Effective Communication Network Structures for Hospital Infection Prevention

预防医院感染的有效通信网络结构

• 批准号: 8140440
• 负责人: Pavani Rangachari
• 金额: $ 2.24万
• 依托单位: AUGUSTA UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-30 至 2012-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8140440
• 关键词: Effective; Communication; Network; Structures; Hospital

DESCRIPTION (provided by applicant): The successful implementation of evidence-based infection prevention practices (such as "maximum barrier precautions for central line insertion") is known to significantly reduce hospital-acquired infections (HAIs), mortality, and costs. However, while some hospitals have successfully implemented these national practice standards, others have failed in their attempts. The theoretical literature on organizational change has underscored the importance of "communication network structures," i.e., the direction and frequency of organizational communication, in enabling tacit knowledge exchange, learning, and improvement. Preliminary health services research in this area suggests that "top-down" communication network structures, where changes to work practices are initiated by those with authority (like administrators), may be most effective for tacit knowledge exchange, learning, and improvement in healthcare organizations. By contrast, recent anecdotal evidence from hospital infection prevention success stories, suggests that "peer-to-peer" communication network structures, where professionals from different subgroups (like physicians and nurses) directly communicate with each other on practice changes, with minimal interference from PIity, may be most effective for improvement on evidence-based practices. These inconsistencies suggest a lack of systematic evidence on which communication network structures are more effective for infection prevention, i.e., which are associated with higher compliance on evidence-based practices and lower HAI rates. Within the context of HAIs, this pilot/feasibility study focuses on central line blood stream infections (CLBSIs). The first aim of this study is to develop methods for measuring the "communication network structure," "content of communication," and "outcomes" related to evidence-based CLBSI prevention practices at the unit level. The "communication network structure" refers to the direction and frequency of communication on CLBSI prevention practices across various professional subgroups and hierarchical levels, including medical faculty, nurses, residents, students, unit managers and hospital administrators. The "content of communication" refers to the type of knowledge (i.e., "tacit" vs. "explicit" knowledge) exchanged on CLBSI practices. "Outcomes" include compliance with CLBSI prevention practices and hospital-acquired CLBSI rates at the unit level. The second aim of the study is to conduct an initial test of the hypothesis that "top-down communication network structures are associated with better infection prevention outcomes." The setting will be two intensive care units in an academic medical center. Data on "communication network structure" and "content of communication" will be collected weekly using "communication logs" completed by participants in each subgroup/level. Data on unit "outcomes" will be collected weekly through medical record review. All data will be collected before and after an "organizational pledge" to improve performance on CLBSI prevention practices. In all, data will be collected over 52 weeks in two units, resulting in 104 unit-week observations. Analysis will include content analysis of types of knowledge exchanged on CLBSI practices; network analysis of communication network structures (alongside unit outcomes); and regression analysis of the relationship between communication network structures and outcomes. PUBLIC HEALTH RELEVANCE: According to the Agency for Healthcare Research and Quality (AHRQ, 2009a), nearly 2 million patients develop hospital-acquired infections (HAIs), which contribute to 99,000 deaths each year and $28 billion to $33 billion in health care costs. The successful implementation of evidence-based infection prevention practices is known to significantly reduce HAIs. This study has potential to make substantive contributions to public health by enabling the successful implementation of evidence-based practice standards in healthcare organizations. In addition to the public at large, study results would be directly beneficial to a variety of stakeholders, including healthcare managers & professionals, accreditation agencies, policy makers, and health service researchers.

