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1.
BMJ ; 367: l5462, 2019 10 09.
Artigo em Inglês | MEDLINE | ID: mdl-31597637

RESUMO

The studyPeden CJ, Stephens T, Martin G et al. Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial. Lancet 2019;393:2213-21.This project was funded by the NIHR Health Services and Delivery Research Programme (project number 12/5005/10).To read the full NIHR Signal, go to https://discover.dc.nihr.ac.uk/content/signal-000789/national-quality-improvement-programmes-need-time-and-resources-to-have-impact.


Assuntos
Dor Abdominal/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório , Tratamento de Emergência , Melhoria de Qualidade/organização & administração , Doença Aguda , Análise por Conglomerados , Procedimentos Clínicos , Procedimentos Cirúrgicos do Sistema Digestório/normas , Tratamento de Emergência/normas , Humanos , Avaliação de Programas e Projetos de Saúde , Melhoria de Qualidade/normas
4.
Implement Sci ; 14(1): 73, 2019 07 18.
Artigo em Inglês | MEDLINE | ID: mdl-31319857

RESUMO

BACKGROUND: Full capacity protocol (FCP) is an internationally recognized intervention designed to address emergency department (ED) crowding. Despite FCP international recognition and positive effects on hospital performance measures, many hospitals, even the most crowded ones, have not implemented FCP. We conducted this study to identify the core components of FCP, explore the key barriers and facilitators associated with the FCP implementation, and provide practical recommendations on how to overcome those barriers. METHODS: To identify the core components of FCP, we used a non-experimental approach. We conducted semi-structured interviews with key informants (e.g., division chiefs, medical directors) involved in the implementation of FCP. We used the Consolidated Framework for Implementation Research (CFIR) to guide data collection and analysis. We used a template analysis approach to determine the relevance of the CFIR constructs to implementing the FCP. We analyzed the responses to the interview questions about FCP definition and FCP key principles, compared different hospitals' FCP official documents, and consulted with the original FCP developer. We then used an adaptation framework to categorize the core components of FCP into three main groups. Finally, we summarized practical recommendations for each barrier based on information provided by the interviewees. RESULTS: A total of 32 interviews were conducted. We observed that FCP has evolved from the idea of transferring boarded patients from ED hallways to inpatient hallways to a practical hospital-wide intervention with several components and multiple levels. The key determinant of successful FCP implementation was collaboration with inpatient nursing staff, as they were often reluctant to have patients boarded in inpatient hallways. Other determinants of successful FCP implementation were reaching consensus about the criteria for activation of each FCP level and actions in each FCP level, modifying the electronic health records system, restructuring the inpatient units to have adequate staffing and resources, complying with external regulations and policies such as fire marshal guidelines, and gaining hospital leaders' support. CONCLUSIONS: The key determinant in implementing FCP is creating a supportive and cooperative hospital culture and encouraging key stakeholders, including inpatient nursing staff, to acknowledge that crowding is a hospital-wide problem that requires a hospital-wide response.


Assuntos
Aglomeração , Serviço Hospitalar de Emergência/organização & administração , Política Organizacional , Avaliação de Programas e Projetos de Saúde/métodos , Melhoria de Qualidade/organização & administração , Humanos
5.
Implement Sci ; 14(1): 74, 2019 07 23.
Artigo em Inglês | MEDLINE | ID: mdl-31337394

