Insights on a National Safety Improvement Learning Collaborative: Using the Consolidated Framework for Implementation Research.

Background: There is a growing interest in quality improvement collaboratives (QICs), even though less remains known about contextual factors that impact collective and local project implementation. A study was undertaken that used the Consolidated Framework for Implementation Research (CFIR) to explore the contextual factors impacting the use of this nationwide QIC in Canada. Methods: A deductive or direct qualitative content analysis using CFIR was employed to explore the contextual factors impacting the implementation of a nationwide QIC and participating organizations. Data were used from document analysis and semi-structured interviews with participants from 30 participating healthcare organizations across Canada. Results: A variety of contextual factors emerged, which influenced the uptake of the QICs across different settings, including intervention characteristics, outer setting, inner setting, and process factors. This study illustrates how organizations can consider a multi-pronged, theory-driven approach to guide the evaluation of safety and quality improvement efforts. Conclusions: This study provides insights into contextual factors that impact the implementation of local safety projects involved in a larger QIC, which may serve as a template or blueprint for healthcare leaders in their efforts to guide the co-design, implementation and evaluation of safety and quality improvement efforts.

Impacto das crises de sibilância em crianças de 0 a 3 anos de uma área de baixa renda no sul do Brasil / Impact of wheezing episodes in children 0 to 3 years old from a low-income area in Southern Brazil

Objetivos: Identificar a prevalência de sibilância e fatores associados em crianças com idade inferior a três anos de uma amostra populacional de baixa renda e medir outros marcadores de gravidade associados à sibilância e à asma nos primeiros anos de vida.Métodos: Os pais ou responsáveis das crianças incluídas foram entrevistados no centro de saúde de atenção primária de uma região de baixa renda da cidade de Porto Alegre, Rio Grande do Sul, e responderam a um questionário desenvolvido para estimar a prevalência de sibilância e avaliar os fatores associados, denominado EISL (Estudo Internacional de Sibilância em Lactentes). Foram incluídos pacientes com idade até 36 meses que consultavam para puericultura e/ou vacinação. Pacientes trazidos na emergência não foram incluídos.Resultados: O estudo avaliou um total de 153 crianças com idade média de 12,6±9,5 meses. Destes, 63% tiveram episódios de sibilância relatados, que ocorreram uma ou mais vezes durante os primeiros três anos de vida. A média de idade do primeiro episódio de sibilância foi 4,9±5,3 meses. Utilizaram β2-agonistas, corticoides orais e corticoides inalatórios 58,2%, 32,7% e 19% dos pacientes, respectivamente. Mais de 58% dos pacientes foram à emergência por sibilância e 13% foram hospitalizados pelo menos uma vez nos primeiros anos de vida.Conclusões: Este estudo mostrou que a prevalência de sibilância foi alta entre as crianças pequenas atendidas em um centro de saúde de uma região de baixa renda da cidade de Porto Alegre, sendo que os primeiros sintomas geralmente ocorreram durante os primeiros dois anos de vida. Além disso, alta frequência de uso de medicamentos e internação hospitalar demonstram o impacto da doença pulmonar obstrutiva neste grupo etário...

Aims: To identify the prevalence of wheezing and associated factors in children younger than three years of age in a sample of low income region, and to measure other markers associated with severity and risk of asthma in early life.Methods: Parents or legal guardians of infants were interviewed at the primary health center in a low-income area from Porto Alegre, Rio Grande do Sul state, and answered a questionnaire designed to estimate the prevalence of wheezing and evaluate the associated risk factors, called EISL (International Study of Wheezing in Infants). We included patients up to 36 months of age visiting for routine examination or vaccination. Patients brought to emergency room were not included.Results: The study evaluated a total of 153 children with a mean age of 12.6±9.5 months. Of them, 63% had at least one episode of wheezing reported, which occurred one or more times during the first year of life. The average age of the first episode of wheezing was 4.9±5.3 months. Use of β2-agonists, oral and inhaled corticosteroids was reported by 58.2%, 32.7% and 19%, respectively. More than 59% of the patients visited an emergency unit due to wheezing episodes and 13% were hospitalized at least once in the first years of life because of wheezing.Conclusions: This study has shown that the prevalence of wheezing on young children is high in a low-income area from Porto Alegre, and the symptoms usually occur during the first two years of life. In addition, high frequency of medication usage and hospitalization demonstrates the impact of obstructive lung disease in this age group...