Tailored Adaptation of the AHRQ VTE QI Guide to Local Hospital Context

项目摘要/摘要 杨医生是外科、手术结果和质量系的助理教授。 改善中心(SOQIC)和医疗保健研究中心(CHS) 范伯格医学院的医学博士。CHS和SOQIC进行安全方面的尖端研究 通过医疗服务和成果的跨学科合作，研究人员在 以便为医疗保健政策提供信息和塑造，并改善医疗保健做法和国家健康。 杨博士的职业目标是成为一名独立资助的研究员，结合先进的定量 以及具有实施和传播科学专业知识的定性分析，以促进有效 提高地方、地区和国家的医疗质量。为了实现这一目标，他将增强他的硕士学位 在此授奖期间，通过在三个领域获得专业知识，获得医疗质量和患者安全学位：(1) 实施和传播科学；(2)定性和混合方法研究；(3)定量研究 评价方法。他将以经验的方式将新知识和技能应用到拟议的项目中。 静脉血栓栓塞症(VTE)，定义为深静脉血栓形成或肺栓塞(PE)， 是导致术后发病率和死亡率的常见的、可预防的原因。体育是导致住院的主要原因 在美国可预防的死亡。目前的职业教育质量措施存在重大缺陷，限制了 医院确定质量改进(QI)可操作目标的能力。因此，应委员会的要求， 医疗保险和医疗补助服务中心，我们的团队创建并验证了新的VTE预防组合 包括术后静脉血栓形成预防的三个最佳实践要素的措施：(1)化学预防， (2)顺序加压装置；(3)早期行走。这项措施帮助医院轻松识别 预防VTE的可操作的QI目标。 此应用程序建议在四种关键类型的12家医院中使用密集、混合的方法进行评估 (大学术；大社区；有QI经验的中小型社区；有QI经验的中小型社区 几乎没有QI经验)来检查医院如何差异化地适应和利用资源，“”预防 医院相关静脉血栓栓塞症：有效质量改进指南》(VTE QI指南) 解决VTE预防综合措施确定的QI目标，同时考虑其 特定于医院的环境。所吸取的经验教训将最终发展为“量身定做的 《AHRQ VTE QI指南》是VTE QI指南的一个补充，它将为医院配备实用的策略，以 在其医院类型和当地环境中调整和实施VTE QI指南。最后，量身定做的价值 将通过比较实施前后遵守VTE的情况来评估VTE QI指南的使用情况 十二所医院的预防综合措施。

Project Summary / Abstract Dr. Yang is an Assistant Professor in the Department of Surgery, Surgical Outcomes and Quality Improvement Center (SOQIC), and the Center for HealthCare Studies (CHS) – Institute for Public Health and Medicine at the Feinberg School of Medicine. CHS and SOQIC conduct cutting-edge research about the safety and quality of healthcare through interdisciplinary collaborations of health services and outcomes researchers in order to inform and shape healthcare policy and to improve healthcare practices and the health of the nation. Dr. Yang's career goal is to become an independently funded investigator combining advanced quantitative and qualitative analytics with expertise in implementation and dissemination science to facilitate effective healthcare quality improvement locally, regionally, and nationally. To fulfill this goal, he will augment his Master's Degree in Healthcare Quality and Patient Safety by gaining expertise in three areas during this award period: (1) implementation and dissemination science, (2) qualitative and mixed methods research, and (3) quantitative evaluation methods. He will apply the new knowledge and skills experientially to the proposed project. Venous thromboembolism (VTE), defined as either a deep venous thrombosis or pulmonary embolism (PE), is a common, preventable cause of postoperative morbidity and mortality. PE is the leading cause of in-hospital preventable death in the United States. The currently quality measures for VTE have important flaws that limit the ability of hospitals to identify actionable targets for quality improvement (QI). Therefore, at the request of the Centers for Medicare and Medicaid Services, our group created and validated a new VTE Prophylaxis Composite Measure that includes the three best practice elements of postoperative VTE prophylaxis: (1) chemoprophylaxis, (2) sequential compression devices, and (3) early ambulation. The measure helps hospitals easily identify actionable QI targets for VTE prophylaxis. This application proposes to use an intensive, mixed methods evaluation in twelve hospitals of four key types (large academic; large community; small/medium community with QI experience; small/medium community with little/no QI experience) to examine how hospitals differentially adapt and utilize the resource, ““Preventing Hospital-Associated Venous Thromboembolism: A Guide for Effective Quality Improvement” (VTE QI Guide) to address QI targets identified by the VTE Prophylaxis Composite Measure, while taking into account their hospital-specific contexts. The lessons learned will culminate in the development of “Tailored Adaptations of the AHRQ VTE QI Guide,” a companion to the VTE QI Guide, which will equip hospitals with practical strategies to adapt and implement the VTE QI Guide within their hospital type and local context. Finally, the value of tailored use of the VTE QI Guide will be assessed by comparing pre- and post-implementation adherence to the VTE Prophylaxis Composite Measure in the twelve hospitals.