Contextual Factors Associated with Implementation Effectiveness within a QIColla

描述（由申请人提供）：提高美国医院护理质量和安全的必要性是公认的。质量改进协作，即来自不同医院的多学科团队围绕一个共同的改进目标联合起来，是在美国和国外加速改进工作的一种流行方法。通过合作，医院分享将临床创新转化为常规实践的方法知识。虽然协作在直觉上是有意义的，但它们的实施成本很高，而且证明其益处的证据有限。最重要的是，人们对参与同一合作的医院之间绩效差异的来源知之甚少，也不知道参与者可以采取什么策略来增加他们成功的可能性。Premier医疗保健联盟最近启动了QUEST，这是一个为期3年的合作项目，已从全国550多家医院的网络中招募了160多家医院。QUEST旨在提高医院在多个质量领域的绩效，包括提高循证护理的依从性、降低成本、提高患者满意度和降低并发症发生率。QUEST合作项目最雄心勃勃的目标之一是降低经风险调整后的医院死亡率。为了实现这一目标，合作参与者正在尝试实施十多种临床实践，从“败血症包”到快速反应小组，旨在提高患有败血症和呼吸衰竭等高风险临床病症的患者的生存率。本研究的主要目的是通过应用一个理论框架来分析推荐临床实践的实施效果，从而调查合作参与者实施建议临床实践的差异来源，这个框架在商业中是众所周知的，但在医疗保健领域相对较新。为了实现这一目标，我们将调查QUEST医院的临床和行政领导，以评估对协作推荐临床实践的看法，以及医院实施环境和策略，如何影响成功实施协作推荐实践的机会（目标1）。然后，我们将检查推荐临床实践的实施与参与医院并发症和死亡率变化之间的关系（目标2）。最后，我们将通过检查参与医院和非参与医院的并发症和风险调整死亡率随时间的变化，对合作的总体影响进行严格评估（目标3）。进一步了解协作方法的好处，以及使一些医院脱颖而出的环境因素和战略，将为当前和未来的协作参与者和组织者提供可操作的信息，并将提高质量改进工作的有效性。

DESCRIPTION (provided by applicant): The need to improve the quality and safety of hospital care in the United States is well-recognized. Quality improvement collaboratives, in which multi-disciplinary teams from different hospitals unite around a common improvement goal, are a popular method for accelerating improvement efforts, both in the United States and abroad. Working collaboratively, hospitals share knowledge about methods to translate clinical innovations into routine practice. Although collaboratives make intuitive sense, they are costly to carry out, and evidence of their benefit is limited. Most significantly, little is known about the sources of performance variation among hospitals participating in the same collaborative, or about the strategies that participants can engage in to increase the likelihood that they will be successful. The Premier healthcare alliance recently launched QUEST, a 3 year collaborative that has enrolled more than 160 hospitals from a network of more than 550 hospitals nationwide. QUEST aims to improve hospital performance across multiple domains of quality, including increasing adherence to evidence based care, reducing costs, improving patient satisfaction, and decreasing rates of complications. One of the most ambitious goals of the QUEST collaborative is to reduce risk-adjusted hospital mortality rates. To accomplish this, collaborative participants are attempting to implement more than a dozen clinical practices, ranging from "sepsis bundles" to rapid response teams, intended to improve survival for patients with high-risk clinical conditions like sepsis and respiratory failure. The primary aim of this study is to investigate the sources of variation in the implementation of recommended clinical practices by collaborative participants by applying a theoretical framework for analyzing implementation effectiveness that is well known in business but relatively new to healthcare. To accomplish this we will survey clinical and administrative leaders at QUEST hospitals in order to assess how perceptions of collaborative-recommended clinical practices, together with the hospital implementation climate and strategies, influence the chances of successful implementation of collaborative recommended practices (Aim 1). We will then examine the association between the implementation of recommended clinical practices and change in complication and mortality rates at participating hospitals (Aim 2). Finally, we will conduct a rigorous evaluation of the overall impact of the collaborative by examining changes in complication and risk-adjusted mortality rates over time at participating and non-participating hospitals (Aim 3). Developing a greater understanding of the benefits of the collaborative approach, and of the contextual factors and strategies that enable some hospitals to excel, will provide actionable information to current and future collaborative participants and organizers, and will increase the effectiveness of quality improvement efforts. PUBLIC HEALTH RELEVANCE: A common approach for improving the quality and safety of hospital care in the United States involves bringing teams of doctors and nurses together from different hospitals to work collaboratively towards a common improvement goal. While the concept makes sense, quality improvement collaboratives are costly to run, and evidence of their benefit is limited. More importantly, little is known about why, within the same collaborative, some hospitals are more successful than others. Through surveys of senior hospital leaders and quality improvement staff, this study will examine how perceptions of new clinical practices, together with other hospital factors, contribute to successful implementation efforts. Additionally, this study will evaluate the effects of a large quality improvement collaborative focused on reducing hospital complication and death rates.