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BackgroundQuality improvement collaboratives (QIC) have proliferated internationally, but there is little empirical evidence for their effectiveness.MethodWe searched Medline, Embase, CINAHL, PsycINFO and the Cochrane Library databases from January 1995 to December 2014. Studies were included if they met the criteria for a QIC intervention and the Cochrane Effective Practice and Organisation of Care (EPOC) minimum study design characteristics for inclusion in a review. We assessed study bias using the EPOC checklist and the quality of the reported intervention using a subset of SQUIRE 1.0 standards.ResultsOf the 220 studies meeting QIC criteria, 64 met EPOC study design standards for inclusion. There were 10 cluster randomised controlled trials, 24 controlled before-after studies and 30 interrupted time series studies. QICs encompassed a broad range of clinical settings, topics and populations ranging from neonates to the elderly. Few reports fully described QIC implementation and methods, intensity of activities, degree of site engagement and important contextual factors. By care setting, an improvement was reported for one or more of the study’s primary effect measures in 83% of the studies (32/39 (82%) hospital based, 17/20 (85%) ambulatory care, 3/4 nursing home and a sole ambulance QIC). Eight studies described persistence of the intervention effect 6 months to 2 years after the end of the collaborative. Collaboratives reporting success generally addressed relatively straightforward aspects of care, had a strong evidence base and noted a clear evidence-practice gap in an accepted clinical pathway or guideline.ConclusionsQICs have been adopted widely as an approach to shared learning and improvement in healthcare. Overall, the QICs included in this review reported significant improvements in targeted clinical processes and patient outcomes. These reports are encouraging, but most be interpreted cautiously since fewer than a third met established quality and reporting criteria, and publication bias is likely.

Since their discovery last century, antibiotics have served society well by saving tens of millions of lives. [...] carbapenems, an antibiotic class that represents the last available weapon against many gram-negative bacilli, are being used increasingly for empirical therapy.

DescriptionThe Quality Improvement field has evolved with a set of methods and tools that support change at multiple levels of the health and health care systems. The impact, scale and sustainability of improvement work is determined by project designs that can accommodate or understand bias and can adapt to continuous learning. Thoughtful design and evaluation are critical for disseminating and scaling up promising improvement programs.The impact and influence of our work can be enhanced by a simple 3-part evaluation framework for improvement research and evaluation that synthesizes existing tools and frameworks from improvement and implementation sciences. The session is directed at QI practitioners and researchers who are responsible for designing improvement work for their organizations and improvement and implementation researchers who are evaluating and disseminating the impact and learning of QI work. Approaches will support improvers to design programs that mitigate biases that otherwise could undermine the credibility of their work and to incorporate rigorous evaluation that will demonstrate how and why the programs did (or did not) work as planned. The session will illustrate the key points of problems and solutions for impact and learning, and the use of the framework through extensive use of examples and case studies of published QI work. Participants will learn how to apply the core design principles and the evaluation framework to achieve greater impact, scale and sustainability of their work, and greater influence of their work though more effective dissemination and publication.

Background Clinical and real-world effectiveness data for the COVID-19 vaccines have shown that they are the best defense in preventing severe illness and death throughout the pandemic. However, in the US, some groups remain more hesitant than others about receiving COVID-19 vaccines. One important group is long-term care workers (LTCWs), especially because they risk infecting the vulnerable and clinically complex populations they serve. There is a lack of research about how best to increase vaccine confidence, especially in frontline LTCWs and healthcare staff. Our aims are to: (1) compare the impact of two interventions delivered online to enhanced usual practice on LTCW COVID-19 vaccine confidence and other pre-specified secondary outcomes, (2) determine if LTCWs’ characteristics and other factors mediate and moderate the interventions’ effect on study outcomes, and (3) explore the implementation characteristics, contexts, and processes needed to sustain a wider use of the interventions. Methods We will conduct a three-arm randomized controlled effectiveness-implementation hybrid (type 2) trial, with randomization at the participant level. Arm 1 is a dialogue-based webinar intervention facilitated by a LTCW and a medical expert and guided by an evidence-based COVID-19 vaccine decision tool. Arm 2 is a curated social media web application intervention featuring interactive, dynamic content about COVID-19 and relevant vaccines. Arm 3 is enhanced usual practice, which directs participants to online public health information about COVID-19 vaccines. Participants will be recruited via online posts and advertisements, email invitations, and in-person visits to care settings. Trial data will be collected at four time points using online surveys. The primary outcome is COVID-19 vaccine confidence. Secondary outcomes include vaccine uptake, vaccine and booster intent for those unvaccinated, likelihood of recommending vaccination (both initial series and booster), feeling informed about the vaccines, identification of vaccine information and misinformation, and trust in COVID-19 vaccine information provided by different people and organizations. Exploration of intervention implementation will involve interviews with study participants and other stakeholders, an in-depth process evaluation, and testing during a subsequent sustainability phase. Discussion Study findings will contribute new knowledge about how to increase COVID-19 vaccine confidence and effective informational modalities for LTCWs. Trial registration NCT05168800 at ClinicalTrials.gov, registered December 23, 2021.

