Malone Sara, Newland Jason, Kudchadkar Sapna R, Prewitt Kim, McKay Virginia, Prusaczyk Beth, Proctor Enola, Brownson Ross C, Luke Douglas A
Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States.
Pediatric Infectious Diseases, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO, United States.
Front Health Serv. 2022 Nov 10;2:1005802. doi: 10.3389/frhs.2022.1005802. eCollection 2022.
Although new evidence-based practices are frequently implemented in clinical settings, many are not sustained, limiting the intended impact. Within implementation science, there is a gap in understanding sustainability. Pediatric healthcare settings have a robust history of quality improvement (QI), which includes a focus on continuation of change efforts. QI capability and sustainability capacity, therefore, serve as a useful concept for connecting the broader fields of QI and implementation science to provide insights on improving care. This study addresses these gaps in understanding of sustainability in pediatric settings and its relationship to QI.
This is a cross-sectional observational study conducted within pediatric academic medical centers in the United States. Clinicians surveyed worked with one of three evidence-based clinical programs: perioperative antimicrobial stewardship prescribing, early mobility in the intensive care unit, and massive blood transfusion administration. Participants completed two assessments: (1) the Clinical Sustainability Assessment Tool (CSAT) and (2) a 19-question assessment that included demographics and validation questions, specifically a subset of questions from the , a QI scale. Initial descriptive and bivariate analyses were conducted prior to building mixed-effects models relating perceived QI to clinical sustainability capacity.
A total of 181 individuals from three different programs and 30 sites were included in the final analyses. QI capability scores were assessed as a single construct (5-point Likert scale), with an average response of 4.16 (higher scores indicate greater QI capability). The overall CSAT score (7-point Likert scale) was the highest for massive transfusion programs (5.51, SD = 0.91), followed by early mobility (5.25, SD = 0.92) and perioperative antibiotic prescribing (4.91, SD = 1.07). Mixed-effects modeling illustrated that after controlling for person and setting level variables, higher perceptions of QI capabilities were significantly related to overall clinical sustainability.
Organizations and programs with higher QI capabilities had a higher sustainability capacity, even when controlling for differences at the individual and intervention levels. Organizational factors that enable evidence-based interventions should be further studied, especially as they relate to sustainability. Issues to be considered by practitioners when planning for sustainability include bedside provider perceptions, intervention achievability, frequency of delivery, and organizational influences.
尽管新的循证实践在临床环境中经常得到实施，但许多实践未能持续下去，限制了预期的影响。在实施科学领域，对可持续性的理解存在差距。儿科医疗环境有着悠久的质量改进历史，其中包括对变革努力的持续关注。因此，质量改进能力和可持续发展能力是一个有用的概念，可将更广泛的质量改进和实施科学领域联系起来，为改善护理提供见解。本研究解决了对儿科环境中可持续性的理解及其与质量改进的关系方面的这些差距。
这是一项在美国儿科学术医疗中心进行的横断面观察性研究。接受调查的临床医生参与了三个循证临床项目之一：围手术期抗菌药物管理处方、重症监护病房的早期活动以及大量输血管理。参与者完成了两项评估：（1）临床可持续性评估工具（CSAT），以及（2）一项包含19个问题的评估，其中包括人口统计学和验证问题，特别是来自质量改进量表的一部分问题。在建立将感知到的质量改进与临床可持续发展能力相关联的混合效应模型之前，进行了初步描述性和双变量分析。
最终分析纳入了来自三个不同项目和30个地点的181名个体。质量改进能力得分被评估为一个单一结构（5点李克特量表），平均得分为4.16（得分越高表明质量改进能力越强）。总体CSAT得分（7点李克特量表）在大量输血项目中最高（5.51，标准差 = 0.91），其次是早期活动（5.25，标准差 = 0.92）和围手术期抗生素处方（4.91，标准差 = 1.07）。混合效应模型表明，在控制了个体和环境水平变量后，对质量改进能力的更高认知与总体临床可持续性显著相关。
即使在控制了个体和干预水平的差异后，具有较高质量改进能力的组织和项目也具有更高的可持续发展能力。应进一步研究促成循证干预的组织因素，尤其是与可持续性相关的因素。从业者在规划可持续性时应考虑的问题包括床边提供者的认知、干预的可实现性、实施频率以及组织影响。