RESUMO

BACKGROUND: Quality improvement collaboratives (QICs) are widely used to improve healthcare, but there are few studies of long-term sustained improved outcomes, and inconsistent evidence about what factors contribute to success. The aim of the study was to open the black box of QICs and compare characteristics and activities in detail of two differing QICs in relation to their changed outcomes from baseline and the following 3 years. METHODS: Final reports of two QICs-one on heart failure care with five teams, and one on osteoarthritis care with seven teams, including detailed descriptions of improvement projects from each QIC's team, were analysed and coded by 18 QIC characteristics and four team characteristics. Goal variables from each team routinely collected within the Swedish Heart Failure Registry (SwedeHF) and the Better Management of Patients with OsteoArthritis Registry (BOA) at year 2013 (baseline), 2014, 2015 and 2016 were analysed with univariate statistics. RESULTS: The two QICs differed greatly in design. The SwedeHF-QIC involved eight experts and ran for 12 months, whereas the BOA-QIC engaged three experts and ran for 6 months. There were about twice as many activities in the SwedeHF-QIC as in the BOA-QIC and they ranged from standardisation of team coordination to better information and structured follow-ups. The outcome results were heterogeneous within teams and across teams and QICs. Both QICs were highly appreciated by the participants and contributed to their learning, e.g. of improvement methods; however, several teams had already reached goal values when the QICs were launched in 2013. CONCLUSIONS: Even though many QI activities were carried out, it was difficult to see sustained improvements on outcomes. Outcomes as specific measurable aspects of care in need of improvement should be chosen carefully. Activities focusing on adherence to standard care programmes and on increased follow-up of patients seemed to lead to more long-lasting improvements. Although earlier studies showed that data follow-up and measurement skills as well as well-functioning data warehouses contribute to sustained improvements, the present registries' functionality and QICs at this time did not support those aspects sufficiently. Further studies on QICs and their impact on improvement beyond the project time should investigate the effect of those elements in particular.


Assuntos
Comportamento Cooperativo , Insuficiência Cardíaca/terapia , Osteoartrite/terapia , Equipe de Assistência ao Paciente/organização & administração , Melhoria de Qualidade/organização & administração , Sistema de Registros , Humanos , Avaliação de Programas e Projetos de Saúde , Suécia , Fatores de Tempo
6.
J Nurs Adm ; 49(7-8): 350-353, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31335517

RESUMO

A quality improvement effort was designed to coordinate care in minimizing sleep interruptions to allow patients 6 or more hours of uninterrupted sleep. An interprofessional team developed a sleep protocol (HUSH) and coordinated care activities to reduce sleep interruptions on a 30-bed medical-surgical-telemetry unit. Changes in patient perceptions of noise and number of hours of restful sleep were compared before and after implementation. Results indicate a 9% improvement in quiet domain scores.


Assuntos
Unidades de Terapia Intensiva , Enfermagem Médico-Cirúrgica/organização & administração , Melhoria de Qualidade/organização & administração , Privação do Sono/prevenção & controle , Sono/fisiologia , Humanos , Ruído/prevenção & controle , Inquéritos e Questionários
7.
Sante Publique ; Vol. 31(1): 165-175, 2019 January February.
Artigo em Francês | MEDLINE | ID: mdl-31210511

RESUMO

OBJECTIVE: Community Health Workers (CHWs) were promoted in Benin to improve maternal and child health care (MCH). To improve community health workers' performance, a Quality Improvement Team (QIT) was set up to reinforce CHW capacities. The objective of this work is to present an assessment of QIT's contribution to CHW's performance and MCH coverage in the municipality of Savè. METHODOLOGY: The design of the study includes a pre- and post- analysis. Data were extracted from CHWs' activity reports and routine health information systems from 2011 to 2014 in 22 health facilities. Individual in-depth interviews were also performed with some key informants. The performance of CHW and the MCH indicators were determined according to the National Community Health Policy. RESULTS: The QIT improved Community Health Workers' performance and maternal and child health indicators in Savè. Educational sessions, skilled delivery care coverage, percentage of newborn seen over twice a week, percentage of children treated according national standards, percentage of children fully immunized, percentage of women using family planning methods were increased. CONCLUSION: The establishment of QIT improved CHW's performance and the use of maternal and child health services in Savè. This strategy could be useful for community-based surveillance.


