Improvement Resources for the CME Professional

January 31, 2011 at 1:21 am Leave a comment

Here are reports on two improvement efforts you may find interesting. I’ll keep a watch out for these when I find them I’ll pass them on.

Development and implementation of a performance improvement project in adult intensive care units: overview of the Improving Medicine Through Pathway Assessment of Critical Therapy in Hospital-Acquired Pneumonia (IMPACT-HAP) study.

Crit Care. 2011 Jan 25;15(1):R38
Mangino JE, et. al.

CONCLUSIONS: Developing a multi-center performance improvement project to operationalize ATS/IDSA guidelines for HAP, VAP, and HCAP is feasible with local consensus pathway directives for implementation and with quality indicators for monitoring compliance with guidelines.
Go here:

A Multifaceted Intervention for Quality Improvement in a Network of Intensive Care Units

A Cluster Randomized Trial
JAMA. Published online January 19, 2011. doi: 10.1001/jama.2010.2000
Damon Scales et. al.

Abstract

Context Evidence-based practices improve intensive care unit (ICU) outcomes, but eligible patients may not receive them. Community hospitals treat most critically ill patients but may have few resources dedicated to quality improvement.

Objective To determine the effectiveness of a multicenter quality improvement program to increase delivery of 6 evidence-based ICU practices.

Design, Setting, and Participants Pragmatic cluster-randomized trial among 15 community hospital ICUs in Ontario, Canada. A total of 9269 admissions occurred during the trial (November 2005 to October 2006) and 7141 admissions during a decay-monitoring period (December 2006 to August 2007).

Intervention We implemented a videoconference-based forum including audit and feedback, expert-led educational sessions, and dissemination of algorithms to sequentially improve delivery of 6 practices. We randomized ICUs into 2 groups. Each group received this intervention, targeting a new practice every 4 months, while acting as control for the other group, in which a different practice was targeted in the same period.

Main Measure Outcomes The primary outcome was the summary ratio of odds ratios (ORs) for improvement in adoption (determined by daily data collection) of all 6 practices during the trial in intervention vs control ICUs.

Results Overall, adoption of the targeted practices was greater in intervention ICUs than in controls (summary ratio of ORs, 2.79; 95% confidence interval [CI], 1.00-7.74). Improved delivery in intervention ICUs was greatest for semirecumbent positioning to prevent ventilator-associated pneumonia (90.0% of patient-days in last month vs 50.0% in first month; OR, 6.35; 95% CI, 1.85-21.79) and precautions to prevent catheter-related bloodstream infection (70.0% of patients receiving central lines vs 10.6%; OR, 30.06; 95% CI, 11.00-82.17). Adoption of other practices, many with high baseline adherence, changed little.

Conclusion In a collaborative network of community ICUs, a multifaceted quality improvement intervention improved adoption of care practices.

Read More:

Here is a tool kit you might find useful. It uses an approach to QI called FOCUS. You may find this approach communicates very well with your constituents.

QI 101 Toolkit

American College of Cardiology PINNACLE NETWORK: Practice Innovation and Clinical Excellence.

The Toolkit can be accessed here:

http://www.cardiosource.org/Science-And-Quality/Quality-Programs/PINNACLE-Network/Quality-and-Performance-Improvement/QI-101-Toolkit.aspx

Here is my latest mantra: Linking Eduction and Quality Improvement – The New Normal

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Entry filed under: CME Issues, Continuing Medical Education, Continung Professional Development, Improvement, PI CME. Tags: , , , , , , , .

My Alliance Experience “Lean” Finds it Way Into CME Offices

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