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Implementing the patient care collaborative model in three general internal medicine units: a mixed-methods healthcare improvement initiative

BACKGROUND: As part of the scale-up of the Patient Care Collaborative (PCC) at our institution, we explored staff perceptions and patient outcomes at different levels of model implementation in three general internal medicine units. METHODS: We conducted a mixed-methods embedded experimental healthc...

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Autores principales: LoPresti, Kelly, Camera, Julianne, Barrett, Elizabeth, Gosse, Caroline, Johnson, Donna, Amirthavasar, Gaya, Nashid, John, Mbuagbaw, Mirabel, Vanniyasingam, Thuvaraha, Mbuagbaw, Lawrence
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7213873/
https://www.ncbi.nlm.nih.gov/pubmed/32354754
http://dx.doi.org/10.1136/bmjoq-2019-000815
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author LoPresti, Kelly
Camera, Julianne
Barrett, Elizabeth
Gosse, Caroline
Johnson, Donna
Amirthavasar, Gaya
Nashid, John
Mbuagbaw, Mirabel
Vanniyasingam, Thuvaraha
Mbuagbaw, Lawrence
author_facet LoPresti, Kelly
Camera, Julianne
Barrett, Elizabeth
Gosse, Caroline
Johnson, Donna
Amirthavasar, Gaya
Nashid, John
Mbuagbaw, Mirabel
Vanniyasingam, Thuvaraha
Mbuagbaw, Lawrence
author_sort LoPresti, Kelly
collection PubMed
description BACKGROUND: As part of the scale-up of the Patient Care Collaborative (PCC) at our institution, we explored staff perceptions and patient outcomes at different levels of model implementation in three general internal medicine units. METHODS: We conducted a mixed-methods embedded experimental healthcare improvement initiative. In the qualitative strand, we conducted five focus group discussions. In the quantitative strand, we used hospital administrative data to compare outcomes (falls per 1000, median length of stay in days and resource use measured as resource intensity weights (RIW), before and after the implementation of the PCC, using χ(2) tests, Wilcoxon’s rank sum tests and interrupted time series analyses. RESULTS: Staff showed considerable knowledge and acceptance of the PCC but expressed mixed feelings with regards to patient safety, workload, communication and teamwork. Staff perceptions varied by level of implementation of the PCC. A number of falls (overall) in the full implementation phase were not significantly different from the preimplementation phase (227 per 1000 vs 200 per 1000; p=0.449), but the number of moderate to severe falls dropped (12 vs 2 per 1000); p<0.001). Median length of stay (5 vs 6 days; p<0.001) and resource use were lower (0.1 vs 0.4; p<0.001) in the full implementation phase compared with the preimplementation phase. The trend analyses showed differences across units. CONCLUSIONS: The PCC was moderately well adopted. Perceptions of the PCC among staff and patient outcomes are likely linked to the levels of implementation. The PCC resulted in improved safety, shorter hospital stays and lower costs of care.
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spelling pubmed-72138732020-05-14 Implementing the patient care collaborative model in three general internal medicine units: a mixed-methods healthcare improvement initiative LoPresti, Kelly Camera, Julianne Barrett, Elizabeth Gosse, Caroline Johnson, Donna Amirthavasar, Gaya Nashid, John Mbuagbaw, Mirabel Vanniyasingam, Thuvaraha Mbuagbaw, Lawrence BMJ Open Qual Quality Improvement Programme BACKGROUND: As part of the scale-up of the Patient Care Collaborative (PCC) at our institution, we explored staff perceptions and patient outcomes at different levels of model implementation in three general internal medicine units. METHODS: We conducted a mixed-methods embedded experimental healthcare improvement initiative. In the qualitative strand, we conducted five focus group discussions. In the quantitative strand, we used hospital administrative data to compare outcomes (falls per 1000, median length of stay in days and resource use measured as resource intensity weights (RIW), before and after the implementation of the PCC, using χ(2) tests, Wilcoxon’s rank sum tests and interrupted time series analyses. RESULTS: Staff showed considerable knowledge and acceptance of the PCC but expressed mixed feelings with regards to patient safety, workload, communication and teamwork. Staff perceptions varied by level of implementation of the PCC. A number of falls (overall) in the full implementation phase were not significantly different from the preimplementation phase (227 per 1000 vs 200 per 1000; p=0.449), but the number of moderate to severe falls dropped (12 vs 2 per 1000); p<0.001). Median length of stay (5 vs 6 days; p<0.001) and resource use were lower (0.1 vs 0.4; p<0.001) in the full implementation phase compared with the preimplementation phase. The trend analyses showed differences across units. CONCLUSIONS: The PCC was moderately well adopted. Perceptions of the PCC among staff and patient outcomes are likely linked to the levels of implementation. The PCC resulted in improved safety, shorter hospital stays and lower costs of care. BMJ Publishing Group 2020-04-30 /pmc/articles/PMC7213873/ /pubmed/32354754 http://dx.doi.org/10.1136/bmjoq-2019-000815 Text en © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Quality Improvement Programme
LoPresti, Kelly
Camera, Julianne
Barrett, Elizabeth
Gosse, Caroline
Johnson, Donna
Amirthavasar, Gaya
Nashid, John
Mbuagbaw, Mirabel
Vanniyasingam, Thuvaraha
Mbuagbaw, Lawrence
Implementing the patient care collaborative model in three general internal medicine units: a mixed-methods healthcare improvement initiative
title Implementing the patient care collaborative model in three general internal medicine units: a mixed-methods healthcare improvement initiative
title_full Implementing the patient care collaborative model in three general internal medicine units: a mixed-methods healthcare improvement initiative
title_fullStr Implementing the patient care collaborative model in three general internal medicine units: a mixed-methods healthcare improvement initiative
title_full_unstemmed Implementing the patient care collaborative model in three general internal medicine units: a mixed-methods healthcare improvement initiative
title_short Implementing the patient care collaborative model in three general internal medicine units: a mixed-methods healthcare improvement initiative
title_sort implementing the patient care collaborative model in three general internal medicine units: a mixed-methods healthcare improvement initiative
topic Quality Improvement Programme
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7213873/
https://www.ncbi.nlm.nih.gov/pubmed/32354754
http://dx.doi.org/10.1136/bmjoq-2019-000815
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