scholarly journals Impact of Quality Improvement (QI) Program on 5-year Risk of Diabetes-related Complications: a Simulation Study

2020 ◽  
Author(s):  
Hui Shao ◽  
Vivian Fonseca ◽  
Roy Furman ◽  
Luigi Meneghini ◽  
Lizheng Shi
Keyword(s):  
Quality Improvement ◽  
Risk Reduction ◽  
Hba1c Level ◽  
Safety Net ◽  
Baseline Hba1c ◽  
Post Intervention ◽  
All Cause Mortality ◽  
The Impact ◽  
Complications And Mortality ◽  
Baseline Hba1c Level

Objective <p>We successfully implemented the ADA’s Diabetes INSIDE<sup>®</sup> quality improvement program at a University hospital and safety-net health system (Tulane and Parkland), focused on system-wide improvement in poorly controlled type 2 diabetes (HbA1c>8.0% [64 mmol/mol]). In this study, we estimated the 5-year risk reduction in complications and mortality associated with the QI program.</p> <p>Research Design and Methods</p> <p>The QI implementation period was one year, followed by the post-intervention period of six months to evaluate the impact of QI on clinical measures. We measured the differences between the baseline and post-intervention clinical outcomes in 2,429 individuals with HbA1c >8% (64 mmol/mol) at baseline and used the Building, Relating, Assessing, Validating Outcomes (BRAVO™) of diabetes model to project the 5-year risk reduction of diabetes-related complications under the assumption that intervention benefits persist over time. An alternative assumption that intervention benefits diminish by 30% every year was also tested.</p> <p>Results</p> <p>The QI program was associated with reductions in HbA1c (-0.84%) and LDL-C (-5.94 mg/dl) among individuals with HbA1c level >8.0% (64 mmol/mol), with greater reduction in HbA1c (-1.67%) and LDL-C (-6.81 mg/dl) among those with HbA1c level > 9.5% at baseline (all p<0.05). The implementation of the Diabetes INSIDE<sup>® </sup>QI program was associated with 5-year risk reductions in major adverse cardiovascular events (MACE, Relative Risk (RR): 0.78, 95% confidence interval (CI):0.75-0.81) and all-cause mortality (RR:0.83, 95% CI: 0.82-0.85) among individuals with baseline HbA1c level >8.0% (64 mmol/mol), and MACE (RR: 0.60, 95% CI:0.56-0.65) and all-cause mortality (RR: 0.61, 95% CI: 0.59-0.64) among individuals with baseline HbA1c level > 9.5% (80 mmol/mol). Sensitivity analysis also identified a substantially lower risk of diabetes-related complications and mortality associated with the QI program.</p> <p>Conclusions</p> <p>Our modeling results suggest that the ADA’s Diabetes INSIDE<sup>®</sup> QI program would benefit the patients and population by substantially reducing the 5-year risk of complications and mortality in individuals with diabetes. </p>

scholarly journals Impact of Quality Improvement (QI) Program on 5-year Risk of Diabetes-related Complications: a Simulation Study

2020 ◽  
Author(s):  
Hui Shao ◽  
Vivian Fonseca ◽  
Roy Furman ◽  
Luigi Meneghini ◽  
Lizheng Shi
Keyword(s):  
Quality Improvement ◽  
Risk Reduction ◽  
Hba1c Level ◽  
Safety Net ◽  
Baseline Hba1c ◽  
Post Intervention ◽  
All Cause Mortality ◽  
The Impact ◽  
Complications And Mortality ◽  
Baseline Hba1c Level

