Study outlines the challenges of conducting quality improvement studies at rural and small community hospitals
Research Activities, June 2009, No. 346
Staff shortages and turnover, other hospital priorities, and lack of technical resources are a few of the many challenges researchers face when trying to conduct quality improvement (QI) studies at rural and small community hospitals, concludes a new study.
Phase one implemented information technology in 64 hospitals to allow the hospitals to collect and make available (via a Web portal) data on specific inpatient quality of care measures (for heart attack, heart failure, and community-acquired pneumonia) and patient safety measures (for example, pressure sores and obstetric trauma).
Phase two of the study randomized 23 of 47 hospitals among the 64 phase one hospitals that committed to participating in the trial to the Web-based benchmarking tool plus an offsite educational program on tools and techniques for implementing and evaluating QI initiatives (the intervention). The 24 control hospitals used the Web-based benchmarking tool only. The CEOs of hospitals in the randomized trial phase provided written consent to participate, including commitment of hospital staff to participate fully with a specifically prescribed leadership team in the educational intervention. Of the 23 intervention hospitals, only 16 completed the offsite educational program, 1 attended the educational sessions but did not complete the required QI project, 3 enrolled in "makeup" sessions, and 3 were unable to attend.
Few clinical leaders and hospital executives attended the educational classes. Also, 12 percent of staff who began the sessions changed jobs, and couldn't implement or disseminate the QI strategies and techniques they learned. Understaffing also made it difficult to target staff to attend the educational classes. The authors suggest that a more effective strategy for designing future QI education programs for rural settings might be an onsite course that could be attended by a larger number of hospital leaders and clinical personnel.
The study was supported in part by the Agency for Healthcare Research and Quality (HS15431). More details are in "Challenges in conducting a hospital-randomized trial of an educational quality improvement intervention in rural and small community hospitals," by Giovanni Filardo, Ph.D., M.P.H., David Nicewander, M.S., Jeph Herrin, Ph.D., and others, in the November/December 2008 American Journal of Medical Quality 23(6), pp. 440-447.