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Declaration of Competing Interests

What Factors Affect Bundle Uptake in a Voluntary Quality Improvement Campaign? An Assessment of Project JOINTS Dmitry Khodyakov, PhD, MA M. Susan Ridgely, JD, MS Christina Huang, MPH Melony E. Sorbero, PhD, MS, MPH Eric C Schneider, MD, MSc. Declaration of Competing Interests.

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Declaration of Competing Interests

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  1. What Factors Affect Bundle Uptake in a Voluntary Quality Improvement Campaign?An Assessment of Project JOINTSDmitry Khodyakov, PhD, MAM. Susan Ridgely, JD, MSChristina Huang, MPHMelony E. Sorbero, PhD, MS, MPHEric C Schneider, MD, MSc

  2. Declaration of Competing Interests • All authors report no competing interests • This study was funded by a grant (R18 AE000051) awarded to the Institute for Healthcare Improvement and the RAND Corporation by the U.S. Department of Health and Human Services

  3. Background • Research points to delays in hospital adoption of evidence-based practices • The Institute for Healthcare Improvement (IHI) introduced a series of innovative strategies to accelerate the spread of such practices • IHI campaign model is an approach that leverages inter-organizational ties and interpersonal influence

  4. Project JOINTS • Project JOINTS (Joining Organizations INTackling SSIs) is one of the latest IHI campaigns • Two cohorts of hospitals (n=323) from 10 U.S. states were recruited • Project JOINTS was conducted in 2011-2012 • Hospitals implemented a 5-component bundle to prevent the spread of surgical site infection (SSI) after hip and knee arthroplasty

  5. Project JOINTS SSI Prevention Bundle • Use an alcohol-containing antiseptic agent for preoperative skin preparation • Instruct patients to bathe/shower with CHG soap for 3 days before surgery • Screen for Staphylococcus aureus (SA) carriage and decolonize SA carriers with 5 days of mupirocinand 3 days of chlorhexidine soap prior to surgery • Appropriate use of prophylactic antibiotics • Appropriate hair removal

  6. Rapid Spread Network (RSN) • RSN is a network of state-level organizations (nodes) that help hospitals catalyze quality improvement • This field infrastructure was developed by IHI during its 100,000 Lives and 5 Million Lives Campaigns

  7. Research Questions • What role did the RSN “nodes” play in Project JOINTS? • Are hospital adherence to quality improvement (QI) methods and the level of hospital engagement in the project associated with the bundle uptake?

  8. Research Methods • Node Interviews • 11 semi-structured interviews with node representatives from Cohorts 1 and 2 • Data were analyzed thematically utilizing Maxqda • Hospital Key Informant Interviews • 73 structured interviews with Cohort 2 hospital representatives (67% participation rate) • Responses were analyzed both qualitatively and quantitatively

  9. Project JOINTS Logic Model

  10. Node Engagement in Project JOINTS

  11. Two Benefits of Node Engagement • Expedite Hospital Recruitment • Have most updated hospital information • Know appropriate contacts • Play an Intermediary Role between IHI and Hospitals • Familiar and trusted source of information • Understand local context and add a personal touch

  12. Adherence to Quality Improvement Methods, Hospital Engagement, and Bundle Uptake

  13. 50 out of 73 Responding Hospitals Used ≥1 Project JOINTS QI Methods

  14. Hospital Engagement in Project JOINTS

  15. Webinar Calls, Electronic Communications, and How-To Guides Were Most Popular

  16. More Than Half of Participating Hospitals Adopted the Complete Bundle • However, most hospitals were already using three of the five components consistently: • Alcohol-containing antiseptic (74%) • Appropriate prophylactic antibiotics (85%) • Appropriate hair removal (99%) • Roughly a third of hospitals reported no change in their practices • Hospitals reporting change focused on new components

  17. Complete Bundle Adoption is Positively Associated with: • The Use of Project JOINTS QI Methods • OR=2.05; 95% CI: .91-4.62, p≤.1 AND • Hospital Engagement in Project JOINTS • OR=1.32; 95% CI: .97-1.81, p≤.1

  18. Initiation/Improved Adherence to Bundle Components is Only Associated with: • Hospital Engagement • IRR=1.11, 95% CI: 1.02-1.21, p≤.05 • The Use of Campaign Materials and Tools • IRR=1.13, 95% CI: 1.01-1.27, p≤.05

  19. Conclusions: The Role of the RSN Nodes • To identify and recruit hospitals • To confer legitimacy to the project • To be a conduit of information rather than a provider of hands-on assistance

  20. Conclusions: Bundle Uptake • More than half of Project JOINTS hospitals adopted the complete bundle • Most were already using 3 bundle components before Project JOINTS • Some reported only partial compliance • Roughly a third of hospitals reported no change in their practices

  21. Conclusions: Factors Affecting Bundle Uptake • The use of QI methods and hospital engagement are positively associated with complete bundle adoption • The use of online and printed IHI materials is positively associated with initiation/improved adherence to bundle components

  22. Lessons Learned • Future campaigns may benefit from increased efforts to actively engage hospitals • Nodes may help do this because they are perceived as trusted conduits of information • Attention should be paid to campaign materials as they are important for bundle uptake • Hospitals should understand and accept evidence behind bundle components • Components should be relatively easy to implement

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