Understanding quality improvement collaboratives through an implementation science lens

Rohweder, Catherine; Wangen, Mary; Black, Molly; Dolinger, Heather; Wolf, Marti; O'Reilly, Carey; Brandt, Heather M.; Leeman, Jennifer

doi:10.1016/j.ypmed.2019.105859

Cited by 23 publications

(19 citation statements)

References 21 publications

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“…Though academic–community partnerships have become quite common, clinical–academic–community partnerships are less common, and when done, their primary focus remains in research capacity building [ 23 ] versus improving care access and quality. Quality improvement collaboratives are also well-known; however, they generally refer to collaborations among similar organizations (i.e., between FQHCs, or partnerships with other large organizations such as the Institute for Health Care Improvement) [ 24 ]. To our knowledge, and based on partners’ feedback, this is the first time these entities have participated in a tripartite QI collaborative, especially one where the academic partner is simply a convener and facilitator, rather than the decision-maker or agenda-setter.…”

Section: Discussionmentioning

confidence: 99%

Project COALESCE—An Example of Academic Institutions as Conveners of Community-Clinic Partnerships to Improve Cancer Screening Access

Tossas

Reitzel

Schifano

et al. 2022

IJERPH

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In Virginia, 56% of colorectal cancers (CRC) are diagnosed late, making it one of three enduring CRC mortality hotspots in the US. Cervical cancer (CCa) exhibits a similar pattern, with 48% late-stage diagnosis. Mortality for these cancers is worse for non-Latinx/e(nL)-Black people relative to nL-White people in Virginia, but preventable with equitable screening access and timely diagnostic follow-up. However, structural barriers, such as fractured referral systems and extended time between medical visits, remain. Because Federally Qualified Health Centers (FQHCs) care for a large proportion of racial and ethnic minorities, and underserved communities, regardless of ability to pay, they are ideal partners to tackle structural barriers to cancer screenings. We piloted a quality improvement initiative at five FQHCs in southcentral Virginia to identify and address structural, race-related barriers to CRC, as well as CCa screening and diagnostic follow-up using evidence-based approaches. Uniquely, FQHCs were paired with local community organizations in a didactic partnership, to elevate the community’s voice while together, increase support, acceptance, uptake, and intervention sustainability. We report on project development, and share preliminary data within the context of project goals, namely, to increase cancer screenings by 5–10%, improve knowledge and diagnostic follow-up processes, and build longitudinal partnerships.

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Section: Discussionmentioning

confidence: 99%

Project COALESCE—An Example of Academic Institutions as Conveners of Community-Clinic Partnerships to Improve Cancer Screening Access

Tossas

Reitzel

Schifano

et al. 2022

IJERPH

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“…This project has strengths as a large-scale implementation was evaluated that included many diverse hospitals representative of the Ontario-wide landscape. Large scale quality improvement implementations are rarely described in the literature [ 36 ]. By studying the implementation of PODS, we are able to understand how the community of practice was helpful and why organizations implemented the intervention in different ways.…”

Section: Discussionmentioning

confidence: 99%

Implementation, spread and impact of the Patient Oriented Discharge Summary (PODS) across Ontario hospitals: a mixed methods evaluation

Hahn‐Goldberg

Huynh

Chaput

et al. 2021

BMC Health Serv Res

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Background Traditional discharge processes lack a patient-centred focus. This project studied the implementation and effectiveness of an individualized discharge tool across Ontario hospitals. The Patient Oriented Discharge Summary (PODS) is an individualized discharge tool with guidelines that was co-designed with patients and families to enable a patient-centred process. Methods Twenty one acute-care and rehabilitation hospitals in Ontario, Canada engaged in a community of practice and worked over a period of 18 months to implement PODS. An effectiveness-implementation hybrid design using a triangulation approach was used with hospital-collected data, patient and provider surveys, and interviews of project teams. Key outcomes included: penetration and fidelity of the intervention, change in patient-centred processes, patient and provider satisfaction and experience, and healthcare utilization. Statistical methods included linear mixed effects models and generalized estimating equations. Results Of 65,221 discharges across hospitals, 41,884 patients (64%) received a PODS. There was variation in reach and implementation pattern between sites, though none of the between site covariates was significantly associated with implementation success. Both high participation in the community of practice and high fidelity were associated with higher penetration. PODS improved family involvement during discharge teaching (7% increase, p = 0.026), use of teach-back (11% increase, p < 0.001) and discussion of help needed (6% increase, p = 0.041). Although unscheduled healthcare utilization decreased with PODS implementation, it was not statistically significant. Conclusions This project highlighted the system-wide adaptability and ease of implementing PODS across multiple patient groups and hospital settings. PODS demonstrated an improvement in patient-centred discharge processes linked to quality standards and health outcomes. A community of practice and high quality content may be needed for successful implementation.

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“…For the field, ascertaining users' needs and developing schemes to meet these needs is most essential. 8 Outcomes should be carefully set while staying close to the field and achieving consensus on which issues should be solved first. Since this is the foundation of the implementation design, it is inevitable to reserve enough time and effort to achieve the desired outcome.…”

Section: A C C E P T E D V E R S I O Nmentioning

confidence: 99%

AI Implementation Science for Social Issues: Pitfalls and Tips

Takaoka

2022

Journal of Epidemiology

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Understanding quality improvement collaboratives through an implementation science lens

Cited by 23 publications

References 21 publications

Project COALESCE—An Example of Academic Institutions as Conveners of Community-Clinic Partnerships to Improve Cancer Screening Access

Project COALESCE—An Example of Academic Institutions as Conveners of Community-Clinic Partnerships to Improve Cancer Screening Access

Implementation, spread and impact of the Patient Oriented Discharge Summary (PODS) across Ontario hospitals: a mixed methods evaluation

AI Implementation Science for Social Issues: Pitfalls and Tips

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