Objective <p>We successfully implemented the ADA’s Diabetes INSIDE<sup>®</sup> quality improvement program at a University hospital and safety-net health system (Tulane and Parkland), focused on system-wide improvement in poorly controlled type 2 diabetes (HbA1c>8.0% [64 mmol/mol]). In this study, we estimated the 5-year risk reduction in complications and mortality associated with the QI program.</p> <p>Research Design and Methods</p> <p>The QI implementation period was one year, followed by the post-intervention period of six months to evaluate the impact of QI on clinical measures. We measured the differences between the baseline and post-intervention clinical outcomes in 2,429 individuals with HbA1c >8% (64 mmol/mol) at baseline and used the Building, Relating, Assessing, Validating Outcomes (BRAVO™) of diabetes model to project the 5-year risk reduction of diabetes-related complications under the assumption that intervention benefits persist over time. An alternative assumption that intervention benefits diminish by 30% every year was also tested.</p> <p>Results</p> <p>The QI program was associated with reductions in HbA1c (-0.84%) and LDL-C (-5.94 mg/dl) among individuals with HbA1c level >8.0% (64 mmol/mol), with greater reduction in HbA1c (-1.67%) and LDL-C (-6.81 mg/dl) among those with HbA1c level > 9.5% at baseline (all p<0.05). The implementation of the Diabetes INSIDE<sup>® </sup>QI program was associated with 5-year risk reductions in major adverse cardiovascular events (MACE, Relative Risk (RR): 0.78, 95% confidence interval (CI):0.75-0.81) and all-cause mortality (RR:0.83, 95% CI: 0.82-0.85) among individuals with baseline HbA1c level >8.0% (64 mmol/mol), and MACE (RR: 0.60, 95% CI:0.56-0.65) and all-cause mortality (RR: 0.61, 95% CI: 0.59-0.64) among individuals with baseline HbA1c level > 9.5% (80 mmol/mol). Sensitivity analysis also identified a substantially lower risk of diabetes-related complications and mortality associated with the QI program.</p> <p>Conclusions</p> <p>Our modeling results suggest that the ADA’s Diabetes INSIDE<sup>®</sup> QI program would benefit the patients and population by substantially reducing the 5-year risk of complications and mortality in individuals with diabetes. </p>

scholarly journals Applying quality improvement principles to improve accident and emergency department overcrowding and flow in Rwanda: a case study

2015 ◽  
Vol 4 (5) ◽  
pp. 47 ◽  
Author(s):  
Jean Claude Byiringiro ◽  
Rex Wong ◽  
Caroline Davis ◽  
Jeffery Williams ◽  
Joseph Becker ◽  
...  
Keyword(s):  
Emergency Department ◽  
Quality Improvement ◽  
Success Factors ◽  
Low Cost ◽  
Post Intervention ◽  
Triage System ◽  
Accident And Emergency ◽  
Number Of Patients ◽  
Accident And Emergency Department ◽  
The Impact

Few case studies exist related to hospital accident and emergency department (A&E) quality improvement efforts in lowerresourced settings. We sought to report the impact of quality improvement principles applied to A&E overcrowding and flow in the largest referral and teaching hospital in Rwanda. A pre- and post-intervention study was conducted. A linked set of strategies included reallocating room space based on patient/visitor demand and flow, redirecting traffic, establishing a patient triage system and installing white boards to facilitate communication. Two months post-implementation, the average number of patients boarding in the A&E hallways significantly decreased from 28 (pre-intervention) to zero (post-intervention), p < .001. Foot traffic per dayshift hour significantly decreased from 221 people to 160 people (28%, p < .001), and non-A&E related foot traffic decreased from 81.4% to 36.3% (45% decrease, p < .001). One hundred percent of the A&E patients have been formally triaged since the implementation of the newly established triage system. Our project used quality improvement principles to reduce the number of patients boarding in the hallways and to decrease unnecessary foot traffic in the A&E department with little investment from the hospital. Key success factors included a collaborative multidisciplinary project team, strong internal champions, data-driven analysis, evidence-based interventions, senior leadership support, and rapid application of initial implementation learnings. Results to date show the application of quality improvement principles can help hospitals in resource-limited settings improve quality of care at relatively low cost.

