Preventing Pressure Ulcers in the Veterans Health Administration Using a Virtual Breakthrough Series Collaborative

Zubkoff, Lisa; Neily, Julia; King, Beth; Morgan, Storm; Young‐Xu, Yinong; Boar, Shoshana; Mills, Peter D.

doi:10.1097/ncq.0000000000000242

Cited by 14 publications

(22 citation statements)

References 8 publications

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“…[40][41][42][43] Virtual (internet-and/or phone-enabled) adaptations of collaboratives are increasingly used to mitigate participation barriers but often still require dedicated learning sessions and often last a year or more. [44][45][46][47][48][49][50] One large-scale quality collaborative in VHA provided virtual monthly coaching but only after teams started executing their planned PDSA cycle. 47,48 LEAP coaches, in contrast, walked teams through every step, week by week, tailoring guidance to the needs of teams and providing feedback on interim progress.…”

Section: Discussionmentioning

confidence: 99%

The LEAP Program: Quality Improvement Training to Address Team Readiness Gaps Identified by Implementation Science Findings

et al. 2020

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Background Integrating evidence-based innovations (EBIs) into sustained use is challenging; most implementations in health systems fail. Increasing frontline teams’ quality improvement (QI) capability may increase the implementation readiness and success of EBI implementation. Objectives Develop a QI training program (“Learn. Engage. Act. Process.” (LEAP)) and evaluate its impact on frontline obesity treatment teams to improve treatment delivered within the Veterans Health Administration (VHA). Design This was a pre-post evaluation of the LEAP program. MOVE! coordinators (N = 68) were invited to participate in LEAP; 24 were randomly assigned to four starting times. MOVE! coordinators formed teams to work on improvement aims. Pre-post surveys assessed team organizational readiness for implementing change and self-rated QI skills. Program satisfaction, assignment completion, and aim achievement were also evaluated. Participants VHA facility-based MOVE! teams. Interventions LEAP is a 21-week QI training program. Core components include audit and feedback reports, structured curriculum, coaching and learning community, and online platform. Main Measures Organizational readiness for implementing change (ORIC); self-rated QI skills before and after LEAP; assignment completion and aim achievement; program satisfaction. Key Results Seventeen of 24 randomized teams participated in LEAP. Participants' self-ratings across six categories of QI skills increased after completing LEAP (p< 0.0001). The ORIC measure showed no statistically significant change overall; the change efficacy subscale marginally improved (p < 0.08), and the change commitment subscale remained the same (p = 0.66). Depending on the assignment, 35 to 100% of teams completed the assignment. Nine teams achieved their aim. Most team members were satisfied or very satisfied (81–89%) with the LEAP components, 74% intended to continue using QI methods, and 81% planned to continue improvement work. Conclusions LEAP is scalable and does not require travel or time away from clinical responsibilities. While QI skills improved among participating teams and most completed the work, they struggled to do so amid competing clinical priorities.

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Section: Discussionmentioning

confidence: 99%

The LEAP Program: Quality Improvement Training to Address Team Readiness Gaps Identified by Implementation Science Findings

et al. 2020

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“…Most published studies on VLCs are descriptive and have not definitively tested its effectiveness to enhance adoption and implementation [16,[71][72][73][74][75][76][77][78][79][80][81][82]. There are also few randomized-clinical trials that evaluate traditional in-person learning collaboratives [14,15,21,22] or compare their effectiveness to other implementation approaches [16,17,71,83].…”

Section: Discussionmentioning

confidence: 99%

A cluster randomized controlled trial comparing Virtual Learning Collaborative and Technical Assistance strategies to implement an early palliative care program for patients with advanced cancer and their caregivers: a study protocol

et al. 2021

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Background Virtual Learning Collaboratives (VLC), learning communities focused on a common purpose, are used frequently in healthcare settings to implement best practices. Yet, there is limited research testing the effectiveness of this approach compared to other implementation strategies. This study evaluates the effectiveness of a VLC compared to Technical Assistance (TA) among community oncology practices implementing ENABLE (Educate, Nurture, Advise, Before Life Ends), an evidence-based, early palliative care telehealth, psycho-educational intervention for patients with newly diagnosed advanced cancer and their caregivers. Methods Using Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) and Proctor’s Implementation Outcomes Frameworks, this two-arm hybrid type-III cluster-randomized controlled trial (RCT) will compare two implementation strategies, VLC versus TA, among the 48 National Cancer Institute Community Oncology Research Program (NCORP) practice clusters that have not historically provided palliative care to all patients with advanced cancer. Three cohorts of practice clusters will be randomized to the study arms. Each practice cluster will recruit 15–27 patients and a family caregiver to participate in ENABLE. The primary study outcome is ENABLE uptake (patient level), i.e., the proportion of eligible patients who complete the ENABLE program (receive a palliative care assessment and complete the six ENABLE sessions over 12 weeks). The secondary outcome is overall program implementation (practice cluster level), as measured by the General Organizational Index at baseline, 6, and 12 months. Exploratory aims assess patient and caregiver mood and quality of life outcomes at baseline, 12, and 24 weeks. Practice cluster randomization will seek to keep the proportion of rural practices, practice sizes, and minority patients seen within each practice balanced across the two study arms. Discussion This study will advance the field of implementation science by evaluating VLC effectiveness, a commonly used but understudied, implementation strategy. The study will advance the field of palliative care by building the capacity and infrastructure to implement an early palliative care program in community oncology practices. Trial registration Clinicaltrials.gov. NCT04062552; Pre-results. Registered: August 20, 2019. https://clinicaltrials.gov/ct2/show/NCT04062552?term=NCT04062552&draw=2&rank=1

