Evaluating Implementation and Barriers to Sustainability of an Asthma Clinical Quality Improvement Project
Purpose and Objectives
Asthma is an important public health issue in Utah and quality asthma care is essential to addressing the burden of asthma. The purpose of this initiative was to evaluate clinical asthma quality improvement (QI) program delivery formats and identify barriers to sustaining QI processes.
The focus of the intervention was to improve clinical asthma care through reducing variation in clinician knowledge about recommended asthma care and facilitating process improvements in asthma care delivery using Academic Detailing (AD) and Learning Collaboratives (LC) QI delivery formats.
A pre/post-test design was used to compare improvements between QI delivery formats in documentation of asthma control and asthma action plans in patient medical charts from baseline to 6-month post-intervention. Content analysis was used to analyze focus group data from a subset of clinics that provided feedback regarding the sustainability of implemented QI processes.
Substantial improvements in the two asthma measures were achieved for both the AD and LC formats. The average percentage of patients with asthma control documentation increased from baseline (AD: 30.7%; LC: 35.2%) to 6 month follow-up (AD: 85.5%; LC: 70.6%). The average percentage of patients with documented AAPs increased from baseline (AD: 4.1 %; LC: 13.0%) to 6 month follow-up (AD: 62.1%; LC: 61.5%). Focus group data showed it became increasingly difficult to maintain QI processes over time due to cumbersome EHR systems and a lack of trained staff, ongoing support, and value seen in QI.
Both AD and LC QI delivery formats were effective in improving QI processes. To maintain QI processes long-term, the following areas should be addressed post-implementation: assistance in overcoming EHR barriers related to QI processes, ongoing training for clinic staff, assistance in building value seen in QI processes, and development of a plan for ongoing support specific to clinic needs.
Uphold, H., & Liu, D. (2023). Evaluating Implementation and Barriers to Sustainability of an Asthma Clinical Quality Improvement Project. Journal of Nursing & Interprofessional Leadership in Quality & Safety, 5 (1). Retrieved from https://digitalcommons.library.tmc.edu/uthoustonjqualsafe/vol5/iss1/4
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