scholarly journals A process evaluation of the improving wisely intervention: a peer-to-peer data intervention to reduce overuse in surgery

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Christine Fahim ◽  
William E. Bruhn ◽  
John G. Albertini ◽  
Marty A. Makary
Keyword(s):  
Process Evaluation ◽  
Improve Patient Care ◽  
Peer To Peer ◽  
Audit And Feedback ◽  
Implementation Quality ◽  
Participant Responsiveness ◽  
Key Informant ◽  
Improvement Interventions ◽  
Perceived Impact ◽  
Quality Improvement Interventions

Abstract Background The Improving Wisely intervention is a peer-to-peer audit and feedback intervention to reduce overuse of Mohs Micrographic Surgery (MMS). The objective of this study was to conduct a process evaluation to evaluate Mohs surgeons’ perceptions of the implementation quality and perceived impact of the Improving Wisely intervention. Methods Surgeons in the Improving Wisely intervention arm, comprised of members of the American College of Mohs Surgeons (ACMS) who co-led the intervention, were invited to complete surveys and key informant interviews. Participants described perceptions of implementation quality (evaluated via dose, quality of implementation, reach and participant responsiveness), perceived impact of the Improving Wisely intervention (evaluated on a 1–5 Likert and qualitatively), and barriers and facilitators to changing surgeons’ clinical practice patterns to reduce Mohs overuse. Results Seven hundred thirty-seven surgeons participated in the survey. 89% were supportive of the intervention. Participants agreed that the intervention would improve patient care and reduce the annual costs of Mohs surgery. Thirty surgeons participated in key informant interviews. 93% were interested in receiving additional data reports in the future. Participants recommended the reports be disseminated annually, that the reports be expanded to include appropriateness data, and that the intervention be extended to non ACMS members. Six themes identifying factors impacting potential MMS overuse were identified. Conclusions Participants were strongly supportive of the intervention. We present the template used to design and implement the Improving Wisely intervention and provide suggestions for specialty societies interested in leading similar quality improvement interventions among their members.

Practice-level quality improvement interventions in primary care: a review of systematic reviews

2015 ◽  
Vol 16 (06) ◽  
pp. 556-577 ◽  
Author(s):  
Ryan Irwin ◽  
Tim Stokes ◽  
Tom Marshall
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Systematic Reviews ◽  
Audit And Feedback ◽  
System Level ◽  
Basic Unit ◽  
Practice Level ◽  
Improvement Effect ◽  
Improvement Interventions ◽  
Quality Improvement Interventions

AimTo present an overview of effective interventions for quality improvement in primary care at the practice level utilising existing systematic reviews.BackgroundQuality improvement in primary care involves a range of approaches from the system-level to patient-level improvement. One key setting in which quality improvement needs to occur is at the level of the basic unit of primary care – the individual general practice. Therefore, there is a need for practitioners to have access to an overview of the effectiveness of quality improvement interventions available in this setting.MethodsDesign:A tertiary evidence synthesis was conducted (a review of systematic reviews). A systematic approach was used to identify and summarise published literature relevant to understanding primary-care quality improvement at the practice level. Quality assessment was via the Critical Appraisal Skills Programme tool for systematic reviews, with data extraction identifying evidence of effect for the examined interventions.Scope:Included reviews had to be relevant to quality improvement at the practice level and relevant to the UK primary-care context. Reviews were excluded if describing system-level interventions.Outcome measures:A range of measures across care structure, process and outcomes were defined and interpreted across the quality improvement interventions.FindingsAudit and feedback, computerised advice, point-of-care reminders, practice facilitation, educational outreach and processes for patient review and follow-up all demonstrated evidence of a quality improvement effect. Evidence of an improvement effect was higher where baseline performance was low and was particularly demonstrated across process measures and measures related to prescribing. Evidence was not sufficient to suggest that multifaceted approaches were more effective than single interventions.ConclusionEvidence exists for a range of quality improvement interventions at the primary-care practice level. More research is required to determine the use and impact of quality improvement interventions using theoretical frameworks and cost-effectiveness analysis.

scholarly journals Improving Diabetes Care in Rural Areas: A Systematic Review and Meta-Analysis of Quality Improvement Interventions in OECD Countries

PLoS ONE ◽  
2013 ◽  
Vol 8 (12) ◽  
pp. e84464 ◽  
Author(s):  
Ignacio Ricci-Cabello ◽  
Isabel Ruiz-Perez ◽  
Antonio Rojas-García ◽  
Guadalupe Pastor ◽  
Daniela C. Gonçalves
Keyword(s):  
Systematic Review ◽  
Quality Improvement ◽  
Diabetes Care ◽  
Rural Areas ◽  
Meta Analysis ◽  
Oecd Countries ◽  
Improvement Interventions ◽  
Quality Improvement Interventions

scholarly journals COVID-19 and the Gaping Wounds of South Africa’s Suboptimal Immunisation Coverage: An Implementation Research Imperative for Assessing and Addressing Missed Opportunities for Vaccination

