Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD 21205, USA.
Implement Sci. 2011 Oct 3;6:115. doi: 10.1186/1748-5908-6-115.
Team-based interventions are effective for improving safety and quality of healthcare. However, contextual factors, such as team functioning, leadership, and organizational support, can vary significantly across teams and affect the level of implementation success. Yet, the science for measuring context is immature. The goal of this study is to validate measures from a short instrument tailored to track dynamic context and progress for a team-based quality improvement (QI) intervention.
Secondary cross-sectional and longitudinal analysis of data from a clustered randomized controlled trial (RCT) of a team-based quality improvement intervention to reduce central line-associated bloodstream infection (CLABSI) rates in intensive care units (ICUs).
Forty-six ICUs located within 35 faith-based, not-for-profit community hospitals across 12 states in the U.S.
Team members participating in an ICU-based QI intervention.
The primary measure is the Team Check-up Tool (TCT), an original instrument that assesses context and progress of a team-based QI intervention. The TCT is administered monthly. Validation measures include CLABSI rate, Team Functioning Survey (TFS) and Practice Environment Scale (PES) from the Nursing Work Index.
Temporal stability, responsiveness and validity of the TCT.
We found evidence supporting the temporal stability, construct validity, and responsiveness of TCT measures of intervention activities, perceived group-level behaviors, and barriers to team progress.
The TCT demonstrates good measurement reliability, validity, and responsiveness. By having more validated measures on implementation context, researchers can more readily conduct rigorous studies to identify contextual variables linked to key intervention and patient outcomes and strengthen the evidence base on successful spread of efficacious team-based interventions. QI teams participating in an intervention should also find data from a validated tool useful for identifying opportunities to improve their own implementation.
团队干预措施对于提高医疗保健的安全性和质量是有效的。然而，团队功能、领导力和组织支持等背景因素在各个团队之间可能存在显著差异，并影响实施成功的程度。但是，衡量背景的科学还不成熟。本研究的目的是验证针对团队为基础的质量改进（QI）干预措施量身定制的短仪器中的测量指标，以跟踪团队的动态背景和进展。
对一项基于团队的质量改进干预措施的集群随机对照试验（RCT）的二次横断面和纵向数据分析，以降低重症监护病房（ICU）中的中心静脉相关血流感染（CLABSI）率。
美国 12 个州的 35 家信仰为基础的非营利性社区医院的 46 个 ICU。
参与 ICU 为基础的 QI 干预的团队成员。
主要测量指标是团队检查工具（TCT），这是一种评估团队为基础的 QI 干预措施的背景和进展的原始工具。TCT 每月进行一次评估。验证性测量指标包括 CLABSI 率、护理工作指数中的团队功能调查（TFS）和实践环境量表（PES）。
TCT 的时间稳定性、响应性和有效性。
我们发现有证据支持 TCT 干预活动、感知的群体行为和团队进展障碍的测量指标的时间稳定性、结构有效性和响应性。
TCT 表现出良好的测量可靠性、有效性和响应性。通过有更多关于实施背景的验证性测量指标，研究人员可以更方便地进行严格的研究，以确定与关键干预和患者结果相关的背景变量，并加强成功推广有效团队干预措施的证据基础。参与干预的 QI 团队也应该发现来自验证工具的数据对识别改善自身实施的机会有用。