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“…[19,26,38] A lack of recording in the results about unintended consequences, such as unexpected bene ts, problems, failures, or costs associated with the intervention or details about lost data, was observed in 38% of the studies. Thus, 44.1% of the articles were classi ed as high quality with 5 to 6 Squire items; [15,[21][22][23]25,26,28,29,34,38,39,41,42,45,48] 44.1% were classi ed as average quality with 3 to 4 Squire items [16][17][18][19][20]24,27,[30][31][32][33]37,40,43,44] and 11.8% were classi ed as low quality with 1 to 2 Squire items. [35,36,46,47]…”

Section: Study Characteristicsmentioning

confidence: 99%

“…International patient safety goals were addressed in 10 studies, ve focused on improved communication between teams and/or with the patient/family, [19,20,26,37,39] three addressed falls reduction, [35,36,47] and two considered health care-related infection prevention. [30,38] Improvement of patient safety culture was the subject of three studies.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…[48] Prevention of adverse events was the subject of four studies. [28,32,33,36] Collaboratives were effective in improving the intended outcomes by 76.5% (26/34), [16,17,20-27, 29-34,36-38,40-42,44-47] reached partial results in 14.7 % (5 /34), [19,28,35,43,48] and did not obtain the desired improvement in 8.8% (3/34). [15,18,39] Improvement sustainability was reported in 10 of the 26 studies with positive results.…”

Section: Study Characteristicsmentioning

confidence: 99%

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Relation Between Quality Improvement Collaboratives and Non-technical Skills Development: a Systematic Review of Complex Interventions

Freitas

Paiva

Junqueira

et al. 2021

Preprint

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Background: Improving the quality of care contributes to the Sustainable Development Goals. Non-technical skills (NTS) such as leadership, teamwork, communication, and use of data for decision-making are the strong points of the learning process of collaboratives for quality improvement in health services.Objective: To evaluate the relationship between the collaboratives and the development of NTS by participating health professionals.Methods: We searched PUBMED, WEB OF SCIENCE, SCOPUS and GOOGLE SCHOLAR (the first 30 pages) and performed a manual search on the IHI (Institute for Healthcare Improvement) website, from Jan 2010 to Dec 2019, for articles published in English, Spanish, and Portuguese. IHI Breakthrough Series Collaborative model project studies with pre- and post-data, and SQUIRE compliant titles were included. The qualitative analysis evaluated the study design, year, country, context, target for improvement, health services, duration of intervention, number of participating professionals, evidence of improvement, effectiveness of the intervention, and NTSResults: From 701 identified abstracts, 34 studies were included for data extraction and qualitative analysis. Improvement of the intended results was reported by 76.5% (26/34), of which only 38.5% (10/26) showed sustainability for six or more months. Improvement in NTS was assessed in five studies, but none assessed their contribution to the dissemination and sustainability of improvement.Conclusions: Collaborative initiatives train professionals in improvement science to incorporate evidence-based practices. It is necessary to include, in the measurement plan of these improvement projects, the assessment of the NTS acquired by the professionals and its relationship with the results achieved, the dissemination level, and the success in terms of sustainability of those gains and best practices.Systematic review registration number: Prospero - CRD42020164190

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Preventing Pressure Ulcers in the Veterans Health Administration Using a Virtual Breakthrough Series Collaborative

Cited by 14 publications

References 8 publications

The LEAP Program: Quality Improvement Training to Address Team Readiness Gaps Identified by Implementation Science Findings

The LEAP Program: Quality Improvement Training to Address Team Readiness Gaps Identified by Implementation Science Findings

A cluster randomized controlled trial comparing Virtual Learning Collaborative and Technical Assistance strategies to implement an early palliative care program for patients with advanced cancer and their caregivers: a study protocol

Relation Between Quality Improvement Collaboratives and Non-technical Skills Development: a Systematic Review of Complex Interventions

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