Improving provider awareness to statin prescribing guidelines: A quality improvement project

Martin, Christy; Phillips, R. A.; Johnson, Cori

doi:10.1016/j.jvn.2019.11.001

Cited by 7 publications

(4 citation statements)

References 10 publications

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“…Strategies such as developing a quality monitoring system would enable practices to assess through clinical pathways and determine at which step low-value imaging is occurring. Next, developing tools in their system to further prevent unnecessary imaging within the organization is needed, such as through EHR prompts and alerts which had been proven to be successful strategies in changing providers' awareness and behavior [27][28][29].…”

Section: Discussionmentioning

confidence: 99%

Understanding the multilevel determinants of clinicians’ imaging decision-making: setting the stage for de-implementation of low-value imaging

Hwang

Birken

Nielsen

et al. 2022

BMC Health Serv Res

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Background De-implementation requires understanding and targeting multilevel determinants of low-value care. The objective of this study was to identify multilevel determinants of imaging for prostate cancer (PCa) and asymptomatic microhematuria (AMH), two common urologic conditions that have contributed substantially to the annual spending on unnecessary imaging in the US. Methods We used a convergent mixed-methods approach involving survey and interview data. Using a survey, we asked 33 clinicians (55% response-rate) to indicate their imaging approach to 8 clinical vignettes designed to elicit responses that would demonstrate guideline-concordant/discordant imaging practices for patients with PCa or AMH. A subset of survey respondents (N = 7) participated in semi-structured interviews guided by a combination of two frameworks that offered a comprehensive understanding of multilevel determinants. We analyzed the interviews using a directed content analysis approach and identified subthemes to better understand the differences and similarities in the imaging determinants across two clinical conditions. Results Survey results showed that the majority of clinicians chose guideline-concordant imaging behaviors for PCa; guideline-concordant imaging intentions were more varied for AMH. Interview results informed what influenced imaging decisions and provided additional context to the varying intentions for AMH. Five subthemes touching on multiple levels were identified from the interviews: National Guidelines, Supporting Evidence and Information Exchange, Organization of the Imaging Pathways, Patients’ Clinical and Other Risk Factors, and Clinicians’ Beliefs and Experiences Regarding Imaging. Imaging decisions for both PCa and AMH were often driven by national guidelines from major professional societies. However, when clinicians felt guidelines were inadequate, they reported that their decision-making was influenced by their knowledge of recent scientific evidence, past clinical experiences, and the anticipated benefits of imaging (or not imaging) to both the patient and the clinician. In particular, clinicians referred to patients’ anxiety and uncertainty or patients’ clinical factors. For AMH patients, clinicians additionally expressed concerns regarding legal liability risk. Conclusion Our study identified comprehensive multilevel determinants of imaging to inform development of de-implementation interventions to reduce low-value imaging, which we found useful for identifying determinants of de-implementation. De-implementation interventions should be tailored to address the contextual determinants that are specific to each clinical condition.

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Section: Discussionmentioning

confidence: 99%

Understanding the multilevel determinants of clinicians’ imaging decision-making: setting the stage for de-implementation of low-value imaging

Hwang

Birken

Nielsen

et al. 2022

BMC Health Serv Res

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“…Overall, inclusive care scores nearly doubled in 8 weeks, from a baseline mean of 43.7% to an endpoint of 83.3%, with significant improvements following EMR customization in Weeks 3 through 6 (Figure 2). EMR reminders to standardize guideline adherence has proven positive outcome improvements in a 2020 QI study by Martin et al 29 In this project, closer analysis of initial scores following conversion to an electronic tool in cycle 2 noted greater improvement in history documentation (SOGI and sexual health history) than counseling and testing metrics, suggesting increased frequency of student identity disclosure, but largely unchanged provider counseling practices. Inclusive care outcome goals were eventually achieved following tests of change in cycles 3 and 4 tailored specifically to the equity goals of the initiative.…”

