Delta Studies: Expanding the Concept of Deviance Studies to Design More Effective Improvement Interventions
Delta Studies: Expanding the Concept of Deviance Studies to Design More Effective Improvement Interventions
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DOI：
10.1007/s11606-020-06199-x
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发表时间：
2020-09-15
影响因子：
5.7
通讯作者：
Finlay, Andrea K.
中科院分区：
文献类型：
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作者：
Harris, Alex H. S.;Hagedorn, Hildi J.;Finlay, Andrea K.
背景改进（执行和反执行）干预措施的效果往往不大。虽然积极和消极的偏差研究已被广泛用于改进科学和质量改进的努力，概念和方法的创新是必要的，以提高我们的能力，利用信息的质量变化，设计更有效的干预措施。目的描述一种新的偏差研究的混合方法扩展，我们称之为“delta研究”。“Delta研究旨在定量识别最近从低绩效变为高绩效的网站，反之亦然，以便定性了解产生最近变化的积极策略，变革代理人面临的挑战以及他们如何克服这些挑战，以及在适用的情况下，最近性能恶化的原因-旨在为低绩效网站的改进干预措施的设计提供信息。我们提供了从这种方法中吸取的经验教训的例子，这些经验教训可能在传统的正偏差或负偏差设计中被遗漏。描述了用于定量识别增量部位的设计考虑因素，包括跟踪哪些质量指标、在什么时间范围内观察变化、如何考虑观察到的变化的可靠性、将患者数量和初始性能作为实施背景因素的考虑因素，以及如何定义有临床意义的变化。方法，以适应定性协议，通过整合定量信息的性能变化。我们提供了示例数据和R代码，可用于以图形方式显示对Delta研究至关重要的初始状态、变化和体积的分布。参与者美国退伍军人健康管理局的患者和设施。关键结果作为一个例子，我们讨论了我们在一项受资助的低价值术前测试研究中就Delta研究设计考虑因素做出的决定。该方法帮助我们找到最近减少了低价值测试负担的网站，并了解他们采用的策略和面临的挑战。结论三角洲研究的概念是一个有前途的混合方法的创新，有效地确定改进策略和其他因素，实际上产生了变化，在现实世界中的设置。
Background The effects of improvement (implementation and de-implementation) interventions are often modest. Although positive and negative deviance studies have been extensively used in improvement science and quality improvement efforts, conceptual and methodological innovations are needed to improve our ability to use information about variation in quality to design more effective interventions. Objective We describe a novel mixed methods extension of the deviance study we term "delta studies." Delta studies seek to quantitatively identify sites that have recently changed from low performers to high performers, or vice versa, in order to qualitatively learn about active strategies that produced recent change, challenges change agents faced and how they overcame them, and where applicable, the causes of recent deterioration in performance-information intended to inform the design of improvement interventions for deployment in low performing sites. We provide examples of lessons learned from this method that may have been missed with traditional positive or negative deviance designs. Design Considerations for quantitatively identifying delta sites are described including which quality metrics to track, over what timeframe to observe change, how to account for reliability of observed change, consideration of patient volume and initial performance as implementation context factors, and how to define clinically meaningful change. Methods to adapt qualitative protocols by integrating quantitative information about change in performance are also presented. We provide sample data and R code that can be used to graphically display distributions of initial status, change, and volume that are essential to delta studies. Participants Patients and facilities of the US Veterans Health Administration. Key Results As an example, we discuss what decisions we made regarding the delta study design considerations in a funded study of low-value preoperative testing. The method helped us find sites that had recently reduced the burden of low-value testing, and learn about the strategies they employed and challenges they faced. Conclusions The delta study concept is a promising mixed methods innovation to efficiently and effectively identify improvement strategies and other factors that have actually produced change in real-world settings.