BMJ Open Quality最新文献

Objectives: This research aimed to identify and co-design recommendations to optimise adolescent and young adult (AYA) healthcare through the development of a statewide strategy.

Methods: An exploratory mixed methods co-design constructionist epistemological framework was used to identify recommendations. Participants comprised young people (15-25 years of age) with experience accessing healthcare for acute or chronic concerns, carers and professionals. Focus groups and a statewide survey were conducted concurrently.

Results: Eighty-one individuals varying in location and fields across Queensland participated in nine focus groups. Themes and subthemes were successfully identified through the thematic analysis of the focus groups. Within the context of barriers and enablers, participants identified gaps and proposed recommendations to optimise care. Across the nine focus groups, consistent themes emerged, demonstrating sufficient data collection and saturation of responses. Additionally, 107 responses were collected, scored and ranked through the statewide survey prioritising predetermined recommendations to optimise AYA care, based on scoping work completed in 2020. Of the 57 recommendations presented to survey participants, 41 (71.9%) of these were classified as 'needed' and 'very important' to optimise AYA healthcare. Collective thematic analysis resulted in a list of prioritised recommendations to improve healthcare services for AYAs.

Conclusion: The research highlighted two central priorities: overcoming systemic challenges within AYA healthcare and establishing a clear, consistent definition and model of quality care in Queensland. The combined findings strongly support the urgent need to embed standardised principles, approaches and practices across the health system to ensure equitable and effective care for all young people.

Background: The overall rates of colorectal cancer (CRC) in the US population have been declining steadily over the past 30 years, in large part due to timely cancer screenings. Despite the emergence of new screening modalities, a large portion of the population has not completed CRC screening in accordance with guidelines. Adequate and timely screening can prevent or detect CRC in earlier stages. Various factors have been identified that influence screening completion. Lower screening rates have been associated with the underserved population, especially in the immigrant community and patients with inadequate access to healthcare. In the USA, primary care clinics associated with internal and family medicine residency programmes often serve as catch-net clinics for the community, serving to provide care to those with a higher burden of social determinants of health.

Objective: We aimed to increase the rates of CRC screening in a primary care clinic associated with the internal medicine residency programme of a large healthcare system. In October 2021, the clinic had a CRC screening rate of 55.40%.

Methods: This prospective quality improvement study was implemented from July 2022 to January 2025 at the resident-run clinic. Data on CRC screening completion were analysed monthly.

Interventions: Six Plan-Do-Study-Act cycles were implemented over the course of the project. These interventions were developed from results of root-cause analyses as well as feedback from patients and providers.

Results: CRC screening rates rose from 55.40% to 65.79% over the period of interest with the implementation of sequential targeted interventions.

Conclusions: Underserved patients are at higher risk of CRC screening incompletion. Multifaceted interventions and multidisciplinary collaboration are essential for increasing CRC screening in this vulnerable population.

Background: Sodium-Glucose Transporter-2 (SGLT2) inhibitors provide both cardiorenal and metabolic benefits but have several adverse side effects. Effective patient education is critical to ensure safe use and patient compliance. This project aimed to assess and address gaps in patient knowledge about SGLT2-inhibitors.

Methods and results: This quality improvement project was conducted in two tertiary and one district general hospitals in the UK in patients who had been prescribed SGLT2-inhibitors for either diabetes or heart failure. Initially, 100 patients were surveyed on their understanding of SGLT2-inhibitor use, including awareness of indications and side-effects. A patient information leaflet was developed in collaboration with the community pharmacy team and distributed to patients. Six months later, a follow-up survey of 54 patients evaluated their confidence in medication use and knowledge of adverse effects.The initial survey revealed: 70% were unaware of their medication, 12% had read the manufacturer's information, 5% were aware of sick-day rules and 12% recognised the risk of UTIs. Diabetic patients demonstrated low awareness of the risk of euglycaemic ketoacidosis (11%) and foot complications (5.6%). Diabetic patients also had higher hospitalisation rates due to drug-related adverse effects. 98% of patients agreed that receiving information about side effects was important. Postintervention, 100% of surveyed patients reported confidence in using SGLT2-inhibitors and knowing when to seek medical advice.

Conclusion: This initiative demonstrates that patients generally lack knowledge regarding the use of SGLT2-inhibitors. Patient education is crucial in improving understanding and medication compliance. Implementing accessible supplemental resources can enhance continued compliance and safety.

