Cluster randomised evaluation of a training intervention to increase the use of statistical process control charts for hospitals in England: making data count.

IF 5.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
Kelly Ann Schmidtke, Laura Kudrna, Laura Quinn, Paul Bird, Karla Hemming, Zoe Venable, Richard Lilford
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引用次数: 0

Abstract

Background: The way that data are presented can influence quality and safety initiatives. Time-series charts highlight changes but do not clarify whether data lie outside expected variation. Statistical process control (SPC) charts make this distinction and have been demonstrated to be effective in supporting hospital initiatives. To improve the uptake of the SPC methodology by hospitals in England, a training intervention was created. The current study evaluates the effectiveness of that training against the background of a wider national initiative to encourage the adoption of SPC charts.

Methods: A parallel cluster randomised trial was conducted with 16 English NHS hospitals. Half were randomised to the training intervention and half to the control. The primary analysis compares the difference in use of SPC charts within hospital board papers in a postrandomisation period (adjusting for baseline use). Trainees completed feedback forms with Likert scale and open-ended items.

Results: Fifteen hospitals participated across the study arms. SPC chart use increased in both intervention and control hospitals between the baseline and postrandomisation period (29 and 30 percentage points, respectively). There was no statistically significant difference between the intervention and control hospitals in use of SPC charts in the postrandomisation period (average absolute difference 9% (95% CI -34% to 52%). In the feedback forms, 93.9% (n=31/33) of trainees affirmed learning and 97.0% (n=32/33) had formed an intention to change their behaviour.

Conclusions: Control chart use increased in both intervention and control hospitals. This is consistent with a rising tide and/or contamination effect, such that the culture of control chart use is spreading across hospitals in England. Further research is needed to support hospitals implementing SPC training initiatives and to link SPC implementation to quality and safety outcomes. Such research could support future quality and safety initiatives nationally and internationally.

Trial registration number: NCT04977414.

对英格兰医院增加使用统计过程控制图的培训干预进行分组随机评估:让数据发挥作用。
背景:数据的展示方式会影响质量和安全措施。时间序列图能突出显示变化,但无法说明数据是否超出预期变化范围。统计过程控制(SPC)图表则能区分这一点,并被证明能有效支持医院的各项举措。为了提高英国医院对 SPC 方法的使用率,我们制定了一项培训干预措施。本研究评估了在鼓励采用 SPC 图表的更广泛的全国性倡议背景下培训的有效性:在 16 家英国国家医疗服务系统医院中开展了一项平行分组随机试验。一半医院被随机分配接受培训干预,一半医院被随机分配接受对照。主要分析比较随机化后医院董事会文件中 SPC 图表使用情况的差异(调整基线使用情况)。受训人员填写了带有李克特量表和开放式项目的反馈表:15 家医院参与了两组研究。从基线到随机后,干预医院和对照医院的 SPC 图表使用率均有所提高(分别提高了 29 个百分点和 30 个百分点)。在随机后阶段,干预医院和对照医院在使用SPC图表方面没有明显的统计学差异(平均绝对差异为9% (95% CI -34%至52%))。在反馈表中,93.9%(n=31/33)的受训人员肯定了学习成果,97.0%(n=32/33)的受训人员表示有意改变自己的行为:结论:干预医院和对照医院的对照表使用率都有所提高。结论:干预医院和对照医院的控制图使用率都有所提高,这与涨潮和/或污染效应相一致,即控制图使用文化正在英格兰的医院中传播。需要进一步开展研究,以支持医院实施 SPC 培训计划,并将 SPC 的实施与质量和安全结果联系起来。此类研究可为国内外未来的质量与安全倡议提供支持:NCT04977414.
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
BMJ Quality & Safety
BMJ Quality & Safety HEALTH CARE SCIENCES & SERVICES-
CiteScore
9.80
自引率
7.40%
发文量
104
审稿时长
4-8 weeks
期刊介绍: BMJ Quality & Safety (previously Quality & Safety in Health Care) is an international peer review publication providing research, opinions, debates and reviews for academics, clinicians and healthcare managers focused on the quality and safety of health care and the science of improvement. The journal receives approximately 1000 manuscripts a year and has an acceptance rate for original research of 12%. Time from submission to first decision averages 22 days and accepted articles are typically published online within 20 days. Its current impact factor is 3.281.
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