Assuntos
Agentes Comunitários de Saúde/organização & administração , Serviços de Saúde Materno-Infantil/organização & administração , Melhoria de Qualidade/organização & administração , Benin , Criança , Saúde da Criança , Serviços de Saúde da Criança/organização & administração , Serviços de Saúde da Criança/normas , Agentes Comunitários de Saúde/normas , Feminino , Humanos , Recém-Nascido , Serviços de Saúde Materno-Infantil/normas
8.
BMC Health Serv Res ; 19(1): 385, 2019 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-31200699

RESUMO

BACKGROUND: As lower-income countries look to develop a mature healthcare workforce and to improve quality and reduce costs, they are increasingly turning to quality improvement (QI), a widely-used strategy in higher-income countries. Although QI is an effective strategy for promoting evidence-based practices, QI interventions often fail to deliver desired results. This failure may reflect a problem with implementation. As the key implementing unit of QI, teams are critical for the success or failure of QI efforts. Thus, we used the model of work-team learning to identify factors related to the effectiveness of newly-formed hospital-based QI teams in Ghana. METHODS: This was a cross-sectional, observational study. We used structural equation modeling to estimate relationships between coaching-oriented team leadership, perceived support for teamwork, team psychological safety, team learning behavior, and QI implementation. We used an observer-rated measure of QI implementation, our outcome of interest. Team-level factors were measured using aggregated survey data from 490 QI team members, resulting in a sample size of 122 teams. We assessed model fit and tested significance of standardized parameters, including direct and indirect effects. RESULTS: Learning behavior mediated a positive relationship between psychological safety and QI implementation (ß = 0.171, p = 0.001). Psychological safety mediated a positive relationship between team leadership and learning behavior (ß = 0.384, p = 0.068). Perceived support for teamwork did not have a significant effect on psychological safety or learning behavior. CONCLUSIONS: Psychological safety and learning behavior are key for the success of newly formed QI teams working in lower-income countries. Organizational leaders and implementation facilitators should consider these leverage points as they work to establish an environment where QI and other team-based activities are supported and encouraged.


Assuntos
Corpo Clínico Hospitalar/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Melhoria de Qualidade/organização & administração , Saúde da Criança/normas , Pré-Escolar , Estudos Transversais , Assistência à Saúde/organização & administração , Gana , Pessoal de Saúde/normas , Humanos , Liderança , Corpo Clínico Hospitalar/normas , Tutoria , Qualidade da Assistência à Saúde , Reprodutibilidade dos Testes
10.
BMC Health Serv Res ; 19(1): 396, 2019 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-31217004

RESUMO

BACKGROUND: Australia is one of many nations struggling with the challenges of delivering quality primary health care (PHC) to increasing numbers of refugees. The OPTIMISE project represents a collaboration between 12 organisations to generate a model of integrated refugee PHC suitable for uptake throughout Australia. This paper describes the methodology of one component; an outreach practice facilitation intervention, directed towards improving the quality of PHC received by refugees in Australian general practices. METHODS: Our mixed methods study will use a cluster stepped wedge randomised controlled trial design set in 3 urban regions of high refugee resettlement in Australia. The intervention was build upon regional partnerships of policy advisors, clinicians, academics and health service managers. Following a regional needs assessment, the partnerships reached consensus on four core areas for intervention in general practice (GP): recording of refugee status; using interpreters; conducting comprehensive health assessments; and referring to refugee specialised services. Refugee health staff trained in outreach practice facilitation techniques will work with GP clinics to modify practice routines relating to the four core areas. 36 general practice clinics with no prior involvement in a refugee health focused practice facilitation will be randomly allocated into early and late intervention groups. The primary outcome will be changes in number of claims for Medical Benefit Service reimbursed comprehensive health assessments among patients identified as being from a refugee background. Changes in practice performance for this and 3 secondary outcomes will be evaluated using multilevel mixed effects models. Baseline data collection will comprise (i) pre-intervention provider survey; (ii) two surveys documenting each practices' structure and approaches to delivery of care to refugees. De-identified medical record data will be collected at baseline, at the end of the intervention and 6 and 12 months following completion. DISCUSSION: OPTIMISE will test whether a regionally oriented practice facilitation initiative can improve the quality of PHC delivered to refugees. Findings have the potential to influence policy and practice in broader primary care settings. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry, ACTRN12618001970235 , 05/12/2018, Retrospectively registered. Protocol Version 1, 21/08/2017.


