Effectiveness of a virtual quality improvement training program to improve reach of weight management programs within a large health system

IF 3.1 2区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Health Services Research Pub Date : 2024-07-25 DOI:10.1111/1475-6773.14344

Laura J. Damschroder MPH, MSc, Richard Evans MS, H. Myra Kim ScD, Jeremy Sussman MD, Michelle B. Freitag MPH, Claire H. Robinson MPH, Jennifer A. Burns MHSA, Nicholas R. Yankey MPH, MSW, Julie C. Lowery PhD

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引用次数: 0

Abstract

Objective

To test effectiveness of the LEAP (Learn Engage Act Process) Program on engaging frontline Veteran Health Administration (VHA) medical center teams in continuous quality improvement (QI), a core capability for learning health systems.

Data Sources and Study Setting

Data sources included VHA electronic health record (EHR) data, surveys, and LEAP coaching field notes.

Study Design

A staggered difference-in-differences study was conducted. Fifty-five facilities participated in LEAP across eight randomly assigned clusters of 6–8 facilities per cluster over 2 years. Non-participating facilities were used as controls. A MOVE! weight management program team completed a Plan-Do-Study-Act cycle of change supported by learning curriculum, coaching, and virtual collaboratives in LEAP facilities. Primary outcome was program reach to Veterans. A mixed-effects model compared pre- versus post-LEAP periods for LEAP versus control facilities. LEAP adherence, satisfaction, and cost to deliver LEAP were evaluated.

Data Collection/Extraction Methods

Thirty months of facility-level EHR MOVE! enrollment data were included in analyses. LEAP Satisfaction and QI skills were elicited via surveys at baseline and 6-month post-LEAP.

Principal findings

Fifty-five facilities were randomly assigned to eight time-period-based clusters to receive LEAP (71% completed LEAP) and 82 non-participating facilities were randomly assigned as controls. Reach in LEAP and control facilities was comparable in the 12-month pre-LEAP period (p = 0.07). Though LEAP facilities experienced slower decline in reach in the 12-month post-LEAP period compared with controls (p < 0.001), this is likely due to unexplained fluctuations in controls. For LEAP facilities, satisfaction was high (all mean ratings >4 on a 5-point scale), self-reported use of QI methods increased significantly (p-values <0.05) 6 months post-LEAP, and delivery cost was $4024 per facility-based team.

Conclusion

Control facilities experienced declining reach in the 12-month post-LEAP period, but LEAP facilities did not, plus they reported higher engagement in QI, an essential capability for learning health systems.

Abstract Image

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虚拟质量改进培训项目对提高大型医疗系统体重管理项目覆盖率的效果。

目标：测试LEAP（Learn Engage Act Process，学习、参与、行动过程）计划对退伍军人健康管理局（VHA）医疗中心一线团队参与持续质量改进（QI）的有效性，持续质量改进是学习型医疗系统的核心能力：研究设计：研究设计：开展了一项交错差异研究。55家医疗机构参加了LEAP，随机分配了8个群组，每个群组6-8家医疗机构，为期2年。未参与的机构作为对照组。MOVE！体重管理计划团队在 LEAP 机构中完成了 "计划-执行-研究-行动 "的变革周期，并辅以学习课程、辅导和虚拟协作。主要结果是该计划对退伍军人的影响。一个混合效应模型比较了 LEAP 与对照设施的 LEAP 前和 LEAP 后时期。数据收集/提取方法：30 个月的设施级 EHR MOVE!通过基线调查和 LEAP 结束后 6 个月的调查，了解 LEAP 满意度和 QI 技能：55家机构被随机分配到8个基于时间段的群组中接受LEAP（71%完成了LEAP），82家未参与LEAP的机构被随机分配为对照组。在LEAP实施前的12个月内，LEAP设施和对照设施的覆盖率相当（p = 0.07）。与对照组相比，LEAP 机构在 LEAP 后 12 个月的覆盖率下降较慢（5 分制，p 4），但自我报告的 QI 方法使用率显著增加（p 值结论：LEAP 机构在 LEAP 后 12 个月的覆盖率下降较慢，但自我报告的 QI 方法使用率显著增加：LEAP实施后的12个月内，对照组医疗机构的覆盖率有所下降，但LEAP医疗机构的覆盖率没有下降。

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来源期刊

Health Services Research 医学-卫生保健

CiteScore

4.80

自引率

5.90%

发文量

193

审稿时长

4-8 weeks

期刊介绍： Health Services Research (HSR) is a peer-reviewed scholarly journal that provides researchers and public and private policymakers with the latest research findings, methods, and concepts related to the financing, organization, delivery, evaluation, and outcomes of health services. Rated as one of the top journals in the fields of health policy and services and health care administration, HSR publishes outstanding articles reporting the findings of original investigations that expand knowledge and understanding of the wide-ranging field of health care and that will help to improve the health of individuals and communities.