Abstract:
:Many hospitals are unable to successfully implement "evidence-based practices" at the unit level. For example, consistent implementation of the central line bundle (CLB), proven to prevent catheter-related bloodstream infections (CRBSIs) is often difficult. This problem has been broadly characterized as "change implementation failure" in health care organizations. Several studies have used retrospective designs to examine the problem; however, there are few prospective studies examining communication dynamics underlying successful implementation of change (eg, evidence-based practices). This prospective study will be set in 2 intensive care units at an academic medical center. At baseline, both units have low compliance with CLB and higher-than-expected CRBSIs. Periodic quality improvement (QI) interventions will be conducted over a 52-week period to promote implementation of CLB in both units. Simultaneously, the following parameters will be examined: (1) Structure and content of communication related to CLB in both units through "communication logs" completed weekly by nurses, physicians, and managers; and (2) outcomes, that is, CLB adherence in both units through weekly chart review. Catheter utilization and CRBSI (infection) rates will serve as additional unit-level outcome measures. The aim is 2-fold: (1) to examine associations between QI interventions and structure and content of communication at the unit level; and (2) to examine associations between structure and content of communication and outcomes at the unit level. The periodic QI interventions are expected to increase CLB adherence and reduce CRBSIs through their influence on structure and content of communication. The prospective design would help examine dynamics in unit-level communication structure and content related to CLB, as well as unit-level outcomes. The study has potential to make significant contributions to theory and practice, particularly if interventions are found to be effective in enabling successful practice change at the unit level. To this effect, the study has potential to provide insights into communication structure and content associated with collective learning and culture change at the unit level. Results and insights are expected to lay a foundation for generating context-sensitive "evidence-based management" strategies for successful practice change at the unit level. An ultimate expected deliverable is the development of an "action-learning framework" for successful implementation of evidence-based practices in health care organizations.
journal_name
Qual Manag Health Carejournal_title
Quality management in health careauthors
Rangachari Pdoi
10.1097/QMH.0b013e31827dea7dsubject
Has Abstractpub_date
2013-01-01 00:00:00pages
16-24issue
1eissn
1063-8628issn
1550-5154pii
00019514-201301000-00003journal_volume
22pub_type
杂志文章abstract::The aim of this study is to empirically identify and present different kinds of practice-based improvement ideas developed in health care services. The focus is on individual placement needs, problems/issues, and the ability to organize work on the development, implementation, and institutionalization of ideas for the...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/QMH.0b013e3182134b3c
更新日期:2011-04-01 00:00:00
abstract::Today's health care programs are being scrutinized like never before and yet few clinicians and managers know how to show the value of programs without time-consuming outcomes research. This is especially true for new and innovative programs that are dependent on outside funding and may not have enough time to show an...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/00019514-200109040-00005
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journal_title:Quality management in health care
pub_type: 杂志文章
doi:
更新日期:1992-10-01 00:00:00
abstract:BACKGROUND:In Thailand, hospital accreditation (HA) is widely recognized as one of the system tools to promote effective operation of universal health coverage. This nationwide study aims to examine the relationship between accredited statuses of the provincial hospitals and their mortality outcomes. METHOD:A 5-year r...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/QMH.0000000000000256
更新日期:2020-07-01 00:00:00
abstract::A variety of approaches are available to monitor and quantify the frequency of medical errors and the harm associated with them. The University HealthSystem Consortium Patient Safety Net provides a categorical, rank-ordered approach for designating harm associated with medical errors but does not lend itself to routin...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/QMH.0b013e3181fa074e
更新日期:2010-10-01 00:00:00
abstract:OBJECTIVES:To identify risks associated with delivery of treatment with oral antineoplastic agents in an outpatient setting and to evaluate additional value and feasibility of engaging patients in a proactive risk analysis. METHODS:We conducted 2 separate but parallel failure mode and effects analyses (FMEAs) among pa...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/QMH.0000000000000199
更新日期:2019-01-01 00:00:00
abstract::Several recent reports show that many physicians feel discontented and unhappy with their work situation. This could in part be due to a decline in status, loss of influence on health care organization, reduced wages etc. It is important to find ways to better understand their experiences of working life to get more f...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/00019514-200401000-00008
更新日期:2004-01-01 00:00:00
abstract:BACKGROUND:The obesity epidemic threatens to shorten life expectancy and reduce the quality of life for large segments of the population. The purpose of this study was to develop a decision rule for referral to a weight-loss program on the basis of the relationship between body mass index (BMI) and self-rated overall h...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/01.QMH.0000281061.15108.f8
更新日期:2007-07-01 00:00:00
abstract:PURPOSE:Medical home care has been identified as a model for improving primary care delivery and population-specific quality and safety outcomes. Questions remain how this model affects older adult quality. This systematic review addresses 2 important questions: Are quality and safety outcomes associated with medical h...
