Assessment of the Protocol-Guided Rapid Evaluation of Veterans Experiencing New Transient Neurological Symptoms (PREVENT) Program for Improving Quality of Care for Transient Ischemic Attack

Bravata, Dawn M.; Myers, Laura J.; Perkins, Anthony J.; Zhang, Ying; Miech, Edward J.; Rattray, Nicholas A.; Penney, Lauren; Levine, Deborah A.; Sico, Jason J.; Cheng, Eric M.; Damush, Teresa M.

doi:10.1001/jamanetworkopen.2020.15920

Cited by 17 publications

(39 citation statements)

References 44 publications

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“… 22 We focused on an all-or-none measure of care quality (the without-fail rate) rather than on individual processes of care or a consolidated measure of quality (e.g., the number of passes divided by the number of processes of care for which a patient is eligible) because all-or-none measures are considered to most closely reflect the interests of patients, 22 examine a whole continuum of care (e.g., not just processes in the Emergency Department), 22 , 23 and although they can be a relatively difficult outcome to change and even small improvements in the absolute rate may reflect substantial changes in practice at the facility level, they are sensitive to change. 12 , 22 , 24 …”

Section: Methodsmentioning

confidence: 99%

Quality of Care and Outcomes for Patients with Acute Ischemic Stroke and Transient Ischemic Attack During the COVID-19 Pandemic

Myers

Perkins

Kilkenny

et al. 2022

Journal of Stroke and Cerebrovascular Diseases

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Section: Methodsmentioning

confidence: 99%

Quality of Care and Outcomes for Patients with Acute Ischemic Stroke and Transient Ischemic Attack During the COVID-19 Pandemic

Myers

Perkins

Kilkenny

et al. 2022

Journal of Stroke and Cerebrovascular Diseases

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“…All six clinical champions provided the names of their respective team members. The facility and participant flow has been previously reported [ 23 ]. Participants were approached by email and telephone.…”

Section: Methodsmentioning

confidence: 99%

Acceptability of a complex team-based quality improvement intervention for transient ischemic attack: a mixed-methods study

Damush

Penney

Miech

et al. 2021

BMC Health Serv Res

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Background The Protocol-guided Rapid Evaluation of Veterans Experiencing New Transient Neurologic Symptoms (PREVENT) program was a complex quality improvement (QI) intervention targeting transient ischemic attack (TIA) evidence-based care. The aim of this study was to evaluate program acceptability among the QI teams and factors associated with degrees of acceptability. Methods QI teams from six Veterans Administration facilities participated in active implementation for a one-year period. We employed a mixed methods study to evaluate program acceptability. Multiple data sources were collected over implementation phases and triangulated for this evaluation. First, we conducted 30 onsite, semi-structured interviews during active implementation with 35 participants at 6 months; 27 interviews with 28 participants at 12 months; and 19 participants during program sustainment. Second, we conducted debriefing meetings after onsite visits and monthly virtual collaborative calls. All interviews and debriefings were audiotaped, transcribed, and de-identified. De-identified files were qualitatively coded and analyzed for common themes and acceptability patterns. We conducted mixed-methods matrix analyses comparing acceptability by satisfaction ratings and by the Theoretical Framework of Acceptability (TFA). Results Overall, the QI teams reported the PREVENT program was acceptable. The clinical champions reported high acceptability of the PREVENT program. At pre-implementation phase, reviewing quality data, team brainstorming solutions and development of action plans were rated as most useful during the team kickoff meetings. Program acceptability perceptions varied over time across active implementation and after teams accomplished actions plans and moved into sustainment. We observed team acceptability growth over a year of active implementation in concert with the QI team’s self-efficacy to improve quality of care. Guided by the TFA, the QI teams’ acceptability was represented by the respective seven components of the multifaceted acceptability construct. Conclusions Program acceptability varied by time, by champion role on QI team, by team self-efficacy, and by perceived effectiveness to improve quality of care aligned with the TFA. A complex quality improvement program that fostered flexibility in local adaptation and supported users with access to data, resources, and implementation strategies was deemed acceptable and appropriate by front-line clinicians implementing practice changes in a large, national healthcare organization. Trial registration clinicaltrials.gov: NCT02769338.

