Disseminating quality improvement: study protocol for a large cluster-randomized trial.
Disseminating quality improvement: study protocol for a large cluster-randomized trial.
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DOI：
10.1186/1748-5908-6-44
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发表时间：
2011-04-27
期刊：
影响因子：
--
通讯作者：
McCarty D
中科院分区：
文献类型：
--
作者：
Quanbeck AR;Gustafson DH;Ford JH 2nd;Pulvermacher A;French MT;McConnell KJ;McCarty D
传播是各组织实施质量改进的一个关键方面。作为一个领域，戒毒治疗产生了有效的干预措施，但传播缓慢，只接触到一小部分需要治疗的人。这项研究调查了四种方法传播质量改进（QI）成瘾治疗计划在美国，据我们所知，有史以来最大的研究组织变革在医疗保健。该试验旨在确定传播成瘾治疗质量改进的最具成本效益的方法。该研究通过将201个成瘾治疗项目随机分为四种干预措施来评估不同QI方法的成本和有效性。每种干预措施都使用基于网络的学习工具包，加上每月电话，辅导，面对面会议，或三者结合。有效性的定义是减少等待时间（首次接触和治疗之间的天数），增加计划的入院率，并增加治疗的持续性。将估计与提供服务有关的资源的机会成本。该研究有三个主要结果：等待时间，年度计划招生和继续治疗。次要结果包括：员工自愿离职，治疗完成和营业利润率。我们也在寻求理解调解人、主持人的角色，以及与组织成功进行变革相关的其他因素。我们正在拟合一个混合效应回归模型，以每个项目的平均每月等待时间和继续率（基于汇总的客户记录），包括隔离状态和干预效应的条款。入院治疗被汇总到一个年度水平，以弥补季节性。我们将按成本对干预措施进行排序，以将其与成本最低的干预措施（每月电话）进行配对比较。根据意向治疗原则，将所有具有结局数据的随机化研究中心纳入分析。分析中的组织协变量包括项目规模、管理得分和状态。该研究为开展大规模随机分组试验提供了七项建议：提供有价值的服务，有明确而重要的目标，寻求强大的盟友，了解招聘挑战，培养承诺，解决人员流动问题，鼓励严谨和灵活性。ClinicalTrials. govNCT00934141
Dissemination is a critical facet of implementing quality improvement in organizations. As a field, addiction treatment has produced effective interventions but disseminated them slowly and reached only a fraction of people needing treatment. This study investigates four methods of disseminating quality improvement (QI) to addiction treatment programs in the U.S. It is, to our knowledge, the largest study of organizational change ever conducted in healthcare. The trial seeks to determine the most cost-effective method of disseminating quality improvement in addiction treatment. The study is evaluating the costs and effectiveness of different QI approaches by randomizing 201 addiction-treatment programs to four interventions. Each intervention used a web-based learning kit plus monthly phone calls, coaching, face-to-face meetings, or the combination of all three. Effectiveness is defined as reducing waiting time (days between first contact and treatment), increasing program admissions, and increasing continuation in treatment. Opportunity costs will be estimated for the resources associated with providing the services. The study has three primary outcomes: waiting time, annual program admissions, and continuation in treatment. Secondary outcomes include: voluntary employee turnover, treatment completion, and operating margin. We are also seeking to understand the role of mediators, moderators, and other factors related to an organization's success in making changes. We are fitting a mixed-effect regression model to each program's average monthly waiting time and continuation rates (based on aggregated client records), including terms to isolate state and intervention effects. Admissions to treatment are aggregated to a yearly level to compensate for seasonality. We will order the interventions by cost to compare them pair-wise to the lowest cost intervention (monthly phone calls). All randomized sites with outcome data will be included in the analysis, following the intent-to-treat principle. Organizational covariates in the analysis include program size, management score, and state. The study offers seven recommendations for conducting a large-scale cluster-randomized trial: provide valuable services, have aims that are clear and important, seek powerful allies, understand the recruiting challenge, cultivate commitment, address turnover, and encourage rigor and flexibility. ClinicalTrials. govNCT00934141
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影响因子：
3.9
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