1. Effectiveness of a virtual quality improvement training program to improve reach of weight management programs within a large health system
- Author
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Damschroder, Laura J., Evans, Richard, Kim, H. Myra, Sussman, Jeremy, Freitag, Michelle B., Robinson, Claire H., Burns, Jennifer A., Yankey, Nicholas R., and Lowery, Julie C.
- Subjects
Weight loss maintenance -- Technology application -- Demographic aspects ,Virtual reality -- Usage -- Health aspects ,Veterans -- Health aspects ,Medical care -- Quality management ,Virtual reality technology ,Company business management ,Technology application ,Business ,Health care industry - 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 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. KEYWORDS clinical trial design and implementation, health care organizations and systems What is known on this topic * Team-based engagement in learning, such as conducting Plan-Do-Study-Act (PDSA) cycles of change as part of continuous quality improvement (QI), is a core competency for mature learning systems. * Many frontline workers lack capability and experience in doing PDSAs and QI. * Easy-to-use, hands-on training is needed to consistently engage frontline teams in QI. What this study adds * LEAP is a 6-month QI learning program with: coaching for frontline teams who learn-as-they-do, paced curriculum that avoids technical jargon, and assignments aimed at completing at least one PDSA cycle in 6 months. * Fifty-five facilities randomly assigned to LEAP experienced less fluctuation and less decline in a key program metric compared to 82 control facilities during the 12-month post-LEAP period in an intention-to-treat analysis. * LEAP resulted in significant increases in use of QI methods and teams reported intentions to continue QI together but also reported time constraints., 1 | INTRODUCTION Strong learning health systems are determined by the degree to which 'clinical informatics, incentives, and culture are aligned to promote continuous improvement and innovation, with best practices [...]
- Published
- 2024
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