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“…(10,11) The design has been described elsewhere. (7,12) Six control sites were matched to each of the six PREVENT active implementation sites on the basis of TIA patient volume, facility complexity (e.g., teaching status, intensive care unit level), and quality of care (measured by the without-fail rate, described below). The total number of control sites was 36.…”

Section: Methodsmentioning

confidence: 99%

“…(29) It was de ned as the proportion of Veterans with TIA at a speci c facility, who received all of the processes of care for which they were eligible from among seven processes of care: brain imaging, carotid artery imaging, neurology consultation, hypertension control, anticoagulation for atrial brillation, antithrombotics, and high/moderate potency statins. (7,12,21) The processes of care were assessed with electronic health record data using validated algorithms. (15,21) The consolidated measure of quality reported at the facility-level described the number of patients who received a process ("passes") divided by number of patients who were eligible for a process ("opportunities").…”

Section: Sustainment Outcomementioning

confidence: 99%

The Perils of a “My Work Here is Done” Perspective: A Mixed Methods Evaluation of Sustainment of an Intervention to Improve Quality of Transient Ischemic Attack Care

Bravata

Miech

Myers

et al. 2021

Preprint

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BACKGROUND Sustaining quality improvement has been recognized as a key implementation challenge. The objectives of this study were to evaluate sustainment during the implementation of a novel quality improvement intervention for Transient Ischemic Attack (TIA) across six geographically diverse medical centers and to identify specific factors contributing to sustainment. METHODS The PREVENT study was a five-year, stepped-wedge implementation trial at six US Department of Veterans Affairs sites; active implementation was initiated in three waves, with two facilities per wave. Six control sites were matched to each of the six PREVENT active implementation sites (total number of control sites was 36). Mixed methods were used to assess change in quality of care from baseline to active implementation to sustainment (measured by the “without-fail rate” and to identify factors which promoted or hindered sustainment. RESULTS The without-fail rate at PREVENT sites improved from 36.7% at baseline to 54.0% during active implementation and settled to 48.3% during sustainment. At control sites, the without-fail rate improved from 38.6% at baseline to 41.8% during active implementation and remained steady at 43.0% during sustainment. Changes in quality of care during sustainment varied across PREVENT sites: the without-fail rate improved at three sites, declined at two sites, and remained unchanged at one site. In adjusted analyses, although the without-fail rate improved at PREVENT sites compared with control sites during active implementation, no statistically significant difference in quality between intervention and control sites was identified during the sustainment phase. Factors that promoted sustainment were integration of key processes of care into routine practice and establishing systems for reflecting and evaluating on performance data to plan quality improvement activities or respond to changes in quality. Challenges during sustainment included competing demands from new facility quality priorities, low patient volume, and potential problems with coding impairing use of performance data. CONCLUSIONS Facilities seeking to sustain evidence-based practices while embodying the Learning Healthcare System’s core values can harness the combined power of staff and data systems by embedding quality improvement processes within routine care and establishing systems for reviewing and reflecting upon performance data.TRIAL REGISTRATION clinicaltrials.gov: NCT02769338

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Assessment of the Protocol-Guided Rapid Evaluation of Veterans Experiencing New Transient Neurological Symptoms (PREVENT) Program for Improving Quality of Care for Transient Ischemic Attack

Abstract: This nonrandomized cluster trial with matched controls implements the Protocol-Guided Rapid Evaluation of Veterans Experiencing New Transient Neurological Symptoms (PREVENT) intervention to improve transient ischemic attack quality of care.

Cited by 17 publications

References 44 publications

Quality of Care and Outcomes for Patients with Acute Ischemic Stroke and Transient Ischemic Attack During the COVID-19 Pandemic

Quality of Care and Outcomes for Patients with Acute Ischemic Stroke and Transient Ischemic Attack During the COVID-19 Pandemic

Acceptability of a complex team-based quality improvement intervention for transient ischemic attack: a mixed-methods study

The Perils of a “My Work Here is Done” Perspective: A Mixed Methods Evaluation of Sustainment of an Intervention to Improve Quality of Transient Ischemic Attack Care

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