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The Perils of a “My Work Here is Done” perspective: a mixed methods evaluation of sustainment of an evidence-based intervention for transient ischemic attack
BACKGROUND: To evaluate quality improvement sustainment for Transient Ischemic Attack (TIA) and identify factors influencing sustainment, which is a challenge for Learning Healthcare Systems. METHODS: Mixed methods were used to assess changes in care quality across periods (baseline, implementation,...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9254423/ https://www.ncbi.nlm.nih.gov/pubmed/35787273 http://dx.doi.org/10.1186/s12913-022-08207-8 |
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author | Bravata, Dawn M. Miech, Edward J. Myers, Laura J. Perkins, Anthony J. Zhang, Ying Rattray, Nicholas A. Baird, Sean A. Penney, Lauren S. Austin, Curt Damush, Teresa M. |
author_facet | Bravata, Dawn M. Miech, Edward J. Myers, Laura J. Perkins, Anthony J. Zhang, Ying Rattray, Nicholas A. Baird, Sean A. Penney, Lauren S. Austin, Curt Damush, Teresa M. |
author_sort | Bravata, Dawn M. |
collection | PubMed |
description | BACKGROUND: To evaluate quality improvement sustainment for Transient Ischemic Attack (TIA) and identify factors influencing sustainment, which is a challenge for Learning Healthcare Systems. METHODS: Mixed methods were used to assess changes in care quality across periods (baseline, implementation, sustainment) and identify factors promoting or hindering sustainment of care quality. PREVENT was a stepped-wedge trial at six US Department of Veterans Affairs implementation sites and 36 control sites (August 2015—September 2019). Quality of care was measured by the without-fail rate: proportion of TIA patients who received all of the care for which they were eligible among brain imaging, carotid artery imaging, neurology consultation, hypertension control, anticoagulation for atrial fibrillation, antithrombotics, and high/moderate potency statins. Key informant interviews were used to identify factors associated with sustainment. RESULTS: The without-fail rate at PREVENT sites improved from 36.7% (baseline, 58/158) to 54.0% (implementation, 95/176) and settled at 48.3% (sustainment, 56/116). At control sites, the without-fail rate improved from 38.6% (baseline, 345/893) to 41.8% (implementation, 363/869) and remained at 43.0% (sustainment, 293/681). After adjustment, no statistically significant difference in sustainment quality between intervention and control sites was identified. Among PREVENT facilities, the without-fail rate improved ≥2% at 3 sites, declined ≥2% at two sites, and remained unchanged at one site during sustainment. Factors promoting sustainment were planning, motivation to sustain, integration of processes into routine practice, leadership engagement, and establishing systems for reflecting and evaluating on performance data. The only factor that was sufficient for improving quality of care during sustainment was the presence of a champion with plans for sustainment. Challenges during sustainment included competing demands, low volume, and potential problems with medical coding impairing use of performance data. Four factors were sufficient for declining quality of care during sustainment: low motivation, champion inactivity, no reflecting and evaluating on performance data, and absence of leadership engagement. CONCLUSIONS: Although the intervention improved care quality during implementation; performance during sustainment was heterogeneous across intervention sites and not different from control sites. Learning Healthcare Systems seeking to sustain evidence-based practices should embed processes within routine care and establish systems for reviewing and reflecting upon performance. TRIAL REGISTRATION: Clinicaltrials.gov (NCT02769338) SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-022-08207-8. |
format | Online Article Text |
