scholarly journals Results of a person-centered maternal health quality improvement intervention in Uttar Pradesh, India

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0242909
Author(s):  
Dominic Montagu ◽  
Katie Giessler ◽  
Michelle Kao Nakphong ◽  
Kali Prasad Roy ◽  
Ananta Basudev Sahu ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Maternal Health ◽  
Intervention Group ◽  
Uttar Pradesh ◽  
World Health ◽  
Quality Improvement Intervention ◽  
Control Group ◽  
Process Of Care ◽  
Quality Improvement Process ◽  
Improvement Intervention

Background Poor patient experiences during delivery in Uttar Pradesh, India is a common problem. It delays presentation at facilities after the onset of labor and contributes to poor maternal health outcomes. Patient-centered maternity care (PCMC) is recognized by the World Health Organization as critical to overall quality. Changing PCMC requires changing the process of care, and is therefore especially challenging. Methods We used a matched case-control design to evaluate a quality improvement process directed at PCMC and based on widely established team-based methods used in many OECD countries. The intervention was introduced into three government facilities and teams supported to brainstorm and test improvements over 12 months. Progress was measured through pre-post interviews with new mothers, scored using a validated PCMC scale. Analysis included chi-squared and difference-in-difference tests. Findings On a scale to 100, the PCMC score of the intervention group increased 22.9 points compared to controls. Deliveries attended by midwives, dais, ASHAs or non-skilled providers resulted in significantly higher PCMC scores than those attended to by nurses or doctors. The intervention was associated with one additional visit from a doctor and over two additional visits from nurses per day, compared to the control group. Interpretation This study has demonstrated the effectiveness of a team-based quality improvement intervention to ameliorate women’s childbirth experiences. These improvements were locally designed and led, and offer a model for potential replication.

scholarly journals A comparison of intensive vs. light-touch quality improvement interventions for maternal health in Uttar Pradesh, India

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Dominic Montagu ◽  
Katie Giessler ◽  
Michelle Kao Nakphong ◽  
Cathy Green ◽  
Kali Prosad Roy ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Maternal Health ◽  
Phase 1 ◽  
Uttar Pradesh ◽  
Halo Effect ◽  
External Input ◽  
Delayed Presentation ◽  
Light Touch ◽  
Process Of Care ◽  
Link Type

Abstract Background Poor patient experiences during delivery leads to delayed presentation at facilities and contributes to poor maternal health outcomes. Person-centered maternity care (PCMC) is a key component of quality. Improving PCMC requires changing the process of care which can be complex and necessitate significant external input, making replication and scale difficult. This study compares the effectiveness two Quality Improvement (QI) intervention phases, one Intensive, one Light-Touch. Methods We use a matched case-control design to compare two phases of a QI Intervention targeting PCMC, with three facilities in each. The Intensive phase was introduced into three government facilities where teams were supported to identify, design, and test potential improvements over 12 months. The Light-Touch phase was subsequently introduced in three other government facilities and changes were tracked over six months. We compared the two groups using multivariate linear regression and difference-in-difference models to assess changes in PCMC outcome Results Both Intensive and Light-Touch arms demonstrated large improvements in PCMC. On a scale from 0 to 100, Intensive facilities increased in PCMC scores from 85.02 to 97.13, while Light-Touch facilities increased from 63.42 to 87.47. For both there was a ‘halo’ effect, with a similar improvement recorded for the specific improvement activities focused on, as w ell as aspects of PCMC not directly addressed. Conclusions This study demonstrates that a short, inexpensive, light-touch and directive intervention can change staff practices and significantly improve the experiences of women during childbirth. It also shows that improvements in a few areas of provider-patient interaction have a ‘halo’ effect, changing many other aspects of patient-provider interaction at the same time. Trial registration QI Phase 1 - NCT04208867. Retrospectively registered. December 19th, 2019. QI Phase 2 –NCT04208841. Retrospectively registered. December 23, 2019.

scholarly journals Sustainment, Sustainability, and Spread Study (SSaSSy): protocol for a study of factors that contribute to the sustainment, sustainability, and spread of practice changes introduced through an evidence-based quality-improvement intervention in Canadian nursing homes

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Whitney B. Berta ◽  
Adrian Wagg ◽  
Lisa Cranley ◽  
Malcolm B. Doupe ◽  
Liane Ginsburg ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Nursing Homes ◽  
High Intensity ◽  
Practice Change ◽  
Quality Improvement Intervention ◽  
Control Group ◽  
Evidence Based ◽  
Phase 2 ◽  
Term Care ◽  
Improvement Intervention