Section: Discussionmentioning

confidence: 80%

“…Overall, inclusive care scores nearly doubled in 8 weeks, from a baseline mean of 43.7% to an endpoint of 83.3%, with significant improvements following EMR customization in Weeks 3 through 6 (Figure 2). EMR reminders to standardize guideline adherence has proven positive outcome improvements in a 2020 QI study by Martin et al 29 In this project, closer analysis of initial scores following con- 15 Additionally, clinic staff composition was 89% female, with all staff self-identifying as heterosexual and cisgender. A retrospective study by Gioia et al 31 found that SGM men were more likely discuss their sexual health with providers they believed to match their own sexual and gender identity, suggesting that efforts to increase staffing diversity may further improve patient comfort.…”

Section: Discussionmentioning

confidence: 90%

Improving equitable access to inclusive sexual healthcare in a small urban college health setting

Gianelis

Butler

2022

Nursing Forum

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Background Sexual and gender minorities (SGM) experience many disparities in sexual health. College health centers must address early inequities for this population. Local Problem Significant access disparity was noted for SGM students at a small urban college health center. The aim of this quality initiative was to increase equitable access by 20% over 90 days. Methods A rapid‐cycle quality improvement project was initiated using a Plan‐Do‐Study‐Act model. Interventions Templated nurse‐led visits, a discussion starter tool, and an inclusive care checklist were introduced, with assurance of equity for each metric, and a focus on team collaboration. Results Access to sexual health services increased by 22.6% over 8 weeks with SGM utilization increasing 2.7‐fold. Guideline‐concordant care improved by 94% for all students. Student comfort scores (Likert range 1–5) also improved, from a baseline of 3.53 to a project mean of 4.62. Conclusions This project addressed equity in a college health setting through improved student engagement, targeted workflow innovation, and enhanced team collaboration. Application of key findings to other health topics will continue to mitigate disparities in college health centers. Tools may also be applied to adolescent and adult primary care settings to improve patient comfort and SGM‐inclusive sexual health service delivery.

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“…28 This type of reminder often takes the form of an EHR “pop-up” guiding a practitioner toward a new or evidence-based practice. 17,28–32 While our Huddle may not be as temporally associated with a task as a pop-up, it does have several potential advantages. First, individuals will receive the reminder daily.…”

Section: Discussionmentioning

confidence: 99%

Improving Knowledge of Active Safety and QI Projects Amongst Practitioners in a Pediatric ICU

Flaherty

Hummel

Vijayarajah³

et al. 2022

Pediatric Quality &Amp; Safety

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Introduction: The success of quality improvement (QI) projects depends on many factors, with communication and knowledge of project-specific practice change being fundamental. This project aimed to improve the knowledge of active safety and QI projects. Methods: Two interventions were trialed to improve knowledge: paired email and meeting announcements followed by a daily huddle to review ongoing projects. Knowledge, measured as the ability to recall a project and its practice change, was the primary outcome. The frequency and duration of the Huddle were process and balancing measures, respectively. Results: Seven days after a meeting/email announcement, 3 of 13 (23%) faculty and fellows recalled the announced practice change. Investigators then tested the effects of the Huddle by assessing practitioners’ knowledge of safety and QI project-related practice changes on the first and last day of a service week. The average percentage of items recalled increased from the beginning to end of a service week by 33% [46% to 79%, 95% confidence interval (CI) 12–53] for faculty and 27% (51% to 77%, 95% CI 13–40) for fellows. The Huddle occurred in four of seven (interquartile range 2–5) days/wk with a mean duration of 4.5 (SD 2) minutes. Follow-up assessment 2 years after Huddle implementation demonstrate sustained increase in item recall [faculty +36% (95% CI +13% to 40%); fellows +35% (95% CI +23% to 47%)]. Conclusions: A daily huddle to discuss safety and QI project-related practice change is an effective and time-efficient communication method to increase knowledge of active projects.

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Improving provider awareness to statin prescribing guidelines: A quality improvement project

Cited by 7 publications

References 10 publications

Understanding the multilevel determinants of clinicians’ imaging decision-making: setting the stage for de-implementation of low-value imaging

Understanding the multilevel determinants of clinicians’ imaging decision-making: setting the stage for de-implementation of low-value imaging

Improving equitable access to inclusive sexual healthcare in a small urban college health setting

Improving Knowledge of Active Safety and QI Projects Amongst Practitioners in a Pediatric ICU

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