Introduction: Eliminating vertical HIV transmission requires high-quality Option B+ services, which provide lifelong antiretroviral therapy to pregnant and breastfeeding women living with HIV. In Malawi, coverage has expanded, but quality remains suboptimal, contributing to challenges in sustaining engagement in care. Quality improvement (QI) approaches can strengthen service delivery and evidence-based practices, with healthcare workers (HCWs) central to implementation. This study explores barriers and opportunities HCWs face in implementing QI in Option B+ within high-volume urban facilities in Lilongwe, Malawi.

Methods: A descriptive phenomenological qualitative study was conducted between March and June 2021 in five health facilities in Lilongwe, Malawi. Semistructured in-depth interviews were conducted with 30 purposively selected HCWs (4-8 per facility) involved in delivering Option B+ services. Thematic analysis was used, with data coded deductively and inductively. The Consolidated Framework for Implementation Research was applied to map the identified themes into relevant domains and constructs.

Results: QI practices among HCWs were hindered by resource constraints, lack of incentives/reimbursement for QI activities conducted beyond working hours, poor communication between QI teams and implementers and resistance or negative attitudes towards QI. Opportunities to enhance QI included increasing meeting frequency, providing mentorship, peer-to-peer learning through exchange visits and securing funding from development partners.

Conclusion: Improving QI utilisation in Option B+ requires mobilising resources and having a structured feedback and mentorship mechanisms. Targeted incentives/reimbursements for HCWs and peer-to-peer learning through exchange visits between facilities can further enhance QI. Therefore, a blended QI approach incorporating these recommendations is needed to better support HCWs in delivering evidence-based interventions, strengthen the health system and may improve engagement outcomes.

Objective: This rapid review aims to understand whether a standardised approach to developing quality standards and indicators for mental health has been used across the WHO European Region and beyond to inform methods to develop quality standards for child and adolescent mental health services.

Introduction: Improving the quality of child and adolescent mental healthcare across the WHO European Region is a priority. Despite advances in quality of care for mental health, many challenges remain, including the lack of a standardised approach to quality improvement.

Inclusion criteria: Papers that outline methods used to develop quality standards or indicators for mental healthcare, published since the year 2000 in English and for use in the WHO European Region, Australia, Canada or the USA, were included.

Methods: Methods were based on guidance from the Joanna Briggs Institute and WHO. Searches were conducted across PubMed, Scopus, PsycInfo and Google Scholar from 16 January to 30 January 2024. The titles/abstracts and full-text articles were screened by two reviewers independently, and the inclusion/exclusion criteria were applied. A template based on five steps proposed to develop health indicators was used to extract relevant data by one reviewer and verified by another.

Results: 21 studies were included in the review. All papers originated from high-income countries, with dominance from the USA, Canada and the UK. Most papers described four or five of the five proposed steps; however, there was variation in the extent to which these steps were described and how they were implemented.

Discussion: The results suggest that no consistent approach has been used to develop quality standards/indicators for mental healthcare. There is a need for more participation from people with lived experience and for more research across a wider geographic area.

Prsopero registration number: CRD42024496509.

Background: Foreign body ingestion is a common reason for paediatric emergency department (ED) attendance. At baseline in our institution, only 55% of children were managed in accordance with international best practice. No local guideline was in place.

Aim: To implement a locally developed guideline and educational intervention to improve adherence to best practice in the management of paediatric foreign body ingestion.

Methods: We conducted a quality improvement project in a single tertiary ED over 5 months, using three plan-do-study-act (PDSA) cycles. Interventions included guideline development, dissemination at NCHD induction and departmental teaching and case-based discussions. The SMART aim was to improve correct management from 55% to >80% within 5 months. The primary outcome measure was the proportion of cases managed correctly according to the guideline. Process measures were unnecessary imaging and inappropriate specialist referrals; return visits were tracked as a balancing measure. Data were analysed descriptively and displayed using a p-chart. Educational impact was explored with case vignettes.

Results: 27 consecutive patients were included in the intervention period. Correct management increased from 55% at baseline to 87%-100% across PDSA cycles, exceeding the SMART aim. Process measures improved: unnecessary imaging decreased from 16% to 12% and inappropriate referrals from 3% to 0%. Avoidable return visits fell from 4% to 0%, without evidence of harm. Case vignette scores improved modestly (54%-63%), with variation across individual cases.

Conclusion: Introduction of a locally developed guideline significantly improved adherence to best practice in paediatric foreign body ingestion. Improvements extended to process and balancing measures, demonstrating a true test of change. Embedding the guideline in induction, teaching and the hospital intranet is expected to support sustainability.

Background: Quality improvement strategies are used in healthcare to enhance the quality, safety and efficiency of service delivery. While the involvement of managers is considered critical, their roles remain underdocumented. This study examines the roles of managers in COMPAS+, a quality improvement collaborative conceived to enhance chronic disease care in Quebec, Canada. It explores managers' specific contributions to quality improvement projects to deepen understanding of effective managerial engagement.

