Quality improvement strategies in medical oncology: A qualitative analysis from a scoping review.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 203-203
Author(s):  
Bryan B. Franco ◽  
Laavanya Dharmakulaseelan ◽  
Simron Singh ◽  
Adam E. Haynes ◽  
Brian M. Wong ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Scoping Review ◽  
Medical Oncology ◽  
Qualitative Content Analysis ◽  
Care Quality ◽  
Institute Of Medicine ◽  
Systematic Assessment ◽  
Processes Of Care ◽  
Outcomes Of Care ◽  
The Impact

203 Background: In 2001, the Institute of Medicine (IOM) outlined imperatives to improve quality of care. Quality improvement (QI) has since become essential to cancer care but barriers still exist to the publication of and participation in QI initiatives, including limited recognition for QI and uncertainty with methodologies. We sought to identify strategies used in QI in scholarly medical oncology literature to provide practical guidance for QI. Methods: We conducted a scoping review using Arksey and O’Malley’s framework. A search of EMBASE and MEDLINE databases found 48,186 unique English citations published between January 2001 and August 2014. We utilized an iterative process to refine the inclusion criteria and two reviewers independently reviewed abstracts, resulting in the inclusion of 270 articles. The reviewers then extracted text segments relevant to QI strategies. A qualitative content analysis approach was used to accurately analyze and summarize this process-oriented data. Results: Fifty-four unique QI strategies identified were used alone or in combination to improve structures or processes of care. Five content categories of strategies that targeted structures of care emerged: 1) more methodical approaches (eg, lean thinking, supply-demand analyses), 2) participatory action research and similar strategies, 3) infrastructure to promote health care provider collaboration, 4) application or improvement of information technology (IT), and 5) progression towards a systematic assessment of all patients’ needs. We identified three categories of QI strategies for processes of care: 1) improving patient-clinician relationships or communications, 2) care navigation, and 3) telehealth. Conclusions: Our review identifiedQI strategies in published literature. Strategies were consistent with and expanded on the IOM’s redesign imperatives such as effective use of IT, development of better teams, and care coordination. Identification of strategies provides professionals with tools to engage in QI and may encourage support and recognition for QI. Future studies should examine the impact of different QI strategies on outcomes of care in oncology.

scholarly journals The use of social media as a tool for stakeholder engagement in health service design and quality improvement: A scoping review

2021 ◽  
Vol 7 ◽  
pp. 205520762199687
Author(s):  
Louisa Walsh ◽  
Nerida Hyett ◽  
Nicole Juniper ◽  
Chi Li ◽  
Sophie Rodier ◽  
...  
Keyword(s):  
Social Media ◽  
Quality Improvement ◽  
Health Service ◽  
First Nations ◽  
Scoping Review ◽  
Media Use ◽  
Qualitative Content Analysis ◽  
Service Design ◽  
Social Media Use ◽  
Communication Models

Background Health-related social media use is common but few health organisations have embraced its potential for engaging stakeholders in service design and quality improvement (QI). Social media may provide new ways to engage more diverse stakeholders and conduct health design and QI activities. Objective To map how social media is used by health services, providers and consumers to contribute to service design or QI activities. Methods The scoping review was undertaken using the Joanna Briggs Institute methodology. An advisory committee of stakeholders provided guidance throughout the review. Inclusion criteria were studies of any health service stakeholders, in any health setting, where social media was used as a tool for communications which influenced or advocated for changes to health service design or delivery. A descriptive numerical summary of the communication models, user populations and QI activities was created from the included studies, and the findings were further synthesised using deductive qualitative content analysis. Results 40 studies were included. User populations included organisations, clinical and non-clinical providers, young people, people with chronic illness/disability and First Nations people. Twitter was the most common platform for design and QI activities. Most activities were conducted using two-way communication models. A typology of social media use is presented, identifying nine major models of use. Conclusion This review identifies the ways in which social media is being used as a tool to engage stakeholders in health service design and QI, with different models of use appropriate for different activities, user populations and stages of the QI cycle.

scholarly journals 116 Measuring the impact of end of life care quality improvement (qi) projects

