Racial and Ethnic Differences in Length of Stay for US Children Hospitalized for Acute Osteomyelitis.

Objective: To examine the associations between race and ethnicity and length of stay (LOS) for US children with acute osteomyelitis.

Study Design: Using the Kids' Inpatient Database, we conducted a cross-sectional study of children <21 years old hospitalized in 2016 or 2019 with acute osteomyelitis. Using survey-weighted negative binomial regression, we modeled LOS by race and ethnicity, adjusting for clinical and hospital characteristics and socioeconomic status.

The CONFIDENT study protocol: a randomized controlled trial comparing two methods to increase long-term care worker confidence in the COVID-19 vaccines.

Background: Clinical and real-world effectiveness data for the COVID-19 vaccines have shown that they are the best defense in preventing severe illness and death throughout the pandemic. However, in the US, some groups remain more hesitant than others about receiving COVID-19 vaccines. One important group is long-term care workers (LTCWs), especially because they risk infecting the vulnerable and clinically complex populations they serve.

Characteristics of achieving clinically important weight loss in two paediatric weight management interventions.

Objective: To examine characteristics and lifestyle behaviours associated with achieving clinically important weight loss (CIWL) in two paediatric weight management interventions (PWMIs).

Methods: We examined 1010 children enrolled in the STAR and Connect for Health trials. We defined achieving CIWL as any participant who had decreased their BMI z-score by ≥0.

Effectiveness of a multistate quality improvement campaign in reducing risk of surgical site infections following hip and knee arthroplasty.

Background: Quality improvement (QI) campaigns appear to increase use of evidence-based practices, but their effect on health outcomes is less well studied.

Objective: To assess the effect of a multistate QI campaign (Project JOINTS, Joining Organizations IN Tackling SSIs) that used the Institute for Healthcare Improvement's Rapid Spread Network to promote adoption of evidence-based surgical site infection (SSI) prevention practices.

Methods: We analysed rates of SSI among Medicare beneficiaries undergoing hip and knee arthroplasty during preintervention (May 2010 to April 2011) and postintervention (November 2011 to September 2013) periods in five states included in a multistate trial of the Project JOINTS campaign and five matched comparison states.

A framework for learning about improvement: embedded implementation and evaluation design to optimize learning.

Improving health care involves many actors, often working in complex adaptive systems. Interventions tend to be multi-factorial, implementation activities diverse, and contexts dynamic and complicated. This makes improvement initiatives challenging to describe and evaluate as matching evaluation and program designs can be difficult, requiring collaboration, trust and transparency.

Highly Adoptable Improvement: A Practical Model and Toolkit to Address Adoptability and Sustainability of Quality Improvement Initiatives.

Background: Failure to consider the impact of change on health care providers is a barrier to success. Initiatives that increase workload and have low perceived value are less likely to be adopted. A practical model and supporting tools were developed on the basis of existing theories to help quality improvement (QI) programs design more adoptable approaches.

Practical recommendations for the evaluation of improvement initiatives.

A lack of clear guidance for funders, evaluators and improvers on what to include in evaluation proposals can lead to evaluation designs that do not answer the questions stakeholders want to know. These evaluation designs may not match the iterative nature of improvement and may be imposed onto an initiative in a way that is impractical from the perspective of improvers and the communities with whom they work. Consequently, the results of evaluations are often controversial, and attribution remains poorly understood.

Salzburg Global Seminar Session 565-'Better Health Care: how do we learn about improvement?'.

A fundamental question for the field of healthcare improvement is the extent to which the results achieved can be attributed to the changes that were implemented and whether or not these changes are generalizable. Answering these questions is particularly challenging because the healthcare context is complex, and the interventions themselves tend to be complex and multi-dimensional. The Salzburg Global Seminar Session 565-'Better Health Care: How do we learn about improvement?' was convened to address questions of attribution, generalizability and rigor, and to think through how to approach these concerns in the field of quality improvement.

Are quality improvement collaboratives effective? A systematic review.

Background: Quality improvement collaboratives (QIC) have proliferated internationally, but there is little empirical evidence for their effectiveness.

Method: We searched Medline, Embase, CINAHL, PsycINFO and the Cochrane Library databases from January 1995 to December 2014. Studies were included if they met the criteria for a QIC intervention and the Cochrane Effective Practice and Organisation of Care (EPOC) minimum study design characteristics for inclusion in a review.

Randomized Trial of Reducing Ambulatory Malpractice and Safety Risk: Results of the Massachusetts PROMISES Project.

Objective: Evaluate application of quality improvement approaches to key ambulatory malpractice risk and safety areas.

Study Setting: In total, 25 small-to-medium-sized primary care practices (16 intervention; 9 control) in Massachusetts.

Study Design: Controlled trial of a 15-month intervention including exposure to a learning network, webinars, face-to-face meetings, and coaching by improvement advisors targeting "3+1" high-risk domains: test result, referral, and medication management plus culture/communication issues evaluated by survey and chart review tools.

Does a quality improvement campaign accelerate take-up of new evidence? A ten-state cluster-randomized controlled trial of the IHI's Project JOINTS.

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.

Choosing Wisely in Newborn Medicine: Five Opportunities to Increase Value.

Background: The use of unnecessary tests and treatments contributes to health care waste. The "Choosing Wisely" campaign charges medical societies with identifying such items. This report describes the identification of 5 tests and treatments in newborn medicine.

Evaluating ambulatory practice safety: the PROMISES project administrators and practice staff surveys.

Background: Ambulatory practices deliver most health care services and contribute to malpractice risk. Yet, policymakers and practitioners often lack information about safety and malpractice risk needed to guide improvement.

Objective: To assess staff and administrator perceptions of safety and malpractice risk in ambulatory settings.

Health care-associated infections among critically ill children in the US, 2007-2012.

Background: Health care-associated infections (HAIs) are harmful and costly and can result in substantial morbidity for hospitalized children; however, little is known about national trends in HAIs in neonatal and pediatric populations. Our objective was to determine the incidence of HAIs among a large sample of hospitals in the United States caring for critically ill children from 2007 to 2012.

Methods: In this cohort study, we included NICUs and PICUs located in hospitals reporting data to the Centers for Disease Control and Prevention's National Healthcare Safety Network for central line-associated bloodstream infections (CLABSIs), ventilator-associated pneumonias, and catheter-associated urinary tract infections.

Measuring Hospital-Wide Mortality-Pitfalls and Potential.

Risk-adjusted hospital-wide mortality has been proposed as a key indicator of system-level quality. Several risk-adjusted measures are available, and one-the hospital standardized mortality ratio (HSMR) - is publicly reported in a number of countries, but not in the United States. This paper reviews potential uses of such measures.

Teamwork methods for accountable care: relational coordination and TeamSTEPPS®.

Background: To deliver greater value in the accountable care context, the Institute of Medicine argues for a culture of teamwork at multiple levels--across professional and organizational siloes and with patients and their families and communities. The logic of performance improvement is that data are needed to target interventions and to assess their impact. We argue that efforts to build teamwork will benefit from teamwork measures that provide diagnostic information regarding the current state and teamwork interventions that can respond to the opportunities identified in the current state.