Abstract Background Implementation scientists and practitioners, alike, recognize the importance of sustaining practice change, however post-implementation studies of interventions are rare. This is a protocol for the Sustainment, Sustainability and Spread Study (SSaSSy). The purpose of this study is to contribute to knowledge on the sustainment (sustained use), sustainability (sustained benefits), and spread of evidence-based practice innovations in health care. Specifically, this is a post-implementation study of an evidence-informed, Care Aide-led, facilitation-based quality-improvement intervention called SCOPE (Safer Care for Older Persons (in long-term care) Environments). SCOPE has been implemented in nursing homes in the Canadian Provinces of Manitoba (MB), Alberta (AB) and British Columbia (BC). Our study has three aims: (i) to determine the role that adaptation/contextualization plays in sustainment, sustainability and spread of the SCOPE intervention; (ii) to study the relative effects on sustainment, sustainability and intra-organizational spread of high-intensity and low-intensity post-implementation “boosters”, and a “no booster” condition, and (iii) to compare the relative costs and impacts of each booster condition. Methods/design SSaSSy is a two-phase mixed methods study. The overarching design is convergent, with qualitative and quantitative data collected over a similar timeframe in each of the two phases, analyzed independently, then merged for analysis and interpretation. Phase 1 is a pilot involving up to 7 units in 7 MB nursing homes in which SCOPE was piloted in 2016 to 2017, in preparation for phase 2. Phase 2 will comprise a quasi-experiment with two treatment groups of low- and high-intensity post-implementation “boosters”, and an untreated control group (no booster), using pretests and post-tests of the dependent variables relating to sustained care and management practices, and resident outcomes. Phase 2 will involve 31 trial sites in BC (17 units) and AB (14 units) nursing homes, where the SCOPE trial concluded in May 2019. Discussion This project stands to advance understanding of the factors that influence the sustainment of practice changes introduced through evidence-informed practice change interventions, and their associated sustainability. Findings will inform our understanding of the nature of the relationship of fidelity and adaptation to sustainment and sustainability, and afford insights into factors that influence the intra-organizational spread of practice changes introduced through complex interventions.

scholarly journals A Comparison of Intensive vs. Light-Touch Quality Improvement Interventions for Maternal Health in Uttar Pradesh, India

2020 ◽  
Author(s):  
Dominic Montagu ◽  
Katie Giessler ◽  
Michelle Kao Nakphone ◽  
Cathy Green ◽  
Kali Prosad Roy ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Maternal Health ◽  
Phase 1 ◽  
Uttar Pradesh ◽  
Halo Effect ◽  
External Input ◽  
Delayed Presentation ◽  
Light Touch ◽  
Process Of Care ◽  
Middle Income

Abstract BackgroundPoor patient experiences during delivery leads to delayed presentation at facilities and contributes to poor maternal health outcomes. Person-centered maternity care (PCMC) is a key component of quality. Improving PCMC requires changing the process of care which can be complex and require significant external input, making replication and scale difficult. This study compared the effectiveness two Quality Improvement (QI) intervention phases, one Intensive, one Light-Touch. MethodsWe used a matched case-control design to compare two phases of a QI Intervention targeting PCMC, with three facilities in each. The Intensive phase was introduced into three government facilities where teams were supported to identify, design, and test potential improvements over 12 months. The Light-Touch phase was subsequently introduced in three other government facilities and changes were tracked over six months. We compared the two groups using multivariate linear regression and difference-in-difference models to assess changes in PCMC outcome. ResultsBoth Intensive and Light-Touch arms demonstrated large improvements in PCMC. On a scale from 0 to 100, Intensive facilities increased in PCMC scores from 85.02 to 97.13, while Light-Touch facilities increased from 63.42 to 87.47. For both there was a ‘halo’ effect, with a similar improvement recorded for the specific improvement activities focused on, as w ell as aspects of PCMC not directly addressed. ConclusionsThis study demonstrated that a short, inexpensive, light-touch and directive intervention can change staff practices and significantly improve the experiences of women during childbirth. It also shows that improvements in a few areas of provider-patient interaction have a ‘halo’ effect, changing many other aspects of patient-provider interaction at the same time. Trial RegistrationQI Phase 1 - NCT04208867. Retrospectively registered. December 19th, 2019. link to the registration:https://clinicaltrials.gov/ct2/show/NCT04208867?term=NCT04208867&draw=2&rank=1QI Phase 2 – NCT04208841. Retrospectively registered. December 23, 2019. link to the registration:https://clinicaltrials.gov/ct2/show/NCT04208841?term=NCT04208841&draw=2&rank=1CONTRIBUTIONS TO THE LITERATURE 98 words· Medical practioners’ treatment of patients are influenced by institutional norms and difficult to change. · Team-based initiatives which actively engage staff have been effective in wealthy countries but are not common in middle-income settings, and have not been applied to person-centered aspects of care.· We found that team-based quality improvement efforts were effective in India at changing patient experience. Once change-practices were identified, these practices were introduced to new facilities with low-intesity support and proved equally effective at improving care.· These findings add to the limited evidence on team-based quality improvement, and provide evidence of effective scaleable implementation opportunities.

