Outreach Education to Improve Quality of Rural ICU Care

Abstract

This study tests whether an outreach educational program tailored to institutional specific patient care practices would improve the quality of care delivered to mechanically ventilated intensive care unit (ICU) patients in rural hospitals. The study was conducted as a randomized control trial using 20 rural Iowa hospitals as the unit of analysis. Twelve randomly selected hospitals received an outreach educational program. After review of the medical records of eligible patients, a multidisciplinary team of intensive care unit specialists from an academic medical center delivered an educational program with content specific to the findings and capacity of the hospital. The outcome measures included patient care processes, patient morbidity and mortality outcomes, and resource use. Results indicated that the outreach program significantly improved many patient care processes (lab work, nursing, dietary management, ventilator management, ventilator weaning). The program marginally reduced hospital ventilator days. Both total length of stay and ICU length of stay fell markedly in the intervention group (by an average of 3.2 and 2.1 d, respectively), while the control group fell only 0.6 and 0.3 d, respectively. However, these effects did not reach statistical significance. Unfortunately, the program had no detectable effects on the clinical outcomes of mortality or nosocomial events. We conclude that an outreach program of this type can effectively improve processes of care in rural ICUs. However, improving processes of care may not always translate into improvement of specific outcomes.

Tailoring quality improvement interventions to identified barriers: a multiple case analysis

“…Hendryx et al . [28] Acute Secondary Effect ± QN: surveys of professionals. QL: several prior qualitative methods (pers.…”

Mechanical ventilation in rural ICUs

“…Treatment variations were found in both the rural and rural referral setting. Specific data on baseline compliance within each process of care category have been previously discussed by Hendryx et al [9]. …”

“…Specific data describing the impact of patient characteristics and process performance on mortality rates have recently been published [8]. Data describing the specific effects of the outreach educational program on patient care processes and outcomes in the treatment group versus control group have also been published [9]. …”

Evaluating the effectiveness of a tailored multifaceted performance feedback intervention to improve the quality of care: protocol for a cluster randomized trial in intensive care

“…However, many have advocated the need for rigorous evaluations using an external control group to evaluate the effect of QI initiatives [45-47], with the cluster randomized trial usually being the preferred method [48,49]. There have been cluster RCTs in the ICU domain that evaluated a multifaceted intervention with audit and feedback as a basic element [50-52]. Some of them were highly successful in increasing adherence to a specific evidence-based treatment, such as the delivery of surfactant therapy to neonates [51] and semi-recumbent positioning to prevent ventilator-associated pneumonia [50].…”