描述(由申请人提供)：已知成功实施循证感染预防实践(如“中心线插入的最大屏障预防措施”)可显著降低医院感染(HAI)、死亡率和成本。然而，尽管一些医院成功地实施了这些国家实践标准，但另一些医院的尝试失败了。关于组织变革的理论文献强调了“沟通网络结构”的重要性，即组织沟通的方向和频率，以促进隐性知识的交流、学习和改进。这一领域的初步卫生服务研究表明，“自上而下”的通信网络结构，其中工作实践的改变是由那些有权威的人(如管理员)发起的，对于医疗保健组织中的隐性知识交流、学习和改进可能是最有效的。相比之下，最近来自医院感染预防成功案例的轶事证据表明，在改进循证实践方面，来自不同小组的专业人员(如医生和护士)在PIity的最小干扰下，直接就实践变化进行交流的“点对点”通信网络结构可能是最有效的。这些不一致表明，缺乏系统的证据表明，哪些通信网络结构在预防感染方面更有效，即哪些结构与循证做法的更高遵从性和较低的HAI率有关。在HAIS的背景下，这项试点/可行性研究的重点是中心线血流感染(CLBSI)。这项研究的第一个目的是开发方法来衡量“通信网络结构”、“通信内容”和“结果”，这些都与循证的CLBSI预防实践有关。“沟通网络结构”是指跨不同专业小组和层级的CLBSI预防实践的沟通方向和频率，包括医务人员、护士、住院医生、学生、单位经理和医院管理人员。“交流的内容”指的是关于CLBSI实践的交流的知识类型(即“隐性”知识与“显性”知识)。“结果”包括遵守CLBSI预防做法和医院在单位一级获得的CLBSI比率。这项研究的第二个目的是对“自上而下的通信网络结构与更好的感染预防结果相关”这一假设进行初步测试。背景是一个学术医疗中心的两个重症监护室。每周将使用每个分组/级别的参与者填写的“通信日志”收集有关“通信网络结构”和“通信内容”的数据。每周将通过病历审查收集有关单位“结果”的数据。所有数据将在“组织承诺”之前和之后收集，以改进CLBSI预防实践的绩效。总共将在52周内以两个单位收集数据，产生104个单位周的观测数据。分析将包括关于CLBSI做法交流的知识类型的内容分析；通信网络结构的网络分析(与单元成果一起)；以及通信网络结构和成果之间关系的回归分析。 公共卫生相关性：根据卫生保健研究和质量机构(AHRQ，2009a)的数据，近200万患者患上医院获得性感染，每年导致9.9万人死亡，医疗费用为280亿至330亿美元。众所周知，成功实施循证感染预防做法可显著减少人类免疫缺陷。这项研究有可能通过在医疗保健组织中成功实施循证实践标准，为公共卫生做出实质性贡献。除了广大公众，研究结果将直接有益于各种利益相关者，包括医疗保健经理和专业人员、认证机构、政策制定者和卫生服务研究人员。

项目成果

Effective communication network structures for hospital infection prevention: a study protocol.

预防医院感染的有效通信网络结构：一项研究协议。

• DOI: 10.1097/qmh.0b013e31827dea7d
• 发表时间: 2013
• 期刊: Quality management in health care
• 影响因子: 1.2
• 作者: Rangachari,Pavani

Role of communication content and frequency in enabling evidence-based practices.

沟通内容和频率在实现循证实践中的作用。

• DOI: 10.1097/qmh.0000000000000017
• 发表时间: 2014
• 期刊: Quality management in health care
• 影响因子: 1.2
• 作者: Rangachari,Pavani;Madaio,Michael;Rethemeyer,RKarl;Wagner,Peggy;Hall,Lauren;Roy,Siddharth;Rissing,Peter
• 通讯作者: Rissing,Peter

Cumulative impact of periodic top-down communications on infection prevention practices and outcomes in two units.

定期自上而下沟通对两个单位感染预防实践和结果的累积影响。

• DOI: 10.1097/hmr.0000000000000038
• 发表时间: 2015
• 期刊: Health care management review
• 影响因子: 2.5
• 作者: Rangachari,Pavani;Madaio,Michael;Rethemeyer,RKarl;Wagner,Peggy;Hall,Lauren;Roy,Siddharth;Rissing,Peter
• 通讯作者: Rissing,Peter

Short or Long End of the Lever? Associations between Provider Communication of the "Asthma-Action Plan" and Outpatient Revisits for Pediatric Asthma.

杠杆的短端还是长端？

• DOI: 10.5430/jha.v4n5p26
• 发表时间: 2015
• 期刊: Journal of hospital administration
• 作者: Rangachari,Pavani;Mehta,Renuka;Rethemeyer,RKarl;Ferrang,Carole;Dennis,Clifton;Redd,Vickie
• 通讯作者: Redd,Vickie