scholarly journals How, why and in what contexts do web-based dashboards support the use of national audit data in quality improvement? Findings from a realist evaluation of a novel, quality dashboard in England (Preprint)

10.2196/28854 ◽  
2021 ◽  
Author(s):  
Natasha Alvarado ◽  
Lynn McVey ◽  
Mai Elshehaly ◽  
Joanne Greenhalgh ◽  
Dawn Dowding ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Realist Evaluation ◽  
National Audit ◽  
Web Based ◽  
Audit Data

How, why and in what contexts do web-based dashboards support the use of national audit data in quality improvement: Findings from a realist evaluation of a novel, quality dashboard in England. (Preprint)

2021 ◽  
Author(s):  
Natasha Alvarado ◽  
Lynn McVey ◽  
Mai Elshehaly ◽  
Joanne Greenhalgh ◽  
Dawn Dowding ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Realist Evaluation ◽  
Support Staff ◽  
Ease Of Use ◽  
Perceived Usefulness ◽  
National Audit ◽  
Local Data ◽  
Care Needs ◽  
Web Based ◽  
Audit Data

UNSTRUCTURED Objective: Dashboards can support data-driven quality improvement in healthcare. They visualise data in ways intended to ease cognitive load and support data comprehension, but how they are best integrated into working practices to impact patient care needs further investigation. This paper reports the findings of a realist evaluation of a web-based, interactive quality dashboard (QualDash) developed to support use of national audit data in quality improvement. Methods: QualDash was co-designed with data users and installed in eight clinical services across five healthcare organisations in England between July and December 2019. Local ‘champions’ were identified to support uptake and adoption. Data to evaluate QualDash were collected between August 2019 and August 2021 and consisted of (1) 148.5 hours of observations including hospital wards and clinical governance meetings, (2) logfiles that captured the extent of use of QualDash and (3) a questionnaire, based on the Technological Acceptance Model, to assess the dashboard’s perceived usefulness and ease of use. Guided by the principles of realist evaluation, data were analysed to understand how, why and in what circumstances QualDash best supported use of national audit data in quality improvement. Results: The services into which QualDash was introduced varied in the amount and type of resources available to support data use. These variations, alongside early staff interactions with QualDash, shaped its use and impact during the evaluation period. Well-resourced sites with skilled audit support staff and local data management systems, continued to use established processes to access and use data. Factors constraining use of QualDash in these contexts included the use of local systems to report metrics not configured in QualDash; staff not being fully aware how QualDash could facilitate their work; and champions’ initial reluctance to lead use of QualDash until some metrics were reconfigured to reflect user expectations. In services less well-resourced to use data, QualDash automated parts of their routine reporting process, streamlining the work of audit support staff, and, in some cases, it highlighted issues with data completeness that they worked to address. Furthermore, questionnaire responses indicated that QualDash was perceived as useful and easy to use despite its variable use in practice. Conclusions: Interactive, web-based dashboards, such as QualDash, have potential to support use of national audit data in quality improvement by facilitating access to and interactions with data. To optimise use and impact, findings suggest that codesign would benefit from greater scrutiny of dashboard visualisations pre-installation, by site staff knowledgeable about metric configurations. Additionally, further consideration should be given to the processes surrounding dashboard use, including data collection, that underpin user confidence in dashboard functions. INTERNATIONAL REGISTERED REPORT RR2-10.1136/bmjopen-2019-033208

scholarly journals Specialist pneumonia intervention nurse service improves pneumonia care and outcome

2021 ◽  
Vol 8 (1) ◽  
pp. e000863
Author(s):  
Robert C Free ◽  
Matthew Richardson ◽  
Camilla Pillay ◽  
Kayleigh Hawkes ◽  
Julie Skeemer ◽  
...  
Keyword(s):  
Quality Improvement ◽  
National Health Service ◽  
Low Cost ◽  
Community Acquired Pneumonia ◽  
National Audit ◽  
Mortality Benefit ◽  
Model Of Care ◽  
Spin Period ◽  
National Health Service Trust ◽  
Set Up

BackgroundA specialist pneumonia intervention nursing (SPIN) service was set up across a single National Health Service Trust in an effort to improve clinical outcomes. A quality improvement evaluation was performed to assess the outcomes associated with implementing the service before (2011–2013) and after (2014–2016) service implementation.ResultsThe SPIN service reviewed 38% of community-acquired pneumonia (CAP) admissions in 2014–2016. 82% of these admissions received antibiotic treatment in <4 hours (68.5% in the national audit). Compared with the pre-SPIN period, there was a significant reduction in both 30-day (OR=0.77 (0.70–0.85), p<0.0001) and in-hospital (OR=0.66 (0.60–0.73), p<0.0001) mortality after service implementation, with a review by the service showing the largest independent 30-day mortality benefit (HR=0.60 (0.53–0.67), p<0.0001). There was no change in length of stay (median 6 days).ConclusionImplementation of a SPIN service improved adherence to BTS guidelines and achieved significant reductions in CAP-associated mortality. This enhanced model of care is low cost, highly effective and readily adoptable in secondary care.