Assuntos
Assistência à Saúde/organização & administração , Atenção Primária à Saúde/organização & administração , Melhoria de Qualidade/organização & administração , Refugiados , Instituições de Assistência Ambulatorial , Austrália , Humanos , Encaminhamento e Consulta
11.
BMC Health Serv Res ; 19(1): 419, 2019 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-31234916

RESUMO

BACKGROUND: The use of clinical performance feedback to support quality improvement (QI) activities is based on the sound rationale that measurement is necessary to improve quality of care. However, concerns persist about the reliability of this strategy, known as Audit and Feedback (A&F) to support QI. If successfully implemented, A&F should reflect an iterative, self-regulating QI process. Whether and how real-world A&F initiatives result in this type of feedback loop are scarcely reported. This study aimed to identify barriers or facilitators to implementation in a team-based primary care context. METHODS: Semi-structured interviews were conducted with key informants from team-based primary care practices in Ontario, Canada. At the time of data collection, practices could have received up to three iterations of the voluntary A&F initiative. Interviews explored whether, how, and why practices used the feedback to guide their QI activities. The Consolidated Framework for Implementation Research was used to code transcripts and the resulting frameworks were analyzed inductively to generate key themes. RESULTS: Twenty-five individuals representing 18 primary care teams participated in the study. Analysis of how the A&F intervention was used revealed that implementation reflected an incomplete feedback loop. Participation was facilitated by the reliance on an external resource to facilitate the practice audit. The frequency of feedback, concerns with data validity, the design of the feedback report, the resource requirements to participate, and the team relationship were all identified as barriers to implementation of A&F. CONCLUSIONS: The implementation of a real-world, voluntary A&F initiative did not lead to desired QI activities despite substantial investments in performance measurement. In small primary care teams, it may take long periods of time to develop capacity for QI and future evaluations may reveal shifts in the implementation state of the initiative. Findings from the present study demonstrate that the potential mechanism of action of A&F may be deceptively clear; in practice, moving from measurement to action can be complex.


Assuntos
Auditoria Clínica , Retroalimentação , Equipe de Assistência ao Paciente , Atenção Primária à Saúde , Melhoria de Qualidade/organização & administração , Humanos , Ontário , Pesquisa Qualitativa , Reprodutibilidade dos Testes , Programas Voluntários
12.
World J Pediatr Congenit Heart Surg ; 10(3): 270-275, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31084314

RESUMO

BACKGROUND: Aiming at fostering local development of cardiology and cardiovascular surgery centers in developing countries, the nonprofit organization Children's HeartLink (CHL) encourages centers to participate in the International Quality Improvement Collaborative Database for Congenital Heart Disease (IQIC). The definition of parameters and data to evaluate patient treatment provides an opportunity to improve quality of care, reducing morbidity and mortality. The objective of the study was to analyze the outcomes of the partnership between CHL and IQIC database with a single pediatric cardiology and cardiovascular surgery center for seven years providing continuous follow-up to guide actions aiming at morbidity and mortality reduction in patients with pediatric and congenital heart diseases. METHODS: Data were collected from January 2011 to December 2017 independently and with external audits and included preoperative information (demographic data, nutritional status, chromosomal abnormalities), Risk Adjustment for Congenital Heart Surgery (RACHS-1) score, and postoperative information such as infections or complications within the first 30 days or until hospital discharge and/or death. RESULTS: In the preoperative period, there was a trend toward an increase in the number of newborn patients. The postoperative period showed significant surgical procedure variations between groups for RACHS-1 risk category ( P = .003), prevalence of risk categories 2 and 3, and an increase in risk categories 4, 5, and 6, mainly in the last two years. Decreases in surgical site infection ( P = .03), bacterial sepsis, and other infections (both P < .001) were observed. At the 30-day postoperative follow-up, there was a decrease of in-hospital ( P = .16) and 30-day ( P = .14) mortality. CONCLUSION: The partnership between CHL and this seven-year analysis of IQIC database demonstrated structural and human flaws, whose resolution led to significant decrease in infection and reduction in mortality despite an increase in the complexity of our pediatric and congenital heart disease population.