Controlling Global Antimicrobial ResistanceDespite efforts to address antimicrobial resistance, many challenges remain, particularly in low- and middle-income countries. Several steps could be taken to accelerate progress.

Following the publication of the original article [1], it was brought to our attention that the title contained an error: “The Institute for Healthcare Improvement’s Project JOINTS” was incorrectly included as “the Institute for Health Improvement’s Project JOINTS”. The title has been corrected to read: “Does a quality improvement campaign accelerate take-up of new evidence? A ten-state cluster-randomized controlled trial of the IHI’s Project JOINTS”. The corrected title has been included in this erratum and updated in the original article.

Background A decade ago, the Institute for Healthcare Improvement pioneered a quality improvement (QI) campaign, leveraging organizational and personal social networks to disseminate new practices. There have been few rigorous studies of the QI campaign approach. Methods Project JOINTS (Joining Organizations IN Tackling SSIs) engaged a network of state-based organizations and professionals in a 6-month QI campaign promoting adherence to three new evidence-based practices known to reduce the risk of infection after joint replacement. We conducted a cluster-randomized trial including ten states (five campaign states and five non-campaign states) with 188 hospitals providing joint replacement to Medicare. We measured adherence to the evidence-based practices before and after the campaign using a survey of surgical staff and a difference-in-difference design with multivariable adjustment to compare adherence to each of the relevant practices and an all-or-none composite measure of the three new practices. Results In the campaign states, there were statistically significant increases in adherence to the three new evidence-based practices promoted by the campaign. Compared to the non-campaign states, the relative increase in adherence to the three new practices in the campaign states ranged between 1.9 and 15.9 percentage points, but only one of these changes (pre-operative nasal screening for Staphylococcus aureus carriage and decolonization prior to surgery) was statistically significant ( p  < 0.05). On the all-or-none composite measure, adherence to all three evidence-based practices increased from 19.6 to 37.9% in the campaign states, but declined slightly in the comparison states, yielding a relative increase of 23 percentage points ( p  = 0.004). In the non-campaign states, changes in adherence were not statistically significant. Conclusions Within 6 months, in a cluster-randomized trial, a multi-state campaign targeting hospitals and professionals involved in surgical care and infection control was associated with an increase in adherence to evidence-based practices that can reduce surgical site infection.

Healthcare personnel often find it challenging to incorporate disciplined quality improvement into their daily work. Planning, managing and completing improvement projects with sufficient rigour to generate credible evidence and potentially publishable knowledge are even more difficult. Nonetheless, careful set-up and agile leveraging of existing resources and expertise can lead to surprisingly robust results. Project designs that integrate data collection with the work itself are especially helpful. Although the general perception is that top-flight journals are loath to publish the results of quality improvement work, accumulating experience suggests that this hurdle can be overcome. The Standards for Quality Improvement Reporting Excellence guidelines provide a promising framework for crafting publications that can meet the exacting standards of peer-reviewed journals.

[...]only analysis of the per-protocol population comparing rates of all bloodstream infections surpassed the threshold for statistical significance--the adjusted incidence rate ratio was 0·64 (95% CI 0·42-0·98; incidence 3·28 vs 4·93 per 1000 days).

[...]roughly 50% of national legislators first served as state legislators; state legislator positions can be considered close proxies for those of Congress.3,4 THE SURVEY We worked with health policy experts who had experience of one or more of federal or state policymaking, federal or state policy analysis, and health care delivery organization. Assessing Policy Figure 1 reflects many of the goals of the ACA (Democrats) and proposals for its repeal (Republicans); a Democratic-only health reform prioritizes improved access and government-led efforts to improve health, whereas a Republican-only reform prioritizes reduced costs for individuals, limited government involvement, and reduced government spending. [...]policies to tackle costs must not have a negative impact on other goals important to each party-namely, improving health and smaller government. [...]given the seemingly inexorable upward trajectory in health care expenses, expectations for success must be modest. Encouragingly, existing bipartisan efforts at payment reform align well within such a framework, as they are intended to reduce costs while improving the delivery of health care services (and, ultimately, improving health).