Strengthening the Contribution of Quality Improvement Research to Evidence Based Health Care

Management and Evaluation, University of Toronto, Toronto, Ontario, Canada M5T 3M6.
Quality and Safety in Health Care (Impact Factor: 2.16). 07/2006; 15(3):150-1. DOI: 10.1136/qshc.2005.017103
Source: PubMed
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Available from: G. Ross Baker, Oct 06, 2015
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    • "This variability fragments the evidence base, making it difficult to compare and synthesize findings across studies. Recent calls to address these challenges focus on the need for theory development to explain how CQI works and factors that influence its effectiveness, and the identification of valid and reliable measures to enable theories to be tested [21-26]. "
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    ABSTRACT: Background Measuring team factors in evaluations of Continuous Quality Improvement (CQI) may provide important information for enhancing CQI processes and outcomes; however, the large number of potentially relevant factors and associated measurement instruments makes inclusion of such measures challenging. This review aims to provide guidance on the selection of instruments for measuring team-level factors by systematically collating, categorizing, and reviewing quantitative self-report instruments. Methods Data sources: We searched MEDLINE, PsycINFO, and Health and Psychosocial Instruments; reference lists of systematic reviews; and citations and references of the main report of instruments. Study selection: To determine the scope of the review, we developed and used a conceptual framework designed to capture factors relevant to evaluating CQI in primary care (the InQuIRe framework). We included papers reporting development or use of an instrument measuring factors relevant to teamwork. Data extracted included instrument purpose; theoretical basis, constructs measured and definitions; development methods and assessment of measurement properties. Analysis and synthesis: We used qualitative analysis of instrument content and our initial framework to develop a taxonomy for summarizing and comparing instruments. Instrument content was categorized using the taxonomy, illustrating coverage of the InQuIRe framework. Methods of development and evidence of measurement properties were reviewed for instruments with potential for use in primary care. Results We identified 192 potentially relevant instruments, 170 of which were analyzed to develop the taxonomy. Eighty-one instruments measured constructs relevant to CQI teams in primary care, with content covering teamwork context (45 instruments measured enabling conditions or attitudes to teamwork), team process (57 instruments measured teamwork behaviors), and team outcomes (59 instruments measured perceptions of the team or its effectiveness). Forty instruments were included for full review, many with a strong theoretical basis. Evidence supporting measurement properties was limited. Conclusions Existing instruments cover many of the factors hypothesized to contribute to QI success. With further testing, use of these instruments measuring team factors in evaluations could aid our understanding of the influence of teamwork on CQI outcomes. Greater consistency in the factors measured and choice of measurement instruments is required to enable synthesis of findings for informing policy and practice.
    Implementation Science 02/2013; 8(1):20. DOI:10.1186/1748-5908-8-20 · 4.12 Impact Factor
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    • "However , extending this link to reduced DTN times will require additional study. Prior work in PI has established many key factors for success, including (a) accurate performance measures developed by a credible source, (b) a plan of action for change, (c) staff buy-in, and (d) institutional support (Auerbach, Landefeld, & Shojania, 2007; Baker, 2006; Naylor, 1998; Peterson, 2005; Zhang et al., 2005). Top-performing hospitals also share cultural characteristics such as visible management support, flexible implementation of standardized protocols , interdisciplinary teams, and an organizational culture of problem solving (Bradley et al., 2006, 2007). "
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    ABSTRACT: Early treatment with intravenous (IV) recombinant tissue plasminogen activator/alteplase (tPA) is associated with improved outcomes for patients with an acute ischemic stroke. Thus, rapid triage and treatment of stroke patients are essential, with a goal of door-to-needle time of no more than 60 minutes. We sought to identify best practices associated with faster treatment among hospitals participating in Get With the Guidelines--Stroke. Qualitative telephone interviews were conducted to elicit strategies being used by these centers to assess, treat, and monitor stroke patients treated with IV tPA. We sequentially carried out these interviews until we no longer identified novel factors. Interviews were conducted with 13 personnel at 7 top-performing U.S. hospitals. With the use of a hermeneutic-phenomenological framework, 5 distinct domains associated with rapid IV tPA delivery were identified. These included (a) communication and teamwork, (b) process, (c) organizational culture, (d) performance monitoring and feedback, and (e) overcoming barriers.
    12/2011; 43(6):329-36. DOI:10.1097/JNN.0b013e318234e7fb
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    • "More recently the emphasis has been on implementing small changes in how care is delivered by using local knowledge and in how care can be improved in real-life settings, rather than assessing whether these interventions are effective (Baker 2006). Recent federal initiatives from the Department of Health and Human Services highlight the importance of understanding the how, why, where, and who in the translation and implementation of evidence-based interventions (National Advisory Mental Health Council Workgroup 2001). "
    Health Services Research 03/2009; 44(1):5-14. DOI:10.1111/j.1475-6773.2008.00936.x · 2.78 Impact Factor
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