2018 ◽  
Author(s):  
S Kite ◽  
A Cracknell ◽  
A Hurlow ◽  
C Iwaniszak ◽  
C Pattison ◽  
...  
Keyword(s):  
Quality Improvement ◽  
End Of Life ◽  
End Of Life Care ◽  
Care Quality ◽  
Life Care ◽  
The Impact

Clinical pathways: An emerging tool for quality improvement.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 222-222
Author(s):  
Hillary Kleiner ◽  
Francesca Pirog
Keyword(s):  
Quality Improvement ◽  
Guideline Adherence ◽  
Clinical Pathways ◽  
Quality Measures ◽  
Care Quality ◽  
Management Tool ◽  
Adherence To Guidelines ◽  
Appropriate Care ◽  
Organizational Quality ◽  
The Impact

222 Background: Clinical pathways have emerged as a tool for payers to encourage provider adherence to evidence-based care. Avalere sought to understand how oncology pathways are incorporated into broader organizational quality improvement initiatives and what impact they have on care quality. Methods: Avalere conducted white and grey literature searches to assess pathways used in quality improvement initiatives. The research was augmented by interviews with leading pathways organizations. Results: Research suggests that pathways can play the following roles in quality improvement: Ensure Adherence to Guidelines. Pathways are typically built on guidelines. Guideline adherence thresholds improve care quality by incentivizing appropriate care. While pathway adherence thresholds are typically set at 80%, little research has been conducted on whether adherence thresholds have improved guideline adherence. Ensure Adherence to Quality Measures. Quality metrics can be tied to pathway adherence, which in turn can also incentivize appropriate care. Quality measures tied to pathways can be used as a risk-mitigation and management tool for providers that assume more risk. Improve Patient Outcomes by Reducing Treatment Variability. Some clinical pathways programs have been shown to improve outcomes. Between 2010-2012, after implementing breast, colon and lung cancer pathways, US Oncology and Aetna experienced 1.2 inpatient days for patients vs. 2.1 prior to launch, as well as a 10% ER visits in the pathways group vs. 14% in the control group. Enable Comparative Outcomes Assessment. CPs could allow for benchmarking of outcomes over time. Treatment choices could be tracked through pathways and the outcomes could potentially be matched to those choices. Conclusions: While pathways have been shown to play a role in quality improvement, initial results have been short-term and isolated. To ensure that pathways can be a viable part of organizational quality improvement, additional research must be conducted on the impact of pathways on outcomes. Additionally, given the lack of pathway transparency and consistency there is a need for increased oversight to ensure that pathways are appropriately incentivizing adherence to guidelines and quality measures.

scholarly journals Nursing Duty Hours’ Length and the Perceived Outcomes of Care

2018 ◽  
Vol 10 (4) ◽  
pp. 1 ◽  
Author(s):  
Mu'taman Khalil Jarrar ◽  
Hamzah Abdul Rahman ◽  
Abdulaziz M. Sebiany ◽  
Mahdi S AbuMadini ◽  
Hj. Masnawaty S ◽  
...  
Keyword(s):  
Night Shift ◽  
Cross Sectional Study ◽  
Poor Quality ◽  
Care Quality ◽  
P Value ◽  
Cross Sectional ◽  
Policy Makers ◽  
Duty Hours ◽  
Outcomes Of Care ◽  
The Impact

BACKGROUND & OBJECTIVE: Working long shifts are associated with fatigue, medical errors and poor outcomes of care. However, there is a lack of guide that can provide policy-makers the optimal duty length in the Malaysian hospitals. The study aims to investigate the impact of nursing duty hours’ length on the quality and safety of care delivered in the “Medical-Surgical Wards” in Malaysia.METHOD: Cross-sectional study was carried out on 12 private hospitals. Data was collected, through questionnaires, from 652 nurses (61.8 % response rate). Stratified random sampling was used in the study. Regression analyses were conducted to explore the impact of the nursing duty hours’ length on the care quality and safety.FINDINGS: The length of nurses’ duty hours is not significantly affecting care quality (F = 1.27 and P value = 0.28) and patient safety (F = 1.81 and P value = 0.13), at p<0.05 significance level.CONCLUSION: Nurse working in hospitals with 10-hours night shift had perceived poor quality (B=-0.11, t=-1.64, p=0.10); and unsafe care (B=-0.17, t=-2.40, p=0.02). Policy makers in Malaysian hospitals can benefit from the study by restructuring duty hours’ length in their hospital.