Vaccines ◽  
2021 ◽  
Vol 9 (7) ◽  
pp. 691
Author(s):  
Chukwudi A. Nnaji ◽  
Charles S. Wiysonge ◽  
Maia Lesosky ◽  
Hassan Mahomed ◽  
Duduzile Ndwandwe
Keyword(s):  
Implementation Research ◽  
Universal Access ◽  
Immunisation Programme ◽  
Practical Implementation ◽  
Research Approach ◽  
Immunisation Coverage ◽  
Missed Opportunities ◽  
Improvement Interventions ◽  
African Context ◽  
Quality Improvement Interventions

Despite South Africa’s substantial investments in and efforts at ensuring universal access to immunisation services, progress has stalled and remains suboptimal across provinces and districts. An additional challenge is posed by the ongoing coronavirus disease 2019 (COVID-19) pandemic, which has disrupted immunisation services globally, including in South Africa. While there is growing evidence that missed opportunities for vaccination (MOV) are a major contributor to suboptimal immunisation progress globally, not much is known about the burden and determinants of MOV in the South African context. Herein, we make a case for assessing MOV as a strategy to address current immunisation coverage gaps while mitigating the adverse impacts of the COVID-19 pandemic on immunisation services. We illustrate a practical implementation research approach to assessing the burden of MOV among children in primary care settings; for understanding the factors associated with MOV; and for designing, implementing, and evaluating context-appropriate quality improvement interventions for addressing missed opportunities. Such efforts are vital for building health system resilience and maintaining immunisation programme capacity to optimally deliver essential health services such as routine childhood immunisation, even during pandemics.

Reducing Hospital-acquired Pressure Injuries Among Pediatric Patients Receiving ECMO: A Retrospective Study Examining Quality Improvement Outcomes

2021 ◽  
Vol 67 (9) ◽  
pp. 14-24
Author(s):  
Jordan Jackson ◽  
Holly Kirkland-Kyhn ◽  
Laura Kenny ◽  
Alana Beres ◽  
Stephanie Mateev
Keyword(s):  
Quality Improvement ◽  
Pediatric Patients ◽  
Wound Care ◽  
Occipital Region ◽  
Provider Education ◽  
Before And After ◽  
Prevention Interventions ◽  
Improvement Interventions ◽  
Quality Improvement Interventions ◽  
Hospital Acquired

BACKGROUND: Pediatric patients immobilized for certain procedures, such as extracorporeal membrane oxygenation (ECMO), are at high risk for developing hospital-acquired pressure injuries (HAPIs). PURPOSE: To evaluate the rate of HAPI occurrence in ECMO patients before and after implementation of prevention interventions. METHODS: Patients younger than 18 years of age who were placed on ECMO from January 2012 through March 2020 were identified, and patient data, including the development of a stage 3, 4, or unstageable pressure injuries, were abstracted. From August 2018 through December 2018, HAPI prevention interventions were implemented, which included targeted HAPI prevention and ECMO provider education, fluidized positioner provider education, and the addition of 2 wound care interventions for ECMO patients. RESULTS: Of the 120 ECMO patients identified, 5 (4.2%) developed a HAPI. All patients developed HAPI in the occipital region, and 1 patient developed an additional HAPI on their back. The median age of patients with HAPI was 1 month (interquartile range [IQR], 0.3–6.8 months). The median duration from ECMO cannulation to identification of HAPI was 9.5 days (IQR, 4.8–32.3 days). The median total run time was 4.9 days (IQR, 2.5-7.6 days): 8.5 days for patients who did develop a HAPI and 4.8 days for those who did not develop a HAPI (P = .02). The overall HAPI rate dropped from 4.8% of ECMO patients before quality improvement interventions to 0% of ECMO patients after quality improvement interventions. CONCLUSIONS: The development of stage 3, 4, or unstageable HAPIs in pediatric ECMO patients was low (4.2%) over the period studied (January 2012 through March 2020). As of the time of this writing, no HAPIs occurred after implementation of provider education in 2018.

scholarly journals Reducing the Risk of Harm from Medication Errors in Children

2013 ◽  
Vol 6 ◽  
pp. HSI.S10454 ◽  
Author(s):  
Daniel R. Neuspiel ◽  
Melissa M. Taylor
Keyword(s):  
Medication Errors ◽  
Health Care Providers ◽  
Adverse Drug Events ◽  
Chronic Illnesses ◽  
Future Research ◽  
Care Providers ◽  
Pediatric Age Group ◽  
Improvement Interventions ◽  
Communication Ability ◽  
Quality Improvement Interventions

Medication errors affect the pediatric age group in all settings: outpatient, inpatient, emergency department, and at home. Children may be at special risk due to size and physiologic variability, limited communication ability, and treatment by nonpediatric health care providers. Those with chronic illnesses and on multiple medications may be at higher risk of experiencing adverse drug events. Some strategies that have been employed to reduce harm from pediatric medication errors include e-prescribing and computerized provider order entry with decision support, medication reconciliation, barcode systems, clinical pharmacists in medical settings, medical staff training, package changes to reduce look-alike/sound-alike confusion, standardization of labeling and measurement devices for home administration, and quality improvement interventions to promote nonpunitive reporting of medication errors coupled with changes in systems and cultures. Future research is needed to measure the effectiveness of these preventive strategies.

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