Resident-initiated interventions to improve inpatient heart-failure management

Oujiri, James; Hakeem, Abdul; Pack, Quinn R.; Holland, Robert; Meyers, David; Hildebrand, Christopher; Bridges, Alan J.; Roach, Mary A.; Vogelman, Bennett

doi:10.1136/bmjqs.2009.039339

Cited by 5 publications

(5 citation statements)

References 19 publications

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“… 53 Only one of three studies 34 57 58 evaluating multifaceted interventions that included audit and feedback as well as reminders reported significant increases in LVEF assessment. 34 Education, 32 reminders 27 and changes in medical records systems 38 did not significantly increase LVEF assessment…”

Section: Resultsmentioning

confidence: 91%

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Effectiveness of implementation interventions in improving physician adherence to guideline recommendations in heart failure: a systematic review

et al. 2018

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BackgroundThe uptake of guideline recommendations that improve heart failure (HF) outcomes remains suboptimal. We reviewed implementation interventions that improve physician adherence to these recommendations, and identified contextual factors associated with implementation success.MethodsWe searched databases from January 1990 to November 2017 for studies testing interventions to improve uptake of class I HF guidelines. We used the Cochrane Effective Practice and Organisation of Care and Process Redesign frameworks for data extraction. Primary outcomes included: proportion of eligible patients offered guideline-recommended pharmacotherapy, self-care education, left ventricular function assessment and/or intracardiac devices. We reported clinical outcomes when available.ResultsWe included 38 studies. Provider-level interventions (n=13 studies) included audit and feedback, reminders and education. Organisation-level interventions (n=18) included medical records system changes, multidisciplinary teams, clinical pathways and continuity of care. System-level interventions (n=3) included provider/institutional incentives. Four studies assessed multi-level interventions. We could not perform meta-analyses due to statistical/conceptual heterogeneity. Thirty-two studies reported significant improvements in at least one primary outcome. Clinical pathways, multidisciplinary teams and multifaceted interventions were most consistently successful in increasing physician uptake of guidelines. Among randomised controlled trials (RCT) (n=10), pharmacist and nurse-led interventions improved target dose prescriptions. Eleven studies reported clinical outcomes; significant improvements were reported in three, including a clinical pathway, a multidisciplinary team and a multifaceted intervention. Baseline assessment of barriers, staff training, iterative intervention development, leadership commitment and policy/financial incentives were associated with intervention effectiveness. Most studies (n=20) had medium risk of bias; nine RCTs had low risk of bias.ConclusionOur study is limited by the quality and heterogeneity of the primary studies. Clinical pathways, multidisciplinary teams and multifaceted interventions appear to be most consistent in increasing guideline uptake. However, improvements in process outcomes were rarely accompanied by improvements in clinical outcomes. Our work highlights the need for improved research methodology to reliably assess the effectiveness of implementation interventions.

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Section: Resultsmentioning

confidence: 91%

“… 46 In contrast, interventions that did not produce significant improvements included audit and feedback 23 and changes to medical records systems. 38 One study, on financial incentives, did not report statistical significance.…”

Section: Resultsmentioning

confidence: 99%

Effectiveness of implementation interventions in improving physician adherence to guideline recommendations in heart failure: a systematic review

et al. 2018

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“…[49][50][51][52] The least common intervention used individual projects in which the trainee worked independently. Most of these studies were rated 'good,' [53][54][55][56] and one received a 'fair'. 57 Most of these studies showed no significant clinical outcomes, 53 55-57 while one study showed significant improvement in care for heart failure patients.…”

Section: Description Of Studiesmentioning

confidence: 99%

“…57 Most of these studies showed no significant clinical outcomes, 53 55-57 while one study showed significant improvement in care for heart failure patients. 54…”

Section: Description Of Studiesmentioning

confidence: 99%

Key characteristics of successful quality improvement curricula in physician education: a realist review

2014

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Purpose Quality improvement (QI) is a common competency that must be taught in all physician training programmes, yet, there is no clear best approach to teach this content in clinical settings. We conducted a realist systematic review of the existing literature in QI curricula within the clinical setting, highlighting examples of trainees learning QI by doing QI. Method Candidate theories describing successful QI curricula were articulated a priori. We searched MEDLINE (1 January 2000 to 12 March 2013), the Cochrane Library (2013) and Web of Science (15 March 2013) and reviewed references of prior systematic reviews. Inclusion criteria included study design, setting, population, interventions, clinical and educational outcomes. The data abstraction tool included categories for setting, population, intervention, outcomes and qualitative comments. Themes were iteratively developed and synthesised using realist review methodology. A methodological quality tool assessed the biases, confounders, secular trends, reporting and study quality. Results Among 39 studies, most were beforeafter design with resident physicians as the primary population. Twenty-one described clinical interventions and 18 described educational interventions with a mean intervention length of 6.58 (SD=9.16) months. Twenty-eight reported successful clinical improvements; no studies reported clinical outcomes that worsened. Characteristics of successful clinical QI curricula include attention to the interface of educational and clinical systems, careful choice of QI work for the trainees and appropriately trained local faculty. Conclusions This realist review identified success characteristics to guide training programmes, medical schools, faculty, trainees, accrediting organisations and funders to further develop educational and improvement resources in QI educational programmes.

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“…Most of these studies were rated ‘good,’53–56 and one received a ‘fair’ 57. Most of these studies showed no significant clinical outcomes,53 55–57 while one study showed significant improvement in care for heart failure patients 54…”

Section: Resultsmentioning

confidence: 99%

Republished: Key characteristics of successful quality improvement curricula in physician education: a realist review

Jones

Shipman

Ogrinc

2015

Postgraduate Medical Journal

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Resident-initiated interventions to improve inpatient heart-failure management

Cited by 5 publications

References 19 publications

Effectiveness of implementation interventions in improving physician adherence to guideline recommendations in heart failure: a systematic review

Effectiveness of implementation interventions in improving physician adherence to guideline recommendations in heart failure: a systematic review

Key characteristics of successful quality improvement curricula in physician education: a realist review

Republished: Key characteristics of successful quality improvement curricula in physician education: a realist review

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