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: 8031201
• 负责人: Pavani Rangachari
• 金额: $ 7.76万
• 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 2012-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8031201
• 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）：众所周知，成功实施以证据为基础的感染预防措施（如“中央静脉导管插入的最大屏障预防措施”）可以显著降低医院获得性感染（HAIs）、死亡率和成本。然而，虽然一些医院成功地实施了这些国家实践标准，但其他医院却未能成功。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，在实现隐性知识交换、学习和改进方面。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（工作实践的变化由有权威的人（如管理员）发起）可能对卫生保健组织的隐性知识交流、学习和改进最为有效。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，“点对点”通信网络结构可能最有效地改进循证实践，其中来自不同亚群体的专业人员（如医生和护士）直接就实践变化相互沟通，而PIity的干扰最小。这些不一致表明，缺乏系统的证据表明，哪种通信网络结构对预防感染更有效，即与循证做法的更高依从性和更低的HAI率相关。在HAIs的背景下，本试点/可行性研究侧重于中心静脉血流感染（clbsi）。本研究的第一个目的是在单位层面开发测量与循证CLBSI预防实践相关的“沟通网络结构”、“沟通内容”和“结果”的方法。“沟通网络结构”是指在不同专业分组和层级之间，包括医学院、护士、住院医师、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。“传播内容”指的是知识的类型（即“隐性”vs“隐性”）。“显性”知识)在CLBSI实践上进行交流。“结果”包括遵守预防CLBSI的做法和医院获得性CLBSI在单位一级的发生率。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有关”的假设进行初步测试。设置将在一个学术医疗中心的两个重症监护病房。每周收集“通信网络结构”和“通信内容”的数据，使用每个分组/级别的参与者完成的“通信日志”。每周将通过医疗记录审查收集单位“结果”数据。所有数据将在“组织承诺”之前和之后收集，以改善CLBSI预防措施的表现。总的来说，数据将在52周内分为两个单元收集，从而进行104个单元周的观察。分析将包括CLBSI实践中知识交流类型的内容分析；通信网络结构的网络分析（与单元结果一起）；并对传播网络结构与结果的关系进行回归分析。