journal_title:Quality management in health care
pub_type: 杂志文章,评审
doi:10.1097/QMH.0000000000000041
更新日期:2014-10-01 00:00:00
abstract::As a group, physicians strive for quality but often resist quality measurement. Cost, inconvenience, lack of time, mistrust of quality measures, and a fear of what assessment may find are all factors contributing to this resistance. However, quality, in both rich and poor counties, continues to be poor at worse and va...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:
更新日期:2006-04-01 00:00:00
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journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/QMH.0000000000000236
更新日期:2020-01-01 00:00:00
abstract::The past decade has been marked by extensive change in the organization of health care delivery systems (the "supply side" of health care). There has been relatively less change in the nature of the health care consumer (the "demand side" of health care). The emergence of the Internet as a consumer health care technol...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/00019514-200008020-00009
更新日期:2000-01-01 00:00:00
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journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/00019514-199907030-00004
更新日期:1999-04-01 00:00:00
abstract::Improvement will be constrained by the function-based organizational model found in most health care organizations. Most components of the typical organization are driven by the concept of division of labor. The organization needs to challenge the underlying assumptions and reengineer from top to bottom. Reengineering...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:
更新日期:1994-04-01 00:00:00
abstract::Like many organizations, Continental Rehabilitation Hospital of San Diego designs and communicates templates and targets for desired changes in behaviors and tracks results. It recognizes and celebrates successes and struggles with its failures. A recent case example demonstrates the importance of generating immediate...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/00019514-199706010-00007
更新日期:1997-10-01 00:00:00
abstract::Pay for performance cannot consist of a one-size-fits-all approach. Variation in quality and cost of care is best measured using a single "value" (quality/cost) score that is decomposed into component cost and quality for every health care encounter type. Economic incentives must be enough to focus the provider's atte...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/00019514-200501000-00004
更新日期:2005-01-01 00:00:00
abstract::Many hospitals are unable to successfully implement evidence-based practices. For example, implementation of the central line bundle (CLB), proven to prevent catheter-related bloodstream infections (CRBSIs), is often challenging. This problem is broadly characterized as a "change implementation failure." A prospective...
journal_title:Quality management in health care
pub_type: 杂志文章,多中心研究
doi:10.1097/QMH.0000000000000017
更新日期:2014-01-01 00:00:00
abstract::Recently in this journal, F. Alemi (Qual Manage Health Care. 2004;13(4):216-221) proposed the use of Tukey's Control Chart because of the unique benefits associated with nonparametric inferential statistics including robust performance with (1) low N sizes, (2) nonnormal data, and (3) the presence of outliers, However...
journal_title:Quality management in health care
pub_type: 评论,杂志文章
doi:10.1097/00019514-200504000-00006
更新日期:2005-04-01 00:00:00
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journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/00019514-200009010-00005
更新日期:2000-10-01 00:00:00
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journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/00019514-199705020-00003
更新日期:1997-01-01 00:00:00
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journal_title:Quality management in health care
pub_type: 历史文章,杂志文章
doi:10.1097/QMH.0b013e3181ccbd07
更新日期:2010-01-01 00:00:00
abstract:BACKGROUND:Multistakeholder alliances-groups of payers, purchasers, providers, and consumers that voluntarily work together to address local health goals-have increasingly been used to improve health care quality within their communities. Under the Robert Wood Johnson Foundation's Aligning Forces for Quality (AF4Q) ini...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/QMH.0000000000000094
更新日期:2016-04-01 00:00:00
abstract::Methods to produce change in physician practice patterns are of increasing importance to payers and regulators as well as to physicians themselves. Because some of the strategies being adopted occur without physician input and participation, they have aroused concern in the medical community. We describe the methods u...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:
更新日期:1997-07-01 00:00:00
abstract::In 1998, the Veterans Health Administration invested in the creation of the Veterans Administration National Quality Scholars Fellowship Program (VAQS) to train physicians in new ways to improve the quality of health care. We describe the curriculum for this program and the lessons learned from our experience to date....
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/00019514-200210030-00006
更新日期:2002-04-01 00:00:00
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journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/QMH.0000000000000191
更新日期:2018-10-01 00:00:00
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journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/00019514-200601000-00007
更新日期:2006-01-01 00:00:00
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journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/00019514-200301000-00004
更新日期:2003-01-01 00:00:00
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journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/QMH.0b013e3181bee127
更新日期:2009-10-01 00:00:00
abstract::The article describes the Breakthrough Series, a collaborative improvement model developed by the Institute for Healthcare Improvement. The model adapts and applies existing knowledge to multiple, similar sites to accomplish common aims. It has been used to address several of the most pressing issues in health care to...
journal_title:Quality management in health care
pub_type: 杂志文章
doi:10.1097/00019514-199806040-00001
更新日期:1998-09-01 00:00:00
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journal_title:Quality management in health care
pub_type: 杂志文章
doi:
更新日期:1997-04-01 00:00:00