scholarly journals The use of theories, frameworks, or models in knowledge translation studies in healthcare settings in China: a scoping review protocol

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Junqiang Zhao ◽  
Xuejing Li ◽  
Lijiao Yan ◽  
Yamei Yu ◽  
Jiale Hu ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Knowledge Translation ◽  
Scoping Review ◽  
Qualitative Content Analysis ◽  
Critical Role ◽  
Reporting Quality ◽  
Open Science ◽  
Eligibility Criteria ◽  
Research And Practice ◽  
Healthcare Settings

Abstract Background Knowledge translation (KT) theories, frameworks, and models (TFMs) can help guide and explain KT processes, and facilitate the evaluation of implementation outcomes. They play a critical role in conducting KT research and practice. Currently, little is known about the usage of TFMs in KT in Chinese healthcare settings. The aim of this scoping review is to identify which TFMs had been used for KT in healthcare settings in China, and how these TFMs were used. Methods The protocol for this scoping review is in accordance with the Arksey and O’Malley framework and further enhanced by the recommendations suggested by Levac et al. We will search 8 databases (4 Chinese and 4 English) to identify relevant studies. Four reviewers (2 for Chinese, 2 for English) will independently screen studies based on the eligibility criteria. The basic characteristic of studies and the TFMs utilization (i.e., what, why, and how) will be extracted. Methodological quality and reporting quality will be assessed using the Mixed Method Appraisal Tool (MMAT) and the Standards for Reporting Implementation Studies (StaRI) (or Standards for Quality Improvement Reporting Excellence, SQUIRE 2.0 for quality improvement studies), respectively. All the retrieved TFMs will be categorized into Nilsen’s classifications of TFMs for KT research. We will employ the qualitative content analysis approach to summarize how these TFMs have been used, and the rationale. A consultation will be conducted through a 1-h interactive virtual meeting with an expert panel of knowledge users. Discussion By conducting this scoping review, we expect to gain a comprehensive and in-depth understanding of why and how TFMs have been used in KT research and practice in China, and to identify gaps and provide recommendations for more efficient and meaningful use of TFMs in the future. Systematic review registration This review has been registered with the Open Science Framework (10.17605/OSF.IO/8NXAM).

scholarly journals Impact of an interdisciplinary malnutrition quality improvement project at a large metropolitan hospital

2020 ◽  
Vol 9 (1) ◽  
pp. e000735 ◽  
Author(s):  
Kelsey Jones Pratt ◽  
Beverly Hernandez ◽  
Robert Blancato ◽  
Jeanne Blankenship ◽  
Kristi Mitchell
Keyword(s):  
At Risk ◽  
Quality Improvement ◽  
Care Delivery ◽  
Care Quality ◽  
Interdisciplinary Teams ◽  
Quality Improvement Initiative ◽  
Infection Rates ◽  
Improvement Project ◽  
Hospitalised Patients ◽  
The Impact

