The protocol-guided rapid evaluation of veterans experiencing new transient neurological symptoms (PREVENT) quality improvement program: rationale and methods
| Autor: | Barbara J Homoya, Laura J. Myers, Jennifer Myers, Lauren D. Murphy, Ying Zhang, Ariel J. Cheatham, Teresa M. Damush, Eric M. Cheng, Dawn M. Bravata, Jared Ferguson, B. Giacherio, Edward Miech, Nicholas A. Rattray, Anthony J. Perkins, Jason J. Sico, Meetesh Kumar, M. J. Ward, Deborah A. Levine |
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| Rok vydání: | 2019 |
| Předmět: |
Quality management
Best practice media_common.quotation_subject Systems redesign lcsh:RC346-429 Study Protocol Clinical Protocols Intervention (counseling) Audit and feedback Medicine Humans Quality (business) Cerebrovascular disease Transient ischemic attack lcsh:Neurology. Diseases of the nervous system media_common Veterans Protocol (science) business.industry Professional development Quality of care General Medicine Benchmarking medicine.disease Quality Improvement Unit of analysis Early Diagnosis Ischemic Attack Transient Implementation science Learning healthcare system Neurology (clinical) Medical emergency business Delivery of Health Care Program Evaluation |
| Zdroj: | BMC Neurology BMC Neurology, Vol 19, Iss 1, Pp 1-12 (2019) |
| ISSN: | 1471-2377 |
| Popis: | BackgroundTransient ischemic attack (TIA) patients are at high risk of recurrent vascular events; timely management can reduce that risk by 70%. The Protocol-guided Rapid Evaluation of Veterans Experiencing New Transient Neurological Symptoms (PREVENT) developed, implemented, and evaluated a TIA quality improvement (QI) intervention aligned with Learning Healthcare System principles.MethodsThis stepped-wedge trial developed, implemented and evaluated a provider-facing, multi-component intervention to improve TIA care at six facilities. The unit of analysis was the medical center. The intervention was developed based on benchmarking data, staff interviews, literature, and electronic quality measures and included: performance data, clinical protocols, professional education, electronic health record tools, and QI support. The effectiveness outcome was the without-fail rate: the proportion of patients who receive all processes of care for which they are eligible among seven processes. The implementation outcomes were the number of implementation activities completed and final team organization level. The intervention effects on the without-fail rate were analyzed using generalized mixed-effects models with multilevel hierarchical random effects. Mixed methods were used to assess implementation, user satisfaction, and sustainability.DiscussionPREVENT advanced three aspects of a Learning Healthcare System. Learning from Data: teams examined and interacted with their performance data to explore hypotheses, plan QI activities, and evaluate change over time. Learning from Each Other: Teams participated in monthly virtual collaborative calls. Sharing Best Practices: Teams shared tools and best practices. The approach used to design and implement PREVENT may be generalizable to other clinical conditions where time-sensitive care spans clinical settings and medical disciplines.Trial registrationclinicaltrials.gov: NCT02769338 [May 11, 2016]. |
| Databáze: | OpenAIRE |
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