The effectiveness of quality improvement collaboratives in improving stroke care and the facilitators and barriers to their implementation: a systematic review

Abstract

Background To successfully reduce the negative impacts of stroke, high-quality health and care practices are needed across the entire stroke care pathway. These practices are not always shared across organisations. Quality improvement collaboratives (QICs) offer a unique opportunity for key stakeholders from different organisations to share, learn and ‘take home’ best practice examples, to support local improvement efforts. This systematic review assessed the effectiveness of QICs in improving stroke care and explored the facilitators and barriers to implementing this approach. Methods Five electronic databases (MEDLINE, CINAHL, EMBASE, PsycINFO, and Cochrane Library) were searched up to June 2020, and reference lists of included studies and relevant reviews were screened. Studies conducted in an adult stroke care setting, which involved multi-professional stroke teams participating in a QIC, were included. Data was extracted by one reviewer and checked by a second. For overall effectiveness, a vote-counting method was used. Data regarding facilitators and barriers was extracted and mapped to the Consolidated Framework for Implementation Research (CFIR). Results Twenty papers describing twelve QICs used in stroke care were included. QICs varied in their setting, part of the stroke care pathway, and their improvement focus. QIC participation was associated with improvements in clinical processes, but improvements in patient and other outcomes were limited. Key facilitators were inter- and intra-organisational networking, feedback mechanisms, leadership engagement, and access to best practice examples. Key barriers were structural changes during the QIC’s active period, lack of organisational support or prioritisation of QIC activities, and insufficient time and resources to participate in QIC activities. Patient and carer involvement, and health inequalities, were rarely considered. Conclusions QICs are associated with improving clinical processes in stroke care; however, their short-term nature means uncertainty remains as to whether they benefit patient outcomes. Evidence around using a QIC to achieve system-level change in stroke is equivocal. QIC implementation can be influenced by individual and organisational level factors, and future efforts to improve stroke care using a QIC should be informed by the facilitators and barriers identified. Future research is needed to explore the sustainability of improvements when QIC support is withdrawn. Trial registration Protocol registered on PROSPERO (CRD42020193966).

Sustainment of a complex culturally competent care intervention for Hispanic living donor kidney transplantation: A longitudinal analysis of adaptations

“…While this seems to have worked well for Site-A, it was not sufficient to overcome contextual barriers in Site-B. Evidence of the effectiveness of learning collaboratives for implementation has been mixed, in large part due to the high degree of protocol variability [39][40][41]. This study only included two sites and 12 learning collaborative meetings, which limited our ability to understand precisely why site differences emerged as a result of the learning collaborative.…”

Stroke care: effectiveness of quality improvement collaboratives

“…The systematic review undertook comprehensive literature searches of five databases (MEDLINE, CINAHL, EMBASE, PsycINFO, Cochrane Library) from date of inception through to June 2020 (Lowther et al 2021). Database searches were supplemented by citation chaining and scoping searches of grey literature (Lowther et al 2021).…”

“…The systematic review by Lowther et al, assessed the effectiveness of QIC's for driving improvements in stroke care and used the Consolidated Framework for Implementation Research (CFIR) (Damschroder et al 2009) to explore the facilitators and barriers to using a QIC to improve care (Lowther et al 2021). The review also sought to consider the extent to which QIC's in stroke care have engaged patients and carers, and considered health inequalities to improve clinical practice (Lowther et al 2021).…”

“…This commentary aims to critically appraise the methods used within the review by Lowther et al, and expand upon the findings in the context of clinical practice (Lowther et al 2021).…”

Quality Improvement in Vascular Surgery

“…Barriers include lack of organisational support and insufficient time and resources. 9 Quality improvement collaboratives are strongly influenced by context, which refers to the system, organisational, or structural makeup of the units involved. 8 There are far fewer reports in the literature of collaborative quality improvement programmes being run in the surgical specialties.…”