A cluster-randomised quality improvement study to improve two inpatient stroke quality indicators

Abstract

Quality improvement training was associated with early DVT improvement, but the effect was not sustained over time and was not seen with dysphagia screening. External quality improvement programmes may quickly boost performance but their effect may vary by indicator and may not sustain over time.

To RCT or not to RCT? The ongoing saga of randomised trials in quality improvement

“…Williams et al 1 describe a well-conducted cluster randomised trial of a stoke quality improvement (QI) initiative, which aimed to improve two inpatient stroke indicators with strong evidence linking them to improved patient outcomes. They randomised five hospitals to receive a QI intervention, and six to receive only indicator feedback.…”

“…Improvement designers are starting to use tools such as the Model for Understanding Success in Quality (MUSIQ) to understand context 3. In the study by Williams et al ,1 it is unclear how much ‘up front’ work was done to understand, influence or modify the context. Indeed, this could be argued as one of the blind spots of the RCT.…”

“…In the study by Williams et al ,1 the what is simple and well described; yet, the performance on two of the primary outcomes suggest that deep vein thrombosis (DVT) prophylaxis and the implementation of swallow screening are at different gestational stages in their journey towards reliability. Understanding the complexity of the proposed changes and pairing this to the skills within the team delivering the change remains a ‘dark art’ and one that is constantly underestimated in improvement practice.…”

Validation of Stroke Meaningful Use Measures in a National Electronic Health Record System

“…Project activities took place under a jointly approved Memorandum of Understanding between the Richard L. Roudebush VA Medical Center (RVAMC) and the OABI. Collection of the criterion standard chart review data took place as part of a prior research project, the Intervention for Stroke Performance Improvement using Redesign Engineering (INSPIRE) project; 6 use of these prior chart review data for the purpose of validating the eCQMs was approved by the local IRB and VA R&D committees.…”

“…Chart review indicators were assessed in the INSPIRE project using the definitions as specified by CMS. 6 Trained chart abstractors used a standardized chart review manual to guide abstraction of data elements. Throughout this study, we conducted a random 10 % interrater reliability assessment for all data elements included in the indicator algorithms; all kappa statistics for these data elements were>0.80.…”