Development of a Novel Composite Process Measure for Venous Thromboembolism Prophylaxis.

BACKGROUND: Postoperative venous thromboembolism (VTE) is important clinically, and VTE quality metrics are used in public reporting and pay-for-performance programs. However, current VTE outcome measures are not valid due to surveillance bias, and the Surgical Care Improvement Project (SCIP-VTE-2) process measure only requires prophylaxis within 24 hours of surgery. OBJECTIVES: We sought to (1) develop a novel measure of VTE prophylaxis that requires early ambulation, mechanical prophylaxis, and chemoprophylaxis throughout the hospitalization, and (2) compare hospital performance on the SCIP-VTE-2 process measure to this novel measure. RESEARCH DESIGN: A new composite measure of ambulation, sequential compression device (SCD), and chemoprophylaxis component measures was developed. The ambulation component required daily ambulation, the SCD component required documentation of continuous use, and the chemoprophylaxis component required patient-appropriate and medication-appropriate dosing and administration. Requirements could also be met with component-specific exceptions. Surgical patients at an academic center from 2012 to 2013 were assessed for SCIP-VTE-2 and composite measure adherence. RESULTS: Of 786 patients, 589 (74.9%) passed the ambulation measure, 494 (62.8%) passed the SCD measure, and 678 (86.3%) passed the chemoprophylaxis measure. A total of 268 (91.8%) SCD failures and 46 (42.6%) chemoprophylaxis failures were ordered but not administered. When comparing the 2 measures, 784 (99.7%) passed SCIP-VTE-2, whereas only 364 (46.3%) passed the composite measure (P<0.001). CONCLUSIONS: This new measure incorporates the critical aspects of VTE prevention to ensure defect-free care. After additional evaluation, this composite VTE prophylaxis measure with appropriate exclusion criteria may be a better alternative to existing VTE process and outcome measures.

Development of the Illinois Surgical Quality Improvement Collaborative (ISQIC): Implementing 21 Components to Catalyze Statewide Improvement in Surgical Care.

INTRODUCTION: In 2014, 56 Illinois hospitals came together to form a unique learning collaborative, the Illinois Surgical Quality Improvement Collaborative (ISQIC). Our objectives are to provide an overview of the first three years of ISQIC focused on (1) how the collaborative was formed and funded, (2) the 21 strategies implemented to support quality improvement (QI), (3) collaborative sustainment, and (4) how the collaborative acts as a platform for innovative QI research. METHODS: ISQIC includes 21 components to facilitate QI that target the hospital, the surgical QI team, and the peri-operative microsystem. The components were developed from available evidence, a detailed needs assessment of the hospitals, reviewing experiences from prior surgical and non-surgical QI Collaboratives, and interviews with QI experts. The components comprise 5 domains: guided implementation (e.g., mentors, coaches, statewide QI projects), education (e.g., process improvement (PI) curriculum), hospital- and surgeon-level comparative performance reports (e.g., process, outcomes, costs), networking (e.g., forums to share QI experiences and best practices), and funding (e.g., for the overall program, pilot grants, and bonus payments for improvement). RESULTS: Through implementation of the 21 novel ISQIC components, hospitals were equipped to use their data to successfully implement QI initiatives and improve care. Formal (QI/PI) training, mentoring, and coaching were undertaken by the hospitals as they worked to implement solutions. Hospitals received funding for the program and were able to work together on statewide quality initiatives. Lessons learned at one hospital were shared with all participating hospitals through conferences, webinars, and toolkits to facilitate learning from each other with a common goal of making care better and safer for the surgical patient in Illinois. Over the first three years, surgical outcomes improved in Illinois. DISCUSSION: The first three years of ISQIC improved care for surgical patients across Illinois and allowed hospitals to see the value of participating in a surgical QI learning collaborative without having to make the initial financial investment themselves. Given the strong support and buy-in from the hospitals, ISQIC has continued beyond the initial three years and continues to support QI across Illinois hospitals.

The experience of owning a guide dog.

PURPOSE: This study explored the dynamics of guide dog ownership in a South African sample. Six participants (five male and one female) from diverse socio-economic backgrounds were interviewed in the Western Cape province of South Africa. The study was performed to provide a clearer understanding of the guide dog and owner relationship, as well as the influence of the dog on the life of a person with blindness. The study also explored the current state of guide dog ownership in the uniquely South African context. METHOD: A qualitative methodology was employed to investigate the research question. All six participants were involved in structured interviewing in order to obtain the data for this study. RESULTS: Eight common themes on guide dog ownership emerged by employing a phenomenological methodology of data analysis. CONCLUSIONS: Guide dog ownership seems to be a life-changing experience, with both negative and positive consequences for the owner. Recommendations to service providers in and for the community of persons with disabilities are made in conclusion of the article, as well as suggestions given for future research on a topic of this nature.

What facilitates the entry of persons with disabilities into South African companies?

PURPOSE: The persistent high unemployment rate for persons with disabilities (PWDs) is a world-wide concern. The aim of this research was to identify facilitating factors for the entry of PWDs into the labour market. METHOD: A survey of Human Resources (HR) managers in South African (SA) companies was conducted to explore what would assist with hiring PWDs. The sample population of companies was identified through the Marketline Library database and supplemented with all Johannesburg Stock Exchange companies. This rendered a population size of 348. RESULTS: A response rate of 25% (86) was achieved. Companies that have appointed PWDs in the past seem more willing to appoint PWDs in the future. Companies value information on accommodation (preparation of the environment and cost) and the impact of disability on job performance most. The use of specialised recruitment agencies, the development of targeted recruitment plans and staff sensitisation training, as well as internships are perceived as the best facilitators for the employment of PWDs. CONCLUSIONS: Rehabilitation practitioners can inform PWDs on the best strategies for approaching companies. Companies with facilitating factors already in place may also be more willing to employ PWDs and rehabilitation practitioners can target these companies as future employers of PWDs.