Methods: This qualitative case study compares the roles played by managers (health network directors, division managers and local service network and family medicine group directors) within four regional health networks that participated in COMPAS+ from 2016 to 2019. Deductive and inductive thematic analysis of workshop reports, action plans and interviews with 24 key actors was performed, informed by a recent scoping review of decision-makers' roles in quality improvement projects and project management literature.

Results: The study revealed variability in project management across cases, particularly in the distribution of responsibility among upper, middle and lower management. Upper management provided strategic direction, middle management oversaw project execution and bridged organisational tiers, while lower management coordinated local change efforts. Middle managers were tasked with project management but often lacked role clarity and training. A significant gap was found in methodological guidance, typically provided by a quality improvement facilitator. This gap hindered projects' potential and, in some cases, led to deviations from the intended quality improvement model.

Conclusions: Effective quality improvement project management requires well-defined managerial roles, training and communication between management levels. Our findings highlight the importance of integrating a facilitator role to provide methodological expertise and ensure adherence to quality improvement processes. Contextual expertise and local change leadership may be complemented by external quality improvement expertise. These insights lay the groundwork for future research on evidence-based strategies for effective project management.

Background: Enhanced recovery after caesarean delivery (ERAC) is gaining popularity and has been shown to improve maternal and neonatal outcomes. We aimed to identify the presence and type of quality improvement (QI) methodology used in ERAC studies through an exploratory analysis, including author surveys and literature review.

Methods: We performed a literature search using four databases (MEDLINE through PubMed, Cumulative Index of Nursing and Allied Health Literature, Web of Science and Embase) to identify ERAC studies. Studies were considered if they compared an 'enhanced' or 'fast track' protocol to a control group and evaluated more than one system or outcome. The adopted QI methodology was evaluated through a standardised questionnaire developed by the authors which was sent to the authors of included studies.

Results: We identified 29 studies. A standardised questionnaire was applied to all included papers to evaluate the presence and type of QI methodology, and 24 authors were approached to complete the survey. We received results from 15 authors, yielding a response rate of 63%. 40% of authors reported use of defined QI methodology, the majority using the Model for Improvement. The QI components most used by those not reporting use of a defined methodology were engagement with multidisciplinary key stakeholders (80%), use of key drivers (87%) and process mapping (60%). Most authors reported use of traditional statistical methodology when analysing results (73%), and 60% reported use of Standards for Quality Improvement Reporting Excellence guidelines. The mean duration of baseline data collection by non-randomised controlled trial studies was 11 months and 9.9 months after implementation.

Conclusion: There is a large variation in the QI practices used in protocol implementation and publication of ERAC studies. The minority of authors report the use of a defined QI methodology and very few report the use of standardised tools in their published works.

Prospero registration number: CRD42023399418.

Introduction: Sudden unexpected infant death (SUID) remains a leading cause of infant mortality in the USA, disproportionately affecting Black/African American infants. In Cook County, Illinois, Black/African American infants had SUID rates 14 times higher than non-Hispanic white infants between 2020 and 2021. Despite widespread safe sleep education, racial disparities persist. Our Specific, Measurable, Acheivable, Relevant, and Time-Bound (SMART) aim was to increase safe sleep compliance among mothers of Black/African American infants discharged from our neonatal intensive care unit (NICU) by 5% over 12 months by providing targeted, equitable and culturally sensitive education, measured using an adapted validated safe sleep survey.

Methods: This project, conducted in a level III NICU at the University of Illinois Hospital in Chicago began planning in May 2023. Baseline data were collected (November 2023-February 2024) via caregiver surveys and chart reviews. Plan-Do-Study-Act (PDSA) cycles (March-November 2024) introduced interventions like the 'Alone-Back-Crib' (ABC) Safe Sleep handouts on SUID disparities, staff education, and short videos. Compliance was assessed postdischarge through surveys and clinic questionnaires, with preintervention and postintervention data analysed using χ² and t-tests. A control chart (p-chart) tracked process changes.

Results: Among 248 infants (70 baseline, 178 intervention), mean safe sleep compliance increased from 96% to 97% (p=0.26). Reports of infants 'never' sleeping alone in a crib declined from 11.4% to 3.9% (p=0.01). Caregivers valued enhanced messaging on SUID disparities.

Conclusions: Despite high baseline compliance, culturally tailored education reinforced safe sleep practices. While overall adherence changed minimally, increased awareness and behavioural shifts highlight the need for sustained interventions, community engagement, implicit bias training and systemic strategies to reduce racial disparities in SUID.