Assuntos
Procedimentos Cirúrgicos Cardíacos/normas , Cardiologia , Cardiopatias Congênitas/cirurgia , Prática Associada , Pediatria , Melhoria de Qualidade/organização & administração , Centros Cirúrgicos/normas , Adolescente , Brasil , Criança , Pré-Escolar , Bases de Dados Factuais , Países em Desenvolvimento , Feminino , Humanos , Lactente , Recém-Nascido , Masculino
13.
Curr Opin Anaesthesiol ; 32(3): 392-397, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31045641

RESUMO

PURPOSE OF REVIEW: To review the developments within paediatric anaesthesia and describe the various factors that have contributed to the improvements in anaesthesia-related outcomes in children. RECENT FINDINGS: During the years substantial improvements in paediatric anaesthesia-related outcomes has derived from safety advances in equipment, drugs, human factor analysis, professional standardization and organization, subspecialty care and regionalization. However, universally agreed outcome measures are lacking. SUMMARY: Despite a steadily and significant improvement in paediatric anaesthesia-related outcomes over the years further and future improvements are still necessary in areas such as adverse-event reporting and long-term neurocognitive outcomes with much more focus on patient/family-centred outcomes. Clinical experts and stakeholders should meet and agree on a consensus to identify indicators that could act as outcome measures in future large-scale prospective observational studies and clinical trials. Such an approach will foster benchmarking and continuous quality assessment and improvement at individual, institutional, interinstitutional, regional, national and international levels and facilitate larger scale clinical research. Furthermore, it will attain a high public health importance and will facilitate comparisons between healthcare provision models leading to optimization of perioperative care delivery.


Assuntos
Anestesia/métodos , Avaliação de Resultados (Cuidados de Saúde)/métodos , Assistência Perioperatória/métodos , Anestesia/efeitos adversos , Anestesia/normas , Benchmarking/organização & administração , Criança , Ensaios Clínicos como Assunto , Humanos , Estudos Observacionais como Assunto , Avaliação de Resultados (Cuidados de Saúde)/estatística & dados numéricos , Assistência Perioperatória/efeitos adversos , Assistência Perioperatória/normas , Melhoria de Qualidade/organização & administração
14.
BMC Health Serv Res ; 19(1): 269, 2019 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-31035997

RESUMO

BACKGROUND: Individuals experiencing disadvantage or marginalisation often face difficulty accessing primary health care. Overcoming access barriers is important for improving the health of these populations. Brokers can empower and enable people to access resources; however, their role in increasing access to health services has not been well-defined or researched in the literature. This review aims to identify whether a health service broker working with health and social service providers in the community can (a) identify individuals experiencing vulnerability who may benefit from improved access to quality primary care, and (b) link these individuals with an appropriate primary care provider for enduring, appropriate primary care. METHODS: Six databases were searched for studies published between January 2008 and August 2015 that evaluated a health service broker intervention linking adults experiencing vulnerability to primary care. Relevant websites were also searched. Included studies were analysed using candidacy theory and a realist matrix was developed to identify mechanisms that may have contributed to changes in response to the interventions in different contexts. RESULTS: Eleven studies were included in the review. Of the eight studies judged to provide detailed description of the programs, the interventions predominately addressed two domains of candidacy (identification of candidacy and navigation), with limited applicability to the third and fourth dimensions (permeability of services and appearances at health services). Six of the eight studies were judged to have successfully linked their target group to primary care. The majority of the interventions focused on assisting patients to reach services and did not look at ways that providers or health services could alter the way they deliver care to improve access. CONCLUSIONS: While specific mechanisms behind the interventions could not be identified, it is suggested that individual advocacy may be a key element in the success of these types of interventions. The interventions were found to address some dimensions of candidacy, with health service brokers able to help people to identify their need for care and to access, navigate and interact with services. More consideration should be given to the influence of providers on patient candidacy, rather than placing the onus on patients.