Abstract WP266: EMS/Hospital Combined Education Decreased Primary Stroke Center Bypass

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Jason P Stopyra ◽  
Myron Waddell ◽  
Emily B Parks
Keyword(s):  
North Carolina ◽  
Quality Improvement ◽  
Service Area ◽  
Education Intervention ◽  
Post Intervention ◽  
Intervention Phase ◽  
Primary Stroke Center ◽  
Stroke Center ◽  
The Impact

Introduction: Historically, community hospitals have had few options for meaningful treatment of patients presenting with acute stroke. As expertise grows in the administration of thrombolytics, primary stroke centers (PSC) fulfill an important role in the reduction of morbidity and mortality related to stroke. It is important for the PSC to partner with Emergency Medical Services (EMS) to change historical perceptions of the quality of PSC care. Education may improve teamwork and increase awareness of the PSC, thereby increasing their utilization in EMS disposition decisions. Objective: The objective of this study is to report the impact of an education intervention on PSC bypass decisions. Methods: The electronic patient care record database from a North Carolina county EMS system was queried as a quality improvement analysis from January 1, 2012 to February 28, 2016. This included 19 months prior to the education intervention, the year during the education intervention, and 19 months after the education intervention. All primary patient transports with Stroke/CVA, or suspected TIA as the primary or secondary impression were included. Interfacility transports were excluded. The recorded call location was determined to either be inside or outside the PSC service area. The hospital the patient was transported to was also recorded. Results: During the pre-intervention phase 222 patients were identified, 48 of which originated in the PSC service area. Of those 48 patients, 16 bypassed the PSC (33.3%). In the post-intervention phase, 94 of 269 total patients were in PSC service area. Only 12 bypasses occurred (12.8%) which is a reduction of 61.7% in PSC bypass compared to the pre-intervention phase. Conclusion: The period following a combined hospital/EMS educational intervention showed significant reduction in PSC bypass.

scholarly journals A case study: Applying quality improvement methods to reduce pre-operative length of stay in a resource-constrained setting in Rwanda

2015 ◽  
Vol 5 (1) ◽  
pp. 41 ◽  
Author(s):  
Ssebuufu Robinson ◽  
Victor Pawelzik ◽  
Abraham Megentta ◽  
Oswald Benimana ◽  
Damascene Mazimpaka ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Problem Solving ◽  
Length Of Stay ◽  
Work Group ◽  
Surgical Patients ◽  
P Value ◽  
Post Intervention ◽  
Quality Of Surgery ◽  
The Impact

Objective: While several studies have focused on improving the quality of surgery, less attention has been paid to reducing pre-operative delays in care. We undertook a hospital quality improvement (QI) effort to reduce pre-operative delays in a teaching hospital in Rwanda. Without a coordinated admission schedule, many surgical patients arriving at the hospital for admissions were turned away because of unavailable beds. For those admitted for surgery, the pre-operative waits were long.Methods: A pre- and post-intervention study was conducted to examine the impact of a QI effort on two metrics: 1) pre-operative length-of-stay (LOS) for elective surgical patients, and 2) the number of elective surgical patients who were turned away on the scheduled admission date. Intervention: A multi-disciplinary work group utilized a Strategic Problem Solving Approach and implemented a centralized patient wait list and new schedule process utilizing the existing resources available at the hospital.Results: The percentage of elective surgical patients with a pre-operative LOS of more than two days was significantly lower in the post-intervention compared with the pre-intervention period (80% versus 26.8%, p-value < .001). The percentage of scheduled patients who were turned away due unavailable inpatient beds significantly decreased from 63.4% to 5.3%, p-value < .001.Conclusions: By following a methodical strategic problem solving approach, the pre-operative LOS was reduced, elective surgical patients turned away due to unavailable beds was decreased at very low financial cost.

scholarly journals Healthcare Quality Improvement Analytics: An Example Using Computerized Provider Order Entry

Healthcare ◽  
2021 ◽  
Vol 9 (9) ◽  
pp. 1187
Author(s):  
Jungwon Cho ◽  
Sangmi Shin ◽  
Youngmi Jeong ◽  
Eunsook Lee ◽  
Soyeon Ahn ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Control Chart ◽  
Healthcare Professionals ◽  
Segmented Regression ◽  
Long Term Effects ◽  
Order Entry ◽  
Post Intervention ◽  
Computerized Provider Order Entry ◽  
Healthcare Settings ◽  
The Impact

