Evidence-Based Quality Improvement: a Scoping Review of the Literature

Hempel, Susanne; Bolshakova, Maria; Turner, Barbara J.; Dinalo, Jennifer; Rose, Danielle E.; Fu, Ning; Clemesha, Chase G.; Rubenstein, Lisa V.; Stockdale, Susan

doi:10.1007/s11606-022-07602-5

Cited by 15 publications

(16 citation statements)

References 68 publications

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“…While developed to improve VA cirrhosis care, GTI's "choose your own adventure" approach is amenable to clinical area specification or customization, while maintaining generalizability. Modification for scaling and spreading GTI continues within VA, in tandem with the larger field of evidence-based quality improvement expanding (55, 56). As the largest integrated healthcare system in the US, .…”

Section: Discussionmentioning

confidence: 99%

Getting to implementation: Adaptation of an implementation playbook

Yakovchenko

Rogal²,

Goodrich³

et al. 2023

Front. Public Health

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IntroductionImplementation strategies supporting the translation of evidence into practice need to be tailored and adapted for maximum effectiveness, yet the field of adapting implementation strategies remains nascent. We aimed to adapt “Getting To Outcomes”® (GTO), a 10-step implementation playbook designed to help community-based organizations plan and evaluate behavioral health programs, into “Getting To Implementation” (GTI) to support the selection, tailoring, and use of implementation strategies in health care settings.MethodsOur embedded evaluation team partnered with operations, external facilitators, and site implementers to employ participatory methods to co-design and adapt GTO for Veterans Health Administration (VA) outpatient cirrhosis care improvement. The Framework for Reporting Adaptations and Modifications to Evidenced-based Implementation Strategies (FRAME-IS) guided documentation and analysis of changes made pre- and post-implementation of GTI at 12 VA medical centers. Data from multiple sources (interviews, observation, content analysis, and fidelity tracking) were triangulated and analyzed using rapid techniques over a 3-year period.ResultsAdaptations during pre-implementation were planned, proactive, and focused on context and content to improve acceptability, appropriateness, and feasibility of the GTI playbook. Modifications during and after implementation were unplanned and reactive, concentrating on adoption, fidelity, and sustainability. All changes were collaboratively developed, fidelity consistent at the level of the facilitator and/or implementer.ConclusionGTO was initially adapted to GTI to support health care teams' selection and use of implementation strategies for improving guideline-concordant medical care. GTI required ongoing modification, particularly in steps regarding team building, context assessment, strategy selection, and sustainability due to difficulties with step clarity and progression. This work also highlights the challenges in pragmatic approaches to collecting and synthesizing implementation, fidelity, and adaptation data.Trial registrationThis study was registered on ClinicalTrials.gov (Identifier: NCT04178096).

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Section: Discussionmentioning

confidence: 99%

Getting to implementation: Adaptation of an implementation playbook

Yakovchenko

Rogal²,

Goodrich³

et al. 2023

Front. Public Health

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“…The framework focuses on supporting “race consciousness” and helping participants recognize the “ordinariness of racism” and its consequences 21 . We applied PHCRP within the Evidence-Based Quality Improvement (EBQI) 24 principles that quality and safety officers at our hospital typically use for QI efforts. We named our QI initiative the Longitudinal Equity Action Plan (LEAP).…”

Section: Methodsmentioning

confidence: 99%

A Public Health Critical Race Praxis Informed Congestive Heart Failure Quality Improvement Initiative on Inpatient General Medicine

et al. 2023

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Background Prior evaluation at our hospital demonstrated that, compared to White patients, Black and Latinx patients with congestive heart failure (CHF) were less likely to be admitted to the cardiology service rather than the general medicine service (GMS). Patients admitted to GMS (compared to cardiology) had inferior rates of cardiology follow-up and 30-day readmission. Objective To develop and test the feasibility and impacts of using quality improvement (QI) methods, in combination with the Public Health Critical Race Praxis (PHCRP) framework, to engage stakeholders in developing an intervention for ensuring guideline-concordant inpatient CHF care across all patient groups. Methods We compared measures for all patients admitted with CHF to GMS between September 2019 and March 2020 (intervention group) to CHF patients admitted to GMS in the previous year (pre-intervention group) and those admitted to cardiology during the pre-intervention and intervention periods (cardiology group). Our primary measures were 30-day readmissions and 14- and 30-day post-discharge cardiology follow-up. Results There were 79 patients admitted with CHF to GMS during the intervention period, all of whom received the intervention. There were similar rates of Black and Latinx patients across the three groups. Compared to pre-intervention, intervention patients had a significantly lower 30-day readmission rate (18.9% vs. 24.8%; p =0.024), though the cardiology group also had a decrease in 30-day readmissions from the pre-intervention to intervention period. Compared to pre-intervention, intervention patients had significantly higher 14-day and 30-day post-discharge follow-up visits scheduled with cardiology (36.7% vs. 24.8%, p =0.005; 55.7% vs. 42.3%, p =0.0029), but no improvement in appointment attendance. Conclusion This study provides a first test of applying the PHCRP framework within a stakeholder-engaged QI initiative for improving CHF care across races and ethnicities. Our study design cannot evaluate causation. However, the improvements in 30-day readmission, as well as in processes of care that may affect it, provide optimism that inclusion of a racism-conscious framework in QI initiatives is feasible and may enhance QI measures. Supplementary Information The online version contains supplementary material available at 10.1007/s11606-023-08086-7.

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“…Following the traditional EBP PICOT question, where P = population, I = intervention, C = comparison, O = outcomes, and T = time, 37 this evidence-based quality improvement 38,39 project sought to answer the question: Are there improvements from baseline (C) in the well-being, burnout, and resilience (O) of nursing personnel (P) 6 months (T) following the initiation of the WE CARE program (I)?…”

Section: Program Developmentmentioning

confidence: 99%

Workforce Engagement for Compassionate Advocacy, Resilience, and Empowerment (WE CARE)

Patrician,

Travis,

Blackburn

et al. 2024

Nursing Administration Quarterly

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Poor well-being and burnout among the nursing workforce were heightened by the COVID-19 pandemic. The purpose of this study was to deliver, spread, and sustain an evidence-based wellness program, Workforce Engagement for Compassionate Advocacy, Resilience, and Empowerment (WE CARE), for nurse leaders, staff registered nurses (RNs), and patient care technicians (PCTs) to ameliorate or prevent burnout, promote resilience, and improve the work environment. The program included Community Resiliency Model (CRM) training provided by a certified 6-member wellness team. A baseline and 6-month follow-up survey included measures of well-being, moral distress, burnout, resilience, perceived organizational support (POS), job satisfaction, intent to leave (ITL), and work environment. A total of 4900 inpatient RNs, PCTs, and leaders of a 1207-bed academic medical center in the southeastern United States were analyzed. From baseline (n = 1533) to 6-month follow-up (n = 1457), well-being, moral distress, burnout, job satisfaction, and work environment improved; however, resilience, POS, and ITL did not. Although we have seen some improvements in well-being and mental health indicators, it is still early in the intervention period to have reached a critical mass with the training and other interventions. The mental health and work environment issues among nurses are so complex, no one-size-fits-all intervention can resolve.

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Evidence-Based Quality Improvement: a Scoping Review of the Literature

Cited by 15 publications

References 68 publications

Getting to implementation: Adaptation of an implementation playbook

Getting to implementation: Adaptation of an implementation playbook

A Public Health Critical Race Praxis Informed Congestive Heart Failure Quality Improvement Initiative on Inpatient General Medicine

Workforce Engagement for Compassionate Advocacy, Resilience, and Empowerment (WE CARE)

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