scholarly journals Quality improvement collaborative aiming for Proactive HEAlthcare of Older People in Care Homes (PEACH): a realist evaluation protocol

BMJ Open ◽  
2018 ◽  
Vol 8 (11) ◽  
pp. e023287 ◽  
Author(s):  
Reena Devi ◽  
Julienne Meyer ◽  
Jay Banerjee ◽  
Claire Goodman ◽  
John Raymond Fletcher Gladman ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Older People ◽  
Care Home ◽  
Realist Evaluation ◽  
Evaluation Framework ◽  
Care Homes ◽  
Quality Improvement Initiative ◽  
Quality Improvement Collaborative ◽  
Programme Theory ◽  
Health And Social Care

IntroductionThis protocol describes a study of a quality improvement collaborative (QIC) to support implementation and delivery of comprehensive geriatric assessment (CGA) in UK care homes. The QIC will be formed of health and social care professionals working in and with care homes and will be supported by clinical, quality improvement and research specialists. QIC participants will receive quality improvement training using the Model for Improvement. An appreciative approach to working with care homes will be encouraged through facilitated shared learning events, quality improvement coaching and assistance with project evaluation.Methods and analysisThe QIC will be delivered across a range of partnering organisations which plan, deliver and evaluate health services for care home residents in four local areas of one geographical region. A realist evaluation framework will be used to develop a programme theory informing how QICs are thought to work, for whom and in what ways when used to implement and deliver CGA in care homes. Data collection will involve participant observations of the QIC over 18 months, and interviews/focus groups with QIC participants to iteratively define, refine, test or refute the programme theory. Two researchers will analyse field notes, and interview/focus group transcripts, coding data using inductive and deductive analysis. The key findings and linked programme theory will be summarised as context-mechanism-outcome configurations describing what needs to be in place to use QICs to implement service improvements in care homes.Ethics and disseminationThe study protocol was reviewed by the National Health Service Health Research Authority (London Bromley research ethics committee reference: 205840) and the University of Nottingham (reference: LT07092016) ethics committees. Both determined that the Proactive HEAlthcare of Older People in Care Homes study was a service and quality improvement initiative. Findings will be shared nationally and internationally through conference presentations, publication in peer-reviewed journals, a graphical illustration and a dissemination video.

scholarly journals Open communication strategies between a triad of ‘experts’ facilitates death in usual place of residence: A realist evaluation

2018 ◽  
Vol 32 (5) ◽  
pp. 980-989 ◽  
Author(s):  
Sonia Dalkin ◽  
Monique Lhussier ◽  
Diana Jones ◽  
Pete Phillipson ◽  
William Cunningham
Keyword(s):  
Primary Care ◽  
Logistic Regression Model ◽  
Care Pathway ◽  
Communication Strategies ◽  
Realist Evaluation ◽  
Mixed Effects ◽  
Place Of Residence ◽  
Open Communication ◽  
Audit Data ◽  
Integrated Care Pathway

Background: In order to meet policy drivers on death in usual place of residence, it is key to understand how shared decision-making can be facilitated in practice. An integrated care pathway was implemented in primary care in the North East of England to facilitate death in usual place of residence. Aim: To understand how, for whom and in which circumstances death in usual place of residence is facilitated. Design: A mixed method realist evaluation was employed. Local primary care practice death audit data were analysed to identify outcomes using a mixed effects logistic regression model. Focus groups and interviews with staff of the integrated care pathway and bereaved relatives were analysed to identify the related contexts and mechanisms. Setting/participants: Death audit data of 4182 patients were readily available from 14 general practitioner practices. Three focus groups were conducted with primary and secondary care staff, voluntary sector organisations and care home representatives. Interviews with bereaved relatives were carried out in participants’ homes ( n = 5). Results: A mixed effects logistic regression model indicated a significant effect of year on death in usual place of residence when compared to a model without year using an analysis of deviance ( p = 0.016). Qualitative analysis suggested that this outcome was achieved when a triad of ‘experts’ (comprising patient, family members/family carers/formal carers and healthcare professionals) used open communication strategies. Conclusion: An empirically supported theory of how, for whom and in which circumstances death in usual place of residence happens is provided, which has important implications for both policy and practice.

