scholarly journals Attacking Quality-of-Care Gaps in Transient Ischemic Attack

Stroke ◽  
2021 ◽  
Author(s):  
Adam G. Kelly
Keyword(s):  
Quality Of Care ◽  
Transient Ischemic Attack ◽  
Care Gaps ◽  
Ischemic Attack

Acceptability of a Complex Team-based Quality Improvement Intervention for Transient Ischemic Attack

2020 ◽  
Author(s):  
Teresa M Damush ◽  
Lauren S. Penney ◽  
Edward J. Miech ◽  
Nicholas A. Rattray ◽  
Sean A. Baird ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Quality Of Care ◽  
Mixed Methods ◽  
Transient Ischemic Attack ◽  
Self Efficacy ◽  
Improve Quality ◽  
Ischemic Attack ◽  
Active Implementation ◽  
Program Acceptability

Abstract Background: The Protocol-guided Rapid Evaluation of Veterans Experiencing New Transient Neurologic Symptoms (PREVENT) program was a complex quality improvement (QI) intervention targeting transient ischemic attack (TIA) evidence-based care. The aim of this study was to evaluate program acceptability among the QI teams and factors associated with degrees of acceptability.Methods: QI teams from six Veterans Administration facilities participated in active implementation for a one-year period. We employed mixed methods to evaluate program acceptability. Multiple data sources were collected over implementation phases and triangulated for this evaluation. First, we conducted 30 onsite, semi-structured interviews during active implementation with 35 participants at 6 months; 27 interviews with 28 participants at 12 months; and 19 participants during program sustainment. Second, we collected participant automated response survey data during the team kick-off meeting. Third, we conducted debriefing meetings after onsite visits and monthly virtual collaborative calls. All interviews and debriefings were audiotaped, transcribed, and de-identified. De-identified files were qualitatively coded and analyzed for common themes and acceptability patterns. We conducted mixed-methods matrix analyses comparing acceptability by satisfaction ratings and by the Theoretical Framework of Acceptability (TFA). Results: Overall, the QI teams reported the PREVENT program was acceptable. At pre-implementation phase, reviewing quality data, team brainstorming solutions and development of action plans were rated as most useful during the team kickoff meetings. Program acceptability perceptions varied over time across active implementation and after teams accomplished actions plans and moved into sustainment. We observed team acceptability growth over a year of active implementation in concert with the QI team’s self-efficacy to improve quality of care. Guided by the TFA, the QI teams’ acceptability was represented by the respective seven components of the multifaceted acceptability construct.Conclusions: Program acceptability varied by time, by champion role on QI team, by team self-efficacy, and by perceived effectiveness to improve quality of care aligned with the TFA. A complex quality improvement program that fostered flexibility in local adaptation and supported users with access to data, resources, and implementation strategies was deemed acceptable and appropriate by front-line clinicians implementing practice changes in a large, national healthcare organization.Trial Registration: clinicaltrials.gov: NCT02769338

scholarly journals Quality of Care for Veterans With Transient Ischemic Attack and Minor Stroke

2018 ◽  
Vol 75 (4) ◽  
pp. 419 ◽  
Author(s):  
Dawn M. Bravata ◽  
Laura J. Myers ◽  
Greg Arling ◽  
Edward J. Miech ◽  
Teresa Damush ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Transient Ischemic Attack ◽  
Minor Stroke ◽  
Ischemic Attack

scholarly journals The Perils of a “My Work Here is Done” Perspective: A Mixed Methods Evaluation of Sustainment of an Intervention to Improve Quality of Transient Ischemic Attack Care

2021 ◽  
Author(s):  
Dawn M Bravata ◽  
Edward J Miech ◽  
Laura J Myers ◽  
Anthony J Perkins ◽  
Ying Zhang ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Quality Of Care ◽  
Mixed Methods ◽  
Transient Ischemic Attack ◽  
Performance Data ◽  
Routine Practice ◽  
Significant Difference ◽  
Ischemic Attack ◽  
Active Implementation