As many as 50% of hospitalised patients are estimated to be malnourished or at risk of malnutrition on hospital admission, but this condition often goes unrecognised, undiagnosed and untreated. Malnutrition is associated with an elevated need for continued medical interventions, higher costs of care and increased patient safety risks. Tampa General Hospital (TGH), a large teaching hospital in the southeastern USA, initiated a project to improve the quality of patient care at its institution. They did this first by focusing on improving the care quality for their malnourished patients (or patients who were at risk of malnourishment) and by using elements of the national Malnutrition Quality Improvement Initiative (MQii) Toolkit as a mechanism to measure and improve quality. The aim of this study was to evaluate the impact of quality improvement interventions on patient length of stay (LOS), infection rates and readmissions, particularly for malnourished patients. The structure of the MQii and the use of the MQii Toolkit helped staff members identify problems and systematically engage in quality improvement processes. Using the MQii Toolkit, TGH implemented a multipronged approach to improving the treatment of malnourished patients that involved creating interdisciplinary teams of staff and identifying gaps in care that could be improved through a series of changes to hospital-wide clinical workflows. They enhanced interdisciplinary coordination through increased dietitian engagement, the use of electronic health record alerts and new surgical protocols. These interventions lasted 8 months in 2016 and data reported here were collected from 985 patients before the interventions (2015) and 1046 patients after the interventions (2017). The study examines how these process changes affected LOS, infection rates and readmissions at TGH. Following implementation of these quality improvement processes, patients who were malnourished or at risk of malnutrition had a 25% reduction in LOS (from 8 to 6 days, p<0.01) and a 35.7% reduction in infection rates (from 14% to 9%, p<0.01). No statistically significant changes in readmission rates were observed. This study adds to a growing body of literature on quality improvement processes hospitals can undertake to better identify and treat malnourished patients. Hospitals and health systems can benefit from adopting similar institution-wide, quality improvement projects, while policy-makers’ support for such programmes can spur more rapid uptake of nutrition-focused initiatives across care delivery settings.

scholarly journals Does coaching matter? Examining the impact of specific practice facilitation strategies on implementation of quality improvement interventions in the Healthy Hearts in the Heartland study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Theresa L. Walunas ◽  
Jiancheng Ye ◽  
Jennifer Bannon ◽  
Ann Wang ◽  
Abel N. Kho ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Project Management ◽  
Regression Tree ◽  
Care Quality ◽  
Successful Implementation ◽  
Practice Facilitation ◽  
Tree Analysis ◽  
Regression Tree Analysis ◽  
Coaching Strategies ◽  
The Impact

Abstract Background Practice facilitation is a multicomponent implementation strategy used to improve the capacity for practices to address care quality and implementation gaps. We sought to assess whether practice facilitators use of coaching strategies aimed at improving self-sufficiency were associated with improved implementation of quality improvement (QI) interventions in the Healthy Hearts in the Heartland Study. Methods We mapped 27 practice facilitation activities to a framework that classifies practice facilitation strategies by the degree to which the practice develops its own process expertise (Doing Tasks, Project Management, Consulting, Teaching, and Coaching) and then used regression tree analysis to group practices by facilitation strategies experienced. Kruskal-Wallis tests were used to assess whether practice groups identified by regression tree analysis were associated with successful implementation of QI interventions and practice and study context variables. Results There was no association between number of strategies performed by practice facilitators and number of QI interventions implemented. Regression tree analysis identified 4 distinct practice groups based on the number of Project Management and Coaching strategies performed. The median number of interventions increased across the groups. Practices receiving > 4 project management and > 6 coaching activities implemented a median of 17 of 35 interventions. Groups did not differ significantly by practice size, association with a healthcare network, or practice type. Statistically significant differences in practice location, number and duration of facilitator visits, and early study termination emerged among the groups, compared to the overall practice population. Conclusions Practices that engage in more coaching-based strategies with practice facilitators are more likely to implement more QI interventions, and practice receptivity to these strategies was not dependent on basic practice demographics.

scholarly journals A Brief History of Quality Improvement in Health Care and Spinal Surgery

2020 ◽  
Vol 10 (1_suppl) ◽  
pp. 5S-9S
Author(s):  
Kevin Hines ◽  
Nikolaos Mouchtouris ◽  
John J. Knightly ◽  
James Harrop
Keyword(s):  
United States ◽  
Health Care ◽  
Quality Improvement ◽  
Spinal Surgery ◽  
Health Care Quality ◽  
The United States ◽  
Care Quality ◽  
Quality Improvement Initiative ◽  
Institute Of Medicine ◽  
Technological Advances

