Does a Quality Improvement Campaign Accelerate Take-Up of New Evidence?

A Ten-State Cluster-Randomized Controlled Trial of the IHI's Project JOINTS

Published in: Implementation Science, (2017)12:51. doi: 10.1186/s13012-017-0579-7 ; doi for erratum: 10.1186/s13012-017-0591-y

Posted on RAND.org on May 23, 2017

by Eric C. Schneider, Melony E. Sorbero, Ann C. Haas, M. Susan Ridgely, Dmitry Khodyakov, Claude Messan Setodji, Gareth Parry, Susan S. Huang, Deborah Yokoe, Donald Goldmann

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Research Question

  1. Would a quality improvement campaign be able to promote adherence to three new evidence-based practices to reduce infection risk after joint replacement surgery?

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.

Key Findings

  • A cluster randomized trial of a quality improvement campaign called Project JOINTS significantly increased adherence to evidence-based practices that can prevent post-surgical infection after hip and knee arthroplasty.
  • States that participated in the campaign improved more in adherence than states not included in the campaign.
  • The design of this randomized trial, and its use of comparison groups and baseline measurements, may prove useful for rapidly assessing the effects of large-scale quality improvement efforts.

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