id | pubmed-9254423 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-92544232022-07-06 The Perils of a “My Work Here is Done” perspective: a mixed methods evaluation of sustainment of an evidence-based intervention for transient ischemic attack Bravata, Dawn M. Miech, Edward J. Myers, Laura J. Perkins, Anthony J. Zhang, Ying Rattray, Nicholas A. Baird, Sean A. Penney, Lauren S. Austin, Curt Damush, Teresa M. BMC Health Serv Res Research BACKGROUND: To evaluate quality improvement sustainment for Transient Ischemic Attack (TIA) and identify factors influencing sustainment, which is a challenge for Learning Healthcare Systems. METHODS: Mixed methods were used to assess changes in care quality across periods (baseline, implementation, sustainment) and identify factors promoting or hindering sustainment of care quality. PREVENT was a stepped-wedge trial at six US Department of Veterans Affairs implementation sites and 36 control sites (August 2015—September 2019). Quality of care was measured by the without-fail rate: proportion of TIA patients who received all of the care for which they were eligible among brain imaging, carotid artery imaging, neurology consultation, hypertension control, anticoagulation for atrial fibrillation, antithrombotics, and high/moderate potency statins. Key informant interviews were used to identify factors associated with sustainment. RESULTS: The without-fail rate at PREVENT sites improved from 36.7% (baseline, 58/158) to 54.0% (implementation, 95/176) and settled at 48.3% (sustainment, 56/116). At control sites, the without-fail rate improved from 38.6% (baseline, 345/893) to 41.8% (implementation, 363/869) and remained at 43.0% (sustainment, 293/681). After adjustment, no statistically significant difference in sustainment quality between intervention and control sites was identified. Among PREVENT facilities, the without-fail rate improved ≥2% at 3 sites, declined ≥2% at two sites, and remained unchanged at one site during sustainment. Factors promoting sustainment were planning, motivation to sustain, integration of processes into routine practice, leadership engagement, and establishing systems for reflecting and evaluating on performance data. The only factor that was sufficient for improving quality of care during sustainment was the presence of a champion with plans for sustainment. Challenges during sustainment included competing demands, low volume, and potential problems with medical coding impairing use of performance data. Four factors were sufficient for declining quality of care during sustainment: low motivation, champion inactivity, no reflecting and evaluating on performance data, and absence of leadership engagement. CONCLUSIONS: Although the intervention improved care quality during implementation; performance during sustainment was heterogeneous across intervention sites and not different from control sites. Learning Healthcare Systems seeking to sustain evidence-based practices should embed processes within routine care and establish systems for reviewing and reflecting upon performance. TRIAL REGISTRATION: Clinicaltrials.gov (NCT02769338) SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-022-08207-8. BioMed Central 2022-07-04 /pmc/articles/PMC9254423/ /pubmed/35787273 http://dx.doi.org/10.1186/s12913-022-08207-8 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Bravata, Dawn M. Miech, Edward J. Myers, Laura J. Perkins, Anthony J. Zhang, Ying Rattray, Nicholas A. Baird, Sean A. Penney, Lauren S. Austin, Curt Damush, Teresa M. The Perils of a “My Work Here is Done” perspective: a mixed methods evaluation of sustainment of an evidence-based intervention for transient ischemic attack |
title | The Perils of a “My Work Here is Done” perspective: a mixed methods evaluation of sustainment of an evidence-based intervention for transient ischemic attack |
title_full | The Perils of a “My Work Here is Done” perspective: a mixed methods evaluation of sustainment of an evidence-based intervention for transient ischemic attack |
title_fullStr | The Perils of a “My Work Here is Done” perspective: a mixed methods evaluation of sustainment of an evidence-based intervention for transient ischemic attack |
title_full_unstemmed | The Perils of a “My Work Here is Done” perspective: a mixed methods evaluation of sustainment of an evidence-based intervention for transient ischemic attack |
title_short | The Perils of a “My Work Here is Done” perspective: a mixed methods evaluation of sustainment of an evidence-based intervention for transient ischemic attack |
title_sort | perils of a “my work here is done” perspective: a mixed methods evaluation of sustainment of an evidence-based intervention for transient ischemic attack |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9254423/ https://www.ncbi.nlm.nih.gov/pubmed/35787273 http://dx.doi.org/10.1186/s12913-022-08207-8 |
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