Evaluation of sustainability after quality improvement (QI) projects in healthcare settings is an essential part of monitoring and future QI planning. With limitations in adopting quasi-experimental study design in real-world practice, healthcare professionals find it challenging to present the sustained effect of QI changes effectively. To provide quantitative methodological approaches for demonstrating the sustainability of QI projects for healthcare professionals, we conducted data analyses based on a QI project to improve the computerized provider order entry system to reduce patients’ dosing frequencies in Korea. Data were collected for 5 years: 24-month pre-intervention, 12-month intervention, and 24-month post-intervention. Then, analytic approaches including control chart, Analysis of Variance (ANOVA), and segmented regression were performed. The control chart intuitively displayed how the outcomes changed over the entire period, and ANOVA was used to test whether the outcomes differed between groups. Last, segmented regression analysis was conducted to evaluate longitudinal effects of interventions over time. We found that the impact of QI projects in healthcare settings should be initiated following the Plan–Do–Study–Act cycle and evaluated long-term effects while widening the scope of QI evaluation with sustainability. This study can serve as a guide for healthcare professionals to use a number of statistical methodologies in their QI evaluations.

Abstract 17076: Empowering Telemetry Technicians to Call Code Blue

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Cody McCoy ◽  
Neil Keshvani ◽  
Maryam Warsi ◽  
Eugene Chu ◽  
Anita Hegde
Keyword(s):  
Clinical Status ◽  
Retrospective Chart Review ◽  
Safety Net ◽  
Post Intervention ◽  
Neurologic Outcomes ◽  
Code Blue ◽  
Safety Net Hospital ◽  
Urban Safety ◽  
Life Threatening ◽  
The Impact

Background: Delays in treatment of in-hospital cardiac arrest (IHCA) events are associated with lower survival and poor neurologic outcomes. With centralized telemetry, telemetry technicians need to notify nursing staff of life-threatening arrhythmias immediately for nursing to verify a patient's clinical status and determine whether code blue activation is necessary. Delays in this verification lead to delays in code activation, which can in turn lead to increased morbidity and mortality. Objective: We sought to assess the impact of empowering telemetry technicians to activate code blues on IHCA code survival, survival to discharge, time to cardiopulmonary resuscitation (CPR), and inappropriate code activation. Methods: We implemented a quality improvement protocol September 1, 2016 at Parkland Memorial Hospital, a 900-bed, urban, safety-net hospital, in Dallas, Texas to empower telemetry technicians to call code blue directly for the following life-threatening arrhythmias: ventricular fibrillation, sustained ventricular tachycardia of greater than 30 seconds, asystole, or bradycardia less than 30 beats/minute. We performed a retrospective chart review of all IHCA in patients on centralized telemetry at Parkland for one year prior to the intervention and three years post intervention to look at code survival and survival to discharge. Secondary outcomes were time to CPR and inappropriate code activation. Results: The pre intervention code survival was 12/20 (60.0%) and the post intervention code survival was 46/55 (83.6%) (p=0.03). The pre intervention survival to discharge was 3/20 (15.0%) and the post intervention survival to discharge was 21/55 (38.2%), (p=0.0585). The time to CPR, in seconds, was 180 versus 120 (p=0.58) for pre and post intervention non-PEA codes. There were 0 inappropriate code activations post intervention. Conclusions: Empowering telemetry technicians to activate code blue for general ward patients on centralized telemetry showed a significant improvement in code survival and a trend in survival to discharge. Importantly, there were no inappropriate code activations by telemetry technicians, highlighting the safety of this intervention.

scholarly journals Quality improvement time-saving intervention to increase use of a clinical decision support tool to reduce low-value diagnostic imaging in a safety net health system