Assuntos
Assistência à Saúde/organização & administração , Pesquisa sobre Serviços de Saúde , Disparidades nos Níveis de Saúde , Atenção Primária à Saúde/organização & administração , Melhoria de Qualidade/organização & administração , Assistência à Saúde/normas , Prática Clínica Baseada em Evidências , Humanos
15.
BMC Health Serv Res ; 19(1): 265, 2019 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-31036000

RESUMO

BACKGROUND: Systems for monitoring effectiveness and quality of rehabilitation services across health care levels are needed. The purpose of this study was to develop and pilot test a quality indicator set for rehabilitation of rheumatic and musculoskeletal diseases. METHODS: The set was developed according to the Rand/UCLA Appropriateness Method, which integrates evidence review, in-person multidisciplinary expert panel meetings and repeated anonymous ratings for consensus building. The quality indicators were pilot-tested for overall face validity and feasibility in 15 specialist and 14 primary care rehabilitation units. Pass rates (percentages of "yes") of the indicators were recorded in telephone interviews with 29 unit managers (structure indicators), and 164 patients (process and outcome indicators). Time use and participants' numeric rating of face validity (0-10, 10 = high validity) were recorded. RESULTS: Nineteen structure, 12 process and five outcome indicators were developed and piloted. Mean (range) sum pass rates for the structure, process and outcome indicators were 59%(84%), 66%(100%) and 84%(100%), respectively. Mean (range) face validity score for managers/patients was 8.3 (8)/7.9 (9), and mean answering time was 6.0/5.5 min. The final indicator set consists of 19 structure, 11 process and three outcome indicators. CONCLUSION: To our knowledge this is the first quality indicator set developed for rehabilitation of rheumatic and musculoskeletal diseases. Good overall face validity and a feasible format indicate a set suitable for monitoring quality in rehabilitation. The variation in pass rates between centers indicates a potential for quality improvement in rheumatic and musculoskeletal rehabilitation in Norway.


Assuntos
Doenças Musculoesqueléticas/reabilitação , Melhoria de Qualidade/organização & administração , Indicadores de Qualidade em Assistência à Saúde/normas , Doenças Reumáticas/reabilitação , Consenso , Estudos de Viabilidade , Humanos , Projetos Piloto , Reprodutibilidade dos Testes
18.
Transplant Proc ; 51(3): 625-631, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30979444

RESUMO

BACKGROUND: The unbalance between the demand and supply of organs for transplant is a universal phenomenon. This study shows Santa Catarina's experience with educational and organizational initiatives in the state's transplant system to describe the result of such actions in increasing donation rates. METHODS: This is a before and after study. Medical data on potential organ donors, listed in the Santa Catarina Transplant Registry between January 2004 and December 2017, were analyzed. This 13-year period was divided into 3 phases. Phase 1, from 2005 to 2007, corresponds to the organization of the program without specific measures. Phase 2, from 2008 to 2011, is associated with theoretical/practical training on family interviews. Phase 3, from 2012 to 2017, is related to the implementation of a protocol for the management of potential deceased donors. RESULTS: Referrals grew from 35.1 per million population (pmp) (phase 1) to 49.4 pmp (phase 1) and 74.0 pmp (phase 3), translating into a 110.8% (P < .001) increase. Lack of family consent dropped from 39.8% to 27.8% in phase 3, a global reduction of 30.1% (P < .001). Loss of donors to cardiac arrest were reduced from 51.9% to 23.3% to 12.2%. Effective donors, which varied from 12.0 pmp to 20.0 pmp and 32.7 pmp, increased by 172.5% (P < .001). CONCLUSIONS: This study demonstrates the positive association between articulated educational initiatives and improvements in potential donors' identification, which, associated with cardiac arrest loss control and increased family consent, brought about significantly better results in organ donation.