scholarly journals Evaluating context-specific evidence-based quality improvement intervention on lymphatic filariasis mass drug administration in Northern Ghana using the RE-AIM framework

2021 ◽  
Vol 49 (1) ◽  
Author(s):  
Alfred Kwesi Manyeh ◽  
Tobias Chirwa ◽  
Rohit Ramaswamy ◽  
Frank Baiden ◽  
Latifat Ibisomi
Keyword(s):  
Quality Improvement ◽  
Needs Assessment ◽  
Lymphatic Filariasis ◽  
Drug Administration ◽  
Mass Drug Administration ◽  
Northern Ghana ◽  
Quality Improvement Intervention ◽  
Evidence Based ◽  
Context Specific ◽  
Improvement Intervention

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.

scholarly journals A quality improvement intervention to reduce emergency department radiography for bronchiolitis

2018 ◽  
Vol 137 ◽  
pp. 1-5 ◽  
Author(s):  
Joel Reiter ◽  
Adin Breuer ◽  
Oded Breuer ◽  
Saar Hashavya ◽  
David Rekhtman ◽  
...  
Keyword(s):  
Emergency Department ◽  
Quality Improvement ◽  
Quality Improvement Intervention ◽  
Improvement Intervention

Efficacy of ‘Foundations’, a Digital Mental Health App to Improve Mental Well-Being, during COVID-19: A Proof-of-Principle Randomised Controlled Trial (Preprint)

2021 ◽  
Author(s):  
Silvina Catuara-Solarz ◽  
Bartlomiej Skorulski ◽  
Inaki Estella ◽  
Claudia Avella-Garcia ◽  
Sarah Shepherd ◽  
...  
Keyword(s):  
Mental Health ◽  
Perceived Stress ◽  
Intervention Group ◽  
Well Being ◽  
Self Report ◽  
World Health ◽  
Randomised Control Trial ◽  
Control Group ◽  
Mental Well Being ◽  
Proof Of Principle

BACKGROUND Against a long-term trend of increasing demand, the COVID-19 pandemic has led to a global rise in common mental disorders. Now more than ever, there is an urgent need for scalable, evidence-based interventions to support mental well-being. OBJECTIVE The aim of this proof-of-principle study was to evaluate the efficacy of a mobile-based app in adults with self-reported symptoms of anxiety and stress in a randomised control trial that took place during the first wave of the COVID-19 pandemic in the UK. METHODS Adults with mild to severe anxiety and moderate to high levels of perceived stress were randomised to either the intervention or control arm. Participants in the intervention arm were given access to the app, Foundations, for the duration of the 4-week study. All participants were required to self-report a range of validated measures of mental well-being (10-item Connor-Davidson Resilience scale [CD-RISC-10]; 7-item Generalised Anxiety Disorder scale [GAD-7]; Office of National Statistics Four Subjective Well-being Questions [ONS-4]; World Health Organisation-5 Well-Being Index [WHO-5]) and sleep (Minimal Insomnia Scale [MISS]) at baseline and weeks 2 and 4; and, in addition, on perceived stress weekly (10-item Perceived Stress Score [PSS]). RESULTS 136 participants completed the study and were included in the final analysis. The intervention group (n=62) showed significant improvements compared to the control group (n=74) on measures of anxiety (GAD-7 score, delta from baseline to week 2 in the intervention group: -1.35 [SD 4.43]; control group: -0.23 [SD 3.24]; t134= 1.71 , P=.04), resilience (CD-RISC score, delta from baseline to week 2 in the intervention group: 1.79 [± SD 4.08]; control group: -0.31 [± SD 3.16]; t134 -3.37, P<.001), sleep (MISS score, delta from baseline to week 2 in the intervention group: -1.16 [± SD 2.67]; control group: -0.26 [± SD 2.29]; t134= 2.13, P=.01), and mental well-being (WHO-5 score, delta from baseline to week 2 in the intervention group: 1.53 [5.30]; control group: -0.23 [± SD 4.20]; t134= -2.16, P=.02) within 2 weeks of using Foundations, with further improvements emerging at week 4. Perceived stress was also reduced within the intervention group, although the results did not reach statistical significance relative to the control group (PSS score, delta from baseline to week 2 in the intervention group: -2.94 [± SD 6.84]; control group: -2.05 [± SD 5.34]; t134= 0.84, P=.20). CONCLUSIONS This study provides proof-of-principle that the digital mental health app, Foundations, can improve measures of mental well-being, anxiety, resilience, and sleep within 2 weeks of use, with greater effects after 4 weeks. It therefore offers potential as a scalable, cost-effective, and accessible solution to enhance mental well-being, even during times of crisis such as the COVID-19 pandemic.

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