While medical and technological advances continue to shape and advance health care, there has been growing emphasis on translating these advances into improvement in overall health care quality outcomes in the United States. Innovators such as Abraham Flexner and Ernest Codman engaged in rigorous reviews of systems and patient outcomes igniting wider spread interest in quality improvement in health care. Codman’s efforts even contributed to the founding of the American College of Surgeons. This society catalyzed a quality improvement initiative across the United States and the formation of the Joint Commission on Accreditation of Hospitals. Since that time, those such as Avedis Donabedian and the Institute of Medicine have worked to structure the process of improving both the quality and delivery of health care. Significant advances include the defining of minimum standards for hospital accreditation, 7 pillars of quality in medicine, and the process by which quality in medicine is evaluated. All of these factors have affected current practice more each day. In a field such as spinal surgery, cost and quality measures are continually emphasized and led to large outcome databases to better evaluate outcomes in complex, heterogeneous populations. Going forward, these databases will be instrumental in developing practice patterns and improving spinal surgery outcomes.

scholarly journals Evolution of the Quality Oncology Practice Initiative Supportive Care Quality Measures Portfolio and Conformance at a Veterans Affairs Medical Center

2013 ◽  
Vol 9 (3) ◽  
pp. e86-e89 ◽  
Author(s):  
Ryan D. Nipp ◽  
Michael J. Kelley ◽  
Christina D. Williams ◽  
Arif H. Kamal
Keyword(s):  
Quality Improvement ◽  
Supportive Care ◽  
Medical Center ◽  
Quality Measures ◽  
Veterans Affairs ◽  
Care Quality ◽  
Processes Of Care ◽  
Treatment Processes ◽  
Standardized Documentation ◽  
Oncology Practice

Most Quality Oncology Practice Initiative quality measures assess diagnosis or treatment processes of care and not supportive care. The authors demonstrate the necessity for standardized documentation methods and quality improvement efforts that remain commensurate with the increasing portfolio of supportive care measures.

scholarly journals Co-produced capability framework for successful patient and staff partnerships in healthcare quality improvement: results of a scoping review

2021 ◽  
pp. bmjqs-2020-012729
Author(s):  
Ruth Cox ◽  
Matthew Molineux ◽  
Melissa Kendall ◽  
Bernadette Tanner ◽  
Elizabeth Miller
Keyword(s):  
Quality Improvement ◽  
Scoping Review ◽  
Best Practice ◽  
Public Involvement ◽  
Qualitative Content Analysis ◽  
Healthcare Quality ◽  
Patient And Public Involvement ◽  
Development Strategies ◽  
Learning And Development ◽  
Healthcare Quality Improvement

BackgroundInternationally, patient and public involvement (PPI) is core policy for health service quality improvement (QI). However, authentic QI partnerships are not commonplace. A lack of patient and staff capability to deliver successful partnerships may be a barrier to meaningful QI collaboration.ObjectivesThe research questions for this scoping review were: What is known regarding the capabilities required for healthcare staff and patients to effectively partner in QI at the service level?; and What is known regarding the best practice learning and development strategies required to build and support those capabilities?MethodsA six-stage scoping review was completed. Five electronic databases were searched for publications from January 2010 to February 2020. The database searches incorporated relevant terms for the following concepts: capabilities for PPI in healthcare QI; and best practice learning and development strategies to support those capabilities. Data were analysed using descriptive statistics and qualitative content analysis.ResultsForty-nine papers were included. Very little peer-reviewed literature focused explicitly on capabilities for QI partnerships and thus implicit paper content was analysed. A Capability framework for successful partnerships in healthcare quality improvement was developed. It includes knowledge, skills and attitudes across three capability domains: Personal Attributes; Relationships and Communication; and Philosophies, Models and Practices, and incorporates 10 capabilities. Sharing power and leadership was discussed in many papers as fundamental and was positioned across all of the domains. Most papers discussed staff and patients’ co-learning (n=28, 57.14%). Workshops or shorter structured training sessions (n=36, 73.47%), and face-to-face learning (n=34, 69.38%) were frequently reported.ConclusionThe framework developed here could guide individualised development or learning plans for patient partners and staff, or could assist organisations to review learning topics and approaches such as training content, mentoring guidelines or community of practice agendas. Future directions include refining and evaluating the framework. Development approaches such as self-reflection, communities of practice, and remote learning need to be expanded and evaluated.

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