Assessments of community mental health support systems: A key informant approach

This article describes the development of a ‘key informant survey’ to assess the performance of local systems of care for persons with a chronic mental illness. The measure yields ratings of: (1) the extent to which clients experience service delivery problems in 11 community support system elements, (2) overall performance of the community support system, and (3) the performance of local mental health authorities. Following pre-testing, the survey was administered to 699 respondents in nine U.S. cities. Internal consistency coefficients were found to be within acceptable ranges for all of the scales across all nine cities. Analyses comparing mean values for performance ratings showed that the nine sites could be arranged into three groups representing high, medium and low system performance. These findings support observations from site visits conducted over several years and suggest that the survey is a valid instrument for assessing local systems of care.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/44310/1/10597_2005_Article_BF02188593.pd

Does a quality improvement campaign accelerate take-up of new evidence? A ten-state cluster-randomized controlled trial of the Institute for Health Improvement’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. 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. Electronic supplementary material The online version of this article (doi:10.1186/s13012-017-0579-7) contains supplementary material, which is available to authorized users

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

Abstract 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

Large, persistent epidemic of adenovirus type 4-associated acute respiratory disease in U.S. army trainees.

In May 1997, a large, persistent epidemic of adenovirus type 4-associated acute respiratory disease began at Fort Jackson, South Carolina, the largest army basic training center. The epidemic lasted until December and declined when vaccine administration resumed. More than 1,000 male and female trainees were hospitalized; 66.1% of those hospitalized had an adenovirus type 4 isolate

Language Access Services for Latinos with Limited English Proficiency: Lessons Learned from Hablamos Juntos

BackgroundThe Robert Wood Johnson Foundation funded Hablamos Juntos (HJ), a $10-million multiyear demonstration to improve access to health care for Latinos with limited English proficiency and to explore cost-effective ways for health care organizations to provide language access services.Hablamos juntosIn this manuscript, the authors draw on their experiences in evaluating HJ, provide brief descriptions of innovative interventions, estimate operating costs, and synthesize lessons learned about implementation. A number of barriers and facilitators are documented.ConclusionThe experience of HJ grantees provides guidance for organizations contemplating similar efforts. In particular, it highlights the need for health care organizations to involve physicians in the design and adoption of language services