Assuntos
Transplante de Órgãos/estatística & dados numéricos , Doadores de Tecidos/educação , Doadores de Tecidos/provisão & distribução , Obtenção de Tecidos e Órgãos/organização & administração , Brasil , Humanos , Melhoria de Qualidade/organização & administração , Sistema de Registros
19.
BMC Health Serv Res ; 19(1): 208, 2019 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-30940130

RESUMO

BACKGROUND: Concerted quality improvement (QI) efforts have been taken to discourage the practice of early elective deliveries (EEDs), but few studies have robustly examined the impact of directed QI interventions in reducing EED practices. Using quasi-experimental methods, we sought to evaluate the impact of a statewide QI intervention to reduce the practice of EEDs. METHODS: Retrospective cohort study of vital records data (2007 to 2013) for all singleton births occurring ≥36 weeks in 66 Tennessee hospitals grouped into three QI cohorts. We used interrupted-time series to estimate the effect of the QI intervention on the likelihood of an EED birth statewide, and by hospital cohort. We compared the distribution of hospital EED percentages pre- and post-intervention. Lastly, we used multivariable logistic regression to estimate the effect of QI interventions on maternal and infant outcomes. RESULTS: Implementation of the QI intervention was associated with significant declines in likelihood of EEDs immediately following the intervention (odds ratio, OR = 0.72; p < 0.001), but these results varied by hospital cohort. Hospital risk-adjusted EED percentages ranged from 1.6-13.6% in the pre-intervention period, which significantly declined to 2.2-9.6% in the post-intervention period (p < 0.001). The QI intervention was also associated with significant reductions in operative vaginal delivery and perineal laceration, and immediate infant ventilation, but increased NICU admissions. CONCLUSIONS: A statewide QI intervention to reduce EEDs was associated with modest but significant declines in EEDs beyond concurrent and national trends, and showed mixed results in related infant and maternal outcomes.


Assuntos
Cesárea/estatística & dados numéricos , Parto Obstétrico/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Melhoria de Qualidade/organização & administração , Procedimentos Desnecessários/estatística & dados numéricos , Adulto , Feminino , Humanos , Lactente , Gravidez , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos , Tennessee/epidemiologia
20.
Glob Health Action ; 12(1): 1587893, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30950778

RESUMO

Poor quality of care is a leading cause of excess morbidity and mortality in low- and middle- income countries (LMICs). Improving the quality of healthcare is complex, and requires an interdisciplinary team equipped with the skills to design, implement and analyse setting-relevant improvement interventions. Such capacity is limited in many LMICs. However, training for healthcare workers in quality improvement (QI) methodology without buy-in from multidisciplinary stakeholders and without identifying setting-specific priorities is unlikely to be successful. The Care Quality Improvement Network (CQIN) was established between Network for Improving Critical care Systems and Training (NICST) and University College London Centre for Perioperative Medicine, with the aim of building capacity for research and QI. A two-day international workshop, in collaboration with the College of Surgeons of Sri Lanka, was conducted to address the above deficits. Innovatively, the CQIN adopts a learning health systems (LHS) approach to improving care by leveraging information captured through the NICST electronic multi-centre acute and critical care surveillance platform. Fifty-two delegates from across the CQIN representing clinical, civic and academic healthcare stakeholders from six countries attended the workshop. Mapping of care processes enabled identification of barriers and drivers to the delivery of care and facilitated the selection of feasible QI methods and matrices. Six projects, reflecting key priorities for improving the delivery of acute care in Asia, were collaboratively developed: improving assessment of postoperative pain; optimising sedation in critical care; refining referral of deteriorating patients; reducing surgical site infection after caesarean section; reducing surgical site infection after elective general surgery; and improving provision of timely electrocardiogram recording for patients presenting with signs of acute myocardial infarction. Future project implementation and evaluation will be supported with resources and expertise from the CQIN partners. This LHS approach to building capacity for QI may be of interest to others seeing to improve care in LMICs.


Assuntos
Fortalecimento Institucional/organização & administração , Países em Desenvolvimento , Pessoal de Saúde/educação , Melhoria de Qualidade/organização & administração , Ásia , Comportamento Cooperativo , Programas Governamentais/organização & administração , Pesquisa sobre Serviços de Saúde , Humanos , Relações Interinstitucionais , Melhoria de Qualidade/normas , Indicadores de Qualidade em Assistência à Saúde , Qualidade da Assistência à Saúde/organização & administração , Sri Lanka , Análise de Sistemas
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