach to Research Translation

Genealogy ◽

10.3390/genealogy3040074 ◽

2019 ◽

Vol 3 (4) ◽

pp. 74

Author(s):

Linda Smith ◽

Leonie Pihama ◽

Ngaropi Cameron ◽

Tania Mataki ◽

Hinewirangi Morgan ◽

...

Keyword(s):

Theory Development ◽

Indigenous Communities ◽

Research Translation ◽

Positive Outcomes ◽

Publicly Funded ◽

Common Term ◽

Kaupapa Māori ◽

Increasing Demand ◽

High Level ◽

The Impact

This paper discusses an indigenous Māori approach, named Thought Space Wānanga, for sharing knowledge and accelerating the translation of research into practical outcomes through transformational practices, policies, and theory development. In contexts such as New Zealand, there is an increasing demand on all publicly funded researchers to demonstrate the impact of their research and to show pathways for achieving social and economic outcomes from single, focused projects. Knowledge translation is the most common term used to describe the link between research and impact and the process of turning research into results. While it is highly debatable whether planning for this at the front end of research will necessarily lead to such high-level outcomes being achieved, many indigenous researchers aim for their research to be translated into real world positive outcomes for indigenous communities. Thought Space Wānanga is a facilitated process framed within Māori cultural protocols, designed to help indigenous Māori researchers meet that aspiration.

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“Impact”, research and slaying Zombies: the pressures and possibilities of the REF

International Journal of Sociology and Social Policy ◽

10.1108/ijssp-04-2016-0047 ◽

2017 ◽

Vol 37 (11-12) ◽

pp. 696-710 ◽

Cited By ~ 8

Author(s):

Robert MacDonald

Keyword(s):

Social Science ◽

Relevant Literature ◽

Social Science Research ◽

Research Priorities ◽

Science Research ◽

Research Impact ◽

Research Governance ◽

Content Type ◽

Research Excellence ◽

The Impact

Purpose The purpose of this paper is to reflect critically upon current debates and tensions in the governance of research in the UK and more widely, particularly the imperative that social science research should demonstrate impact beyond the academy. Design/methodology/approach Drawing implicitly upon the Bevir’s theory of governance, the paper positions discourses about “research excellence and research impact” as elite narratives that are rooted genealogically in forms of managerial audit culture which seek to govern the practices of social science academics. The paper reviews relevant literature, draws upon key contributions that have shaped debate and refers to the author’s own research and experiences of “research impact”. Findings Initiatives such as the UK’s “Research Excellence Framework” can be understood as a form of governance that further enables already present neo-liberalising tendencies in the academy. The “impact agenda” has both negative (e.g. it can distort research priorities and can lead to overstatement of “real world” effects) and positive potential (e.g. to provide institutional space for work towards social justice, in line with long-standing traditions of critical social science and “public sociology”). Research limitations/implications There is a need for more critical research and theoretical reflection on the value, threats, limitations and potential of current forms of research governance and “impact”. Originality/value To date, there are very few article-length, critical discussions of these developments and issues in research governance, even fewer that connect these debates to longer-standing radical imperatives in social science.

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Quality Improvement Implementation and Maintenance of a Paediatric Early Warning System

10.21203/rs.3.rs-83016/v1 ◽

2020 ◽

Author(s):

Heather P Duncan ◽

Amber Oliver ◽

Karl Emms ◽

Yvonne Heward ◽

Adrienne P Hudson

Keyword(s):

Cardiac Arrest ◽

Intensive Care ◽

Quality Improvement ◽

Action Research ◽

Hospital Mortality ◽

Early Warning ◽

Human Interaction ◽

Paediatric Intensive Care ◽

Audit And Feedback ◽

The Impact

Abstract Background: Paediatric Early Warning (PEW) systems have led to earlier identification and escalation of treatment with subsequent admission to Paediatric Intensive Care (PIC) in deteriorating children. The impact on reductions in cardiac arrest and mortality vary between the heterogeneous studies, showing both unchanged and reduced cardiac arrest, morbidity and mortality. Identifying and managing critical illness on wards is a complex and dynamic process involving technology, human interaction, cultural context and environment. We introduced a PEW system to reduce potentially avoidable cardiac arrest and death.Methods: We report an Implementation Science Quality Improvement (QI) natural experiment using the Medical Research Councils (MRC) Guidelines for Developing and Evaluating Complex Interventions, Action Research, Action Research Theory and methods. The aim of this program was to identify learning, refinement and improvement opportunities to reduce poor outcomes. The interventions were 1) developing an observation and monitoring policy to standardise practice and provide a template for optimal care, 2) standardized charting with an embedded PEW score, 3) clinical skills training, 4) clinical process audit and feedback and 5) outcome surveillance.The process measures were 1) timeliness and impact for unplanned Paediatric Intensive Care (PIC) admissions, 2) clinical assessment skills and 3) chart completion compliance. The outcome measures included 4) total and predictable cardiac arrests and 5) hospital mortality. Data collection started in 2004, the PEW system was implemented in 2008, and the outcomes were reported through 2018.Results: In our specialist children’s hospital, we completed six improvement cycles over 10 years. 1) Timely PIC admissions improved after implementation (39% to 92%). Patients with unplanned PIC admissions had significantly lower severity of illness and mortality but a longer length of stay. 2) Routine clinical observation accuracy improved (66 to 82%) following multimodal training. 3) Chart completion compliance improved (87 to 99%). In 2018, 2% of observations had missing or inaccurate parameters with a consequent inaccurate total PEW score. 4) The total cardiac arrest rate was significantly reduced (0.36 to 0.16 per 1000 admissions). The small numbers of predictable cardiac arrests showed a decreasing trend. 5) Hospital mortality was significantly reduced (3.46 to 2.24 per 1000 admissions). Outcomes improved approximately 18 months after implementation and have not changed significantly since 2010 despite increasing critical care resources in and out of PIC. The impact of the PEW system on these outcomes is possible but not conclusive.Conclusion: Implementation of the PEW system as a complex intervention using QI methods is associated with improved clinical skill accuracy, chart compliance and detection of deterioration associated with more timely unplanned PIC admissions. These improvements were associated with a significant reduction in cardiac arrest and mortality.

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