Abstract BACKGROUND Sustaining quality improvement has been recognized as a key implementation challenge. The objectives of this study were to evaluate sustainment during the implementation of a novel quality improvement intervention for Transient Ischemic Attack (TIA) across six geographically diverse medical centers and to identify specific factors contributing to sustainment. METHODS The PREVENT study was a five-year, stepped-wedge implementation trial at six US Department of Veterans Affairs sites; active implementation was initiated in three waves, with two facilities per wave. Six control sites were matched to each of the six PREVENT active implementation sites (total number of control sites was 36). Mixed methods were used to assess change in quality of care from baseline to active implementation to sustainment (measured by the “without-fail rate” and to identify factors which promoted or hindered sustainment. RESULTS The without-fail rate at PREVENT sites improved from 36.7% at baseline to 54.0% during active implementation and settled to 48.3% during sustainment. At control sites, the without-fail rate improved from 38.6% at baseline to 41.8% during active implementation and remained steady at 43.0% during sustainment. Changes in quality of care during sustainment varied across PREVENT sites: the without-fail rate improved at three sites, declined at two sites, and remained unchanged at one site. In adjusted analyses, although the without-fail rate improved at PREVENT sites compared with control sites during active implementation, no statistically significant difference in quality between intervention and control sites was identified during the sustainment phase. Factors that promoted sustainment were integration of key processes of care into routine practice and establishing systems for reflecting and evaluating on performance data to plan quality improvement activities or respond to changes in quality. Challenges during sustainment included competing demands from new facility quality priorities, low patient volume, and potential problems with coding impairing use of performance data. CONCLUSIONS Facilities seeking to sustain evidence-based practices while embodying the Learning Healthcare System’s core values can harness the combined power of staff and data systems by embedding quality improvement processes within routine care and establishing systems for reviewing and reflecting upon performance data.TRIAL REGISTRATION clinicaltrials.gov: NCT02769338

scholarly journals Quality of Care and Ischemic Stroke Risk After Hospitalization for Transient Ischemic Attack

2015 ◽  
Vol 8 (6 suppl 3) ◽  
pp. S117-S124 ◽  
Author(s):  
Emily C. O’Brien ◽  
Xin Zhao ◽  
Gregg C. Fonarow ◽  
Phillip J. Schulte ◽  
David Dai ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Quality Of Care ◽  
Transient Ischemic Attack ◽  
Stroke Risk ◽  
Ischemic Stroke Risk ◽  
Ischemic Attack

scholarly journals LO61: Geographic variation in Transient Ischemic Attack (TIA)/minor stroke care in Alberta emergency departments (EDs)

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S49
Author(s):  
M. Leong ◽  
E. Lang ◽  
S.D. Coutts ◽  
J. Stang ◽  
D. Wang ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Transient Ischemic Attack ◽  
Recurrent Stroke ◽  
Stroke Care ◽  
Minor Stroke ◽  
Care Pathways ◽  
Risk Factor Management ◽  
Index Visit ◽  
Ischemic Attack

Introduction: The risk of recurrent stroke following a transient ischemic attack (TIA) has been estimated to be as much as 5 percent in the first 48 hours and ten percent in the first week following initial TIA symptoms, but can be modified as a result of intensive risk factor management. Care pathways for these patients vary between different regions within Alberta with Edmonton admitting more TIA patients and Calgary using computed tomography angiography (CTA) based triage. To examine regional differences in the quality of care, the rate of admission for stroke within 90 days of an index ED visit for TIA/minor stroke was investigated. Methods: Data analysts from the Data Integration, Measurement and Reporting (DIMR) branch of Alberta Health Services (AHS) used the National Ambulatory Care Reporting System (NACRS) to identify patients in Alberta who were admitted for stroke within 90-days of an index emergency department (ED) visit for TIA/minor stroke from April 2010 to March 2016. Information extracted included patient demographics, region of residence (Edmonton, Calgary or non-major urban [NMU]), return diagnosis and timing of return ED visit. Analysis included descriptive summaries and proportions were compared using a χ2 test. Results: During the study period, there were 26,232 index visits to Alberta EDs for TIA/minor stroke. 5426 (26.1%) of patients were admitted on their index visit. Calgary (22.5%) had lower rates of admission on index visit followed by Edmonton (31.4%) and the NMU (46%). 20,806 (79.3%) were discharged home following their index visit. Of the patients discharged on their index visit 729 (3.5%) had an admission for stroke within 90-days of their index ED visit with rates in Edmonton (3.8%) and the NMU regions (3.8%) being significantly higher than Calgary (2.8%, p<0.01). Conclusion: Our study demonstrates significantly lower rates of admission for stroke within 90-days of ED visit for minor stroke/TIA in Calgary compared to Edmonton and the NMU. Further work should focus on validating this result and consideration of standardized care pathways that promote effective resource utilization and quality of care.