2021 ◽  
Vol 10 (1) ◽  
pp. e001076
Author(s):  
Bryanna Lee ◽  
John Mafi ◽  
Maitraya K Patel ◽  
Andrea Sorensen ◽  
Sitaram Vangala ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Back Pain ◽  
Decision Support ◽  
Clinical Decision Support ◽  
Clinical Decision ◽  
Safety Net ◽  
Urgent Care ◽  
Intervention Site ◽  
Time Saving ◽  
The Impact

ImportanceElectronic health record (EHR) clinical decision support (CDS) tools can provide evidence-based feedback at the point of care to reduce low-value imaging. Success of these tools has been limited partly due to lack of engagement by busy clinicians.ObjectiveMeasure the impact of a time-saving quality improvement intervention to increase engagement with a CDS tool for low back pain imaging ordering.Design, setting and participantsWe conducted a quasi-experimental difference-in-differences analysis at (BLINDED), examining back pain imaging orders from 29 May 2015 to 07 January 2016. The intervention site was (BLINDED) Emergency Medicine/Urgent Care Center (n=5736) and control sites included all other (BLINDED) hospitals and clinics (n=1621). In May 2015, the Department of Health Services installed a CDS tool that triggered a survey when clinicians ordered an imaging test, generating an ‘appropriateness score’ based on the American College of Radiology guidelines. Clinicians often bypassed the tool, resulting in ‘unscored’ tests.InterventionTo increase clinician engagement with the tool and decrease the rate of unscored imaging tests, a new policy was implemented at the intervention site on 15 August 2015. If clinicians completed the CDS survey and scored an appropriateness score >3, they could forego a previously mandatory telephone call for pre-imaging utilisation review with the radiology department.Main outcomes and measuresWe used EHR data to measure pre–post-intervention differences in: (1) percentage of unscored tests and (2) percentage of tests with high appropriateness scores (>7).ResultsPercentage of unscored tests decreased from 69.4% to 10.4% at the intervention site and from 50.6% to 34.8% at the control sites (between-group difference: −23.3%, p<0.001). Percentage of high scoring tests increased from 26.5% to 75.0% at the intervention site and from 17.2% to 22.7% at the control sites (between-group difference: 19%, p<0.001).ConclusionWorkflow time-saving interventions may increase physician engagement with CDS tools and have potential to improve practice patterns.

scholarly journals Effectiveness of the German disease management programs: quasi-experimental analyses assessing the population-level health impact

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jacob Burns ◽  
Christoph Kurz ◽  
Michael Laxy
Keyword(s):  
Type 2 Diabetes ◽  
Disease Management ◽  
Time Lag ◽  
Population Level ◽  
Synthetic Control ◽  
Post Intervention ◽  
Disease Management Programs ◽  
All Cause Mortality ◽  
The Impact

Abstract Background In 2002–2003 disease management programs (DMPs) for type 2 diabetes and coronary heart disease were introduced in Germany to improve the management of these conditions. Today around 6 million Germans aged 56 and older are enrolled in one of the DMPs; however, their effect on health remains unclear. Methods We estimated the impact of German DMPs on circulatory and all-cause mortality using a synthetic control study. Specifically, using routinely available data, we compared pre and post-intervention trends in mortality of individuals aged 56 and older for 1998–2014 in Germany to trends in other European countries. Results Average circulatory and all-cause mortality in Germany and the synthetic control was 1.63 and 3.24 deaths per 100 persons. Independent of model choice, circulatory and all-cause mortality decreased non-significantly less in Germany than in the synthetic control; for the model with a 3 year time lag, for example, by 0.12 (95%-CI: − 0.20; 0.44) and 0.22 (95%-CI: − 0.40; 0.66) deaths per 100 persons, respectively. Further main analyses, as well as sensitivity and subgroup analyses supported these results. Conclusions We observed no effect on circulatory or all-cause mortality at the population-level. However, confidence intervals were wide, meaning we could not reject the possibility of a positive effect. Given the substantial costs for administration and operation of the programs, further comparative effectiveness research is needed to clarify the value of German DMPs for type 2 diabetes and CHD.

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