Informatics Applications in Neonatology

2011 ◽  
pp. 1215-1234
Author(s):  
Malcolm Battin ◽  
David Knight ◽  
Carl Kuschel
Keyword(s):  
Decision Making ◽  
Quality Improvement ◽  
Clinical Practice ◽  
Data Collection ◽  
Information Sources ◽  
Physiological Monitoring ◽  
Multiple Sources ◽  
Web Based ◽  
Data Intensive ◽  
Information Tools

Neonatal care is an extremely data-intensive activity. Physiological monitoring equipment is used extensively along with web-based information tools and knowledge sources. Merging data from multiple sources adds value to this data collection. Neonatal databases assist with collecting, displaying, and analyzing data from a number of sources. Although the construction of such databases can be difficult, it can provide helpful support to clinical practice including surveillance of infectious diseases and even medical error. Along with recording outcomes, such systems are extremely useful for the support of audit and quality improvement as well as research. Electronic information sources are often helpful in education and communication with parents and others, both within the unit and at a distance. Systems are beginning to be used to help with decision making – for example in the case of weaning neonates from ventilators, and this work is likely to become more important in the future.

scholarly journals The National Pain Audit for specialist pain services in England and Wales 2010–2014

2018 ◽  
Vol 13 (3) ◽  
pp. 185-193 ◽  
Author(s):  
Cathy Price ◽  
Amanda C de C Williams ◽  
Blair H Smith ◽  
Alex Bottle
Keyword(s):  
Quality Improvement ◽  
Waiting Times ◽  
Pain Clinic ◽  
Standards Of Care ◽  
National Audit ◽  
England And Wales ◽  
Safety Standards ◽  
Diagnostic Coding ◽  
Pain Clinics ◽  
Pain Services

Introduction: Numerous reports highlight variations in pain clinic provision between services, particularly in the provision of multidisciplinary services and length of waiting times. A National Audit aims to identify and quantify these variations, to facilitate raising standards of care in identified areas of need. This article describes a Quality Improvement Programme cycle covering England and Wales that used such an approach to remedy the paucity of data on the current state of UK pain clinics. Methods: Clinics were audited over a 4-year period using standards developed by the Faculty of Pain Medicine of The Royal College of Anaesthetists. Reporting was according to guidance from a recent systematic review of national surveys of pain clinics. A range of quality improvement measures was introduced via a series of roadshows led by the British Pain Society. Results: 94% of clinics responded to the first audit and 83% responded to the second. Per annum, 0.4% of the total national population was estimated to attend a specialist pain service. A significant improvement in multidisciplinary staffing was found (35–56%, p < 0.001) over the 4-year audit programme, although this still requires improvement. Very few clinics achieved recommended evidence-based waiting times, although only 2.5% fell outside government targets; this did not improve. Safety standards were generally met. Clinicians often failed to code diagnoses. Conclusion: A National Audit found that while generally safe many specialist pain services in England and Wales fell below recommended standards of care. Waiting times and staffing require improvement if patients are to get effective and timely care. Diagnostic coding also requires improvement.

scholarly journals Development and Assessment of a Web-Based Clinical Quality Improvement Curriculum

2014 ◽  
Vol 6 (1) ◽  
pp. 147-150 ◽  
Author(s):  
Mamata Yanamadala ◽  
Jeffrey Hawley ◽  
Richard Sloane ◽  
Jonathan Bae ◽  
Mitchell T. Heflin ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Educational Interventions ◽  
Content Delivery ◽  
First Year ◽  
Teaching Tool ◽  
Test Analysis ◽  
Web Based ◽  
Protected Time ◽  
Internal Medicine Residents ◽  
Academic Year

Abstract Background Understanding quality improvement (QI) is an important skill for physicians, yet educational interventions focused on teaching QI to residents are relatively rare. Web-based training may be an effective teaching tool in time-limited and expertise-limited settings. Intervention We developed a web-based curriculum in QI and evaluated its effectiveness. Methods During the 2011–2012 academic year, we enrolled 53 first-year internal medicine residents to complete the online training. Residents were provided an average of 6 hours of protected time during a 1-month geriatrics rotation to sequentially complete 8 online modules on QI. A pre-post design was used to measure changes in knowledge of the QI principles and self-assessed competence in the objectives of the course. Results Of the residents, 72% percent (37 of 51) completed all of the modules and pretests and posttests. Immediate pre-post knowledge improved from 6 to 8.5 for a total score of 15 (P &lt; .001) and pre-post self-assessed competence in QI principles on paired t test analysis improved from 1.7 to 2.7 on a scale of 5 for residents who completed all of the components of the course. Conclusions Web-based training of QI in this study was comparable to other existing non–web-based curricula in improving learner confidence and knowledge in QI principles. Web-based training can be an efficient and effective mode of content delivery.

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