Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D) Precision Monitoring to Transform Care (PRIS-M) Quality Enhancement Research Initiative (QUERI), Indianapolis, IN, USA.
VA HSR&D Center for Health Information and Communication (CHIC); Richard L. Roudebush VA Medical Center, 11H, 1481 W 10th St, Indianapolis, IN, 46202, USA.
J Gen Intern Med. 2021 Feb;36(2):322-332. doi: 10.1007/s11606-020-06100-w. Epub 2020 Nov 3.
The Protocol-guided Rapid Evaluation of Veterans Experiencing New Transient Neurologic Symptoms (PREVENT) program was designed to address systemic barriers to providing timely guideline-concordant care for patients with transient ischemic attack (TIA).
We evaluated an implementation bundle used to promote local adaptation and adoption of a multi-component, complex quality improvement (QI) intervention to improve the quality of TIA care Bravata et al. (BMC Neurology 19:294, 2019).
A stepped-wedge implementation trial with six geographically diverse sites.
The six facility QI teams were multi-disciplinary, clinical staff.
PREVENT employed a bundle of key implementation strategies: team activation; external facilitation; and a community of practice. This strategy bundle had direct ties to four constructs from the Consolidated Framework for Implementation Research (CFIR): Champions, Reflecting & Evaluating, Planning, and Goals & Feedback.
Using a mixed-methods approach guided by the CFIR and data matrix analyses, we evaluated the degree to which implementation success and clinical improvement were associated with implementation strategies. The primary outcomes were the number of completed implementation activities, the level of team organization and > 15 points improvement in the Without Fail Rate (WFR) over 1 year.
Facility QI teams actively engaged in the implementation strategies with high utilization. Facilities with the greatest implementation success were those with central champions whose teams engaged in planning and goal setting, and regularly reflected upon their quality data and evaluated their progress against their QI plan. The strong presence of effective champions acted as a pre-condition for the strong presence of Reflecting & Evaluating, Goals & Feedback, and Planning (rather than the other way around), helping to explain how champions at the +2 level influenced ongoing implementation.
The CFIR-guided bundle of implementation strategies facilitated the local implementation of the PREVENT QI program and was associated with clinical improvement in the national VA healthcare system.
clinicaltrials.gov: NCT02769338.
Protocol-guided Rapid Evaluation of Veterans Experiencing New Transient Neurologic Symptoms (PREVENT) 计划旨在解决为短暂性脑缺血发作（TIA）患者提供及时符合指南的护理方面的系统障碍。
我们评估了一套实施工具包，用于促进多组件复杂质量改进（QI）干预措施的本地化适应和采用，以改善 TIA 护理质量。Bravata 等人（BMC Neurology 19:294, 2019）。
一个具有六个地理位置不同的站点的逐步楔形实施试验。
六个设施的 QI 团队是多学科的临床工作人员。
PREVENT 采用了一套关键的实施策略：团队激活；外部促进；以及实践社区。该策略包与实施研究综合框架（CFIR）的四个结构直接相关：冠军、反思与评估、规划和目标与反馈。
使用 CFIR 指导的混合方法和数据矩阵分析，我们评估了实施成功和临床改善与实施策略之间的关联程度。主要结果是完成实施活动的数量、团队组织的水平以及在 1 年内无失败率（WFR）提高 15 分以上。
设施 QI 团队积极参与实施策略，利用率很高。实施最成功的设施是那些有核心冠军的设施，他们的团队参与规划和目标设定，并定期反思他们的质量数据，并根据他们的 QI 计划评估他们的进展。有效的冠军的强大存在是反思与评估、目标与反馈和规划（而不是相反）的前提条件，有助于解释+2 级别的冠军如何影响持续的实施。
CFIR 指导的实施策略包促进了 PREVENT QI 计划的本地化实施，并与退伍军人事务部医疗保健系统的临床改善相关。
clinicaltrials.gov: NCT02769338。