scholarly journals Acceptability of a complex team-based quality improvement intervention for transient ischemic attack: a mixed-methods study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Teresa M. Damush ◽  
Lauren S. Penney ◽  
Edward J. Miech ◽  
Nicholas A. Rattray ◽  
Sean A. Baird ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Quality Of Care ◽  
Mixed Methods ◽  
Transient Ischemic Attack ◽  
Mixed Methods Study ◽  
Improve Quality ◽  
Ischemic Attack ◽  
Active Implementation ◽  
Program Acceptability

Abstract Background The Protocol-guided Rapid Evaluation of Veterans Experiencing New Transient Neurologic Symptoms (PREVENT) program was a complex quality improvement (QI) intervention targeting transient ischemic attack (TIA) evidence-based care. The aim of this study was to evaluate program acceptability among the QI teams and factors associated with degrees of acceptability. Methods QI teams from six Veterans Administration facilities participated in active implementation for a one-year period. We employed a mixed methods study to evaluate program acceptability. Multiple data sources were collected over implementation phases and triangulated for this evaluation. First, we conducted 30 onsite, semi-structured interviews during active implementation with 35 participants at 6 months; 27 interviews with 28 participants at 12 months; and 19 participants during program sustainment. Second, we conducted debriefing meetings after onsite visits and monthly virtual collaborative calls. All interviews and debriefings were audiotaped, transcribed, and de-identified. De-identified files were qualitatively coded and analyzed for common themes and acceptability patterns. We conducted mixed-methods matrix analyses comparing acceptability by satisfaction ratings and by the Theoretical Framework of Acceptability (TFA). Results Overall, the QI teams reported the PREVENT program was acceptable. The clinical champions reported high acceptability of the PREVENT program. At pre-implementation phase, reviewing quality data, team brainstorming solutions and development of action plans were rated as most useful during the team kickoff meetings. Program acceptability perceptions varied over time across active implementation and after teams accomplished actions plans and moved into sustainment. We observed team acceptability growth over a year of active implementation in concert with the QI team’s self-efficacy to improve quality of care. Guided by the TFA, the QI teams’ acceptability was represented by the respective seven components of the multifaceted acceptability construct. Conclusions Program acceptability varied by time, by champion role on QI team, by team self-efficacy, and by perceived effectiveness to improve quality of care aligned with the TFA. A complex quality improvement program that fostered flexibility in local adaptation and supported users with access to data, resources, and implementation strategies was deemed acceptable and appropriate by front-line clinicians implementing practice changes in a large, national healthcare organization. Trial registration clinicaltrials.gov: NCT02769338.

scholarly journals The quality of medication optimization among patients with transient ischemic attack or minor stroke

2019 ◽  
Vol 3 (1) ◽  
pp. 36-46
Author(s):  
Jaclyn Myers ◽  
Dawn M. Bravata ◽  
Jason Sico ◽  
Laura Myers ◽  
Seemant Chaturvedi ◽  
...  
Keyword(s):  
Transient Ischemic Attack ◽  
Minor Stroke ◽  
Ischemic Attack ◽  
Medication Optimization
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