Effective Communication Network Structures for Hospital Infection Prevention

描述（由申请人提供）：已知成功实施循证感染预防实践（如“中心静脉导管插入的最大屏障预防措施”）可显著降低医院获得性感染（HAI）、死亡率和费用。然而，尽管一些医院成功地实施了这些国家实践标准，但其他医院的尝试却失败了。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，使隐性知识的交流，学习和改进。在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，工作实践的变化是由那些有权威的人（如管理员）发起的，可能是最有效的隐性知识交流，学习和改善医疗机构。相比之下，最近的轶事证据从医院感染预防成功的故事，表明“点对点”的通信网络结构，其中来自不同亚组的专业人士（如医生和护士）直接相互沟通的做法变化，最小的干扰PIity，可能是最有效的改善循证实践。这些不一致表明缺乏系统的证据，说明哪些通信网络结构对预防感染更有效，即，这与更高的循证实践依从性和更低的HAI率有关。在HAI的背景下，该试点/可行性研究重点关注中心线血流感染（CLBSI）。本研究的第一个目的是制定方法来衡量“通信网络结构”，“通信内容”和“成果”相关的循证CLBSI预防措施在单位一级。“沟通网络结构”是指在不同专业亚组和层级之间，包括医学教师、护士、居民、学生、单位管理人员和医院管理人员，就CLBSI预防实践进行沟通的方向和频率。“交流内容”是指知识的类型（即，“隐性”与“显性”知识）就CLBSI做法进行了交流。“结果”包括对CLBSI预防实践的依从性和单位水平的医院获得性CLBSI率。这项研究的第二个目的是对“自上而下的沟通网络结构与更好的感染预防结果有关”这一假设进行初步检验。“设置将是两个重症监护室在一个学术医疗中心。每周将使用每个分组/级别的参与者填写的“通信日志”收集关于“通信网络结构”和“通信内容”的数据。将通过病历审查每周收集单元“结局”数据。所有数据将在“组织承诺”之前和之后收集，以提高CLBSI预防实践的绩效。总的来说，将在52周内以两个单位收集数据，得到104个单位周的观察结果。分析将包括对CLBSI实践中交流的知识类型进行内容分析;对通信网络结构进行网络分析（以及单元结果）;以及对通信网络结构和结果之间的关系进行回归分析。 公共卫生相关性：根据医疗保健研究和质量机构（AHRQ，2009年a）的数据，近200万患者发生医院获得性感染（HAI），每年导致99，000人死亡，医疗保健费用为280亿至330亿美元。已知成功实施循证感染预防实践可显著减少HAI。这项研究有可能通过在医疗机构中成功实施循证实践标准，为公共卫生做出实质性贡献。除了公众之外，研究结果还将直接有益于各种利益相关者，包括医疗保健管理人员和专业人员，认证机构，政策制定者和卫生服务研究人员。

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.