Biomedical subjects

Peter D Mills

Publications and source records attributed to Peter D Mills.

9 recordsLinked to original sources

PubMed2006

Actions and implementation strategies to reduce suicidal events in the Veterans Health Administration.

BACKGROUND: Veterans possess many risk factors for suicide, making suicide prevention in the Veterans Health Administration (VHA) a particular challenge. METHODS: An analysis was conducted of 94 aggregated root cause analyses (RCAs) for parasuicidal behavior and 43 single-case suicide RCAs submitted from 75 VHA facilities to determine primary root causes for suicide and parasuicidal behaviors and to gain information about action plans, success factors and obstacles to improvement. Telephone follow-up interviews were conducted with each facility. RESULTS: The aggregate reviews included 775 individual cases of parasuicidal behavior. The top root causes of parasuicidal behavior were poor assessment and communication of patient risk, patient stressors, and need for staff and patients training. Forty-eight percent of the action plans developed to address the root causes involved a policy change, 30% involved staff training, and 14% involved making a specific clinical change. Eight-eight percent of the actions adequately addressed the root cause, of which 68.1% were fully implemented. DISCUSSION: There is little agreement on the definition of "parasuicide," and it is likely the case that parasuicide behaviors are underreported in our system. To encourage reporting, patient safety staff should collaborate with providers and use a more inclusive definition of parasuicide.

Hospitals, Veterans↗

PubMed2005

Using aggregate root cause analysis to reduce falls.

BACKGROUND: In certain categories of adverse events, Department of Veterans Affairs (VA) facilities may combine data to produce an aggregate review of the data. Individual root cause analyses are still required for the more serious adverse events. About 100 of the VA acute and long term care facilities contributed data to an analysis of results of 176 root cause analyses (RCAs) for patient falls occurring in the VA system. METHODS: Success was measured through a decreased report of falls and major injures due to falls after each organization's action plans were implemented. In addition, telephone interviews were conducted to understand success factors as well as barriers to implementation of clinical improvements. RESULTS: Of the 745 actions generated (that addressed the root cause), 435 (61.4%) had been fully implemented and another 148 (20.9%) had been partially implemented; 34.4% of the facilities reported reducing falls and 38.9% reported reducing major injuries due to falls. DISCUSSION: The action plans associated with these reductions focused on making specific clinical changes at the bedside rather than policy changes or educating staff. Specific interventions most highly associated with reductions in falls and injuries included environmental assessments, toileting interventions, and interventions that directly addressed the root cause and were the responsibility of a single person (as opposed to a group).

Accidental Falls↗

PubMed2005

One-year follow-up after a collaborative breakthrough series on reducing falls and fall-related injuries.

BACKGROUND: Multisite facilitated quality improvement (QI) projects, called collaborative Breakthrough Series (BTS), have been shown to improve care, but it is also important to evaluate the lasting effects and spread of changes of BTSs. A project focused on fall and injury-related prevention started in Spring 2001; after the project's end, support was provided through e-mail and periodic conference calls. METHODS: One year after project completion, team contacts were interviewed to determine if they had maintained gains or made further improvements. RESULTS: For the 34 (of 37 teams) interviewed, 82.4% reported they had stayed together as a team; 97.1%, that they continued to collect data; 93.9%, that they had maintained gains; 82.4%, that they had spread changes to new locations; and 85.3%, that they had begun to work on new topics. High team performance at one year correlated with first-meeting team characteristics Leadership Support (r = .456, p = .019) and Prior Experience with Quality Improvement and Teamwork (r = .393, p = .047) and with follow-up team characteristics Leadership Support (r = .614, p < .001), Teamwork Skills (r = .377, p = .033), and Skills Gained from the Project (r = .410, p = .020). CONCLUSIONS: Leadership support, experience with quality improvement and teamwork, teamwork skills, and skills gained from the project were correlated with teams' abilities to achieve and maintain success.

Accidental Falls↗

PubMed2004

Characteristics of successful quality improvement teams: lessons from five collaborative projects in the VHA.

BACKGROUND: A pre-post observational design was used to study the aggregate results of five national Breakthrough Series (BTS) collaboratives run within Veterans Health Administration (VHA) to identify the organizational, interpersonal, and systemic characteristics of successful improvement teams. METHODS: One hundred thirty-one medical quality improvement teams participated in five BTS collaboratives in the VHA between 1999 and 2002. Team characteristics were assessed using a team questionnaire before and after the BTS collaboratives. RESULTS: Fifty-seven percent of participating teams were rated as successful (a > or = 20% improvement from baseline for at least two months before the collaboratives' end). More high-performing medical quality improvement teams perceived their work to be part of their organization's key strategic goals. By the end of the BTS collaboratives, high-performing teams had more front-line staff support and stronger team leadership. DISCUSSION: Strong organizational support, strong team leadership, and high levels of interpersonal team skills help medical quality improvement teams go further to improve clinical care. It is recommended that quality improvement teams become integrated with their organization's key strategic goals, that improvement teams stay together, and that leadership and team training be provided to improve clinical outcomes.

Analysis of Variance↗

PubMed2004

A cognitive aid for cardiac arrest: you can't use it if you don't know about it.

BACKGROUND: A cognitive aid developed by the Department of Veterans Affairs (VA) and distributed to all VA facilities provides caregivers with information to minimize omission of critical steps when diagnosing and treating cardiac arrest. In 2002, caregivers were surveyed about the usefulness of the cognitive aid and the success of its dissemination throughout the VA. METHODS: Fifty randomly selected VA hospitals were sent a letter to alert them of the upcoming survey. Twenty surveys were sent to each of the selected hospitals with instructions to distribute the survey to specific caregiver types. RESULTS: Nine (18%) of the VA hospitals had not used the cognitive aid tool because of dissemination problems. Of the 565 caregivers responding to the survey, 59% (332) were aware of the cognitive aid. Of these 332, 96% agreed that putting the cognitive aid on code carts is a good idea. There were 234 respondents who were both aware of the cognitive aid and had been involved in at least one code within the past 30 days. Of these 234, some 29 (12%) used the aid during a code, 28 of whom agreed that the cognitive aid was helpful during the code. DISCUSSION: Both new and experienced caregivers find the cognitive aid helpful when responding to "code" situations. However, cognitive aids cannot be helpful if theintended users are unaware of their availability. Dissemination and awareness of the aids can be problematic in large health care systems.

Audiovisual Aids↗

PubMed2003

A multihospital safety improvement effort and the dissemination of new knowledge.

BACKGROUND: Research on the transfer of medical technology and guidelines suggests that this transfer is driven more by interpersonal relationships than by new research or available information and that it is inconsistent, largely unsuccessful, and strongly influenced by local factors. Yet studies of collaborative, multiple-hospital improvement efforts have shown these transfers to be effective for the specific microsystems participating in the project. The diffusion of medical innovations beyond the participating teams was studied during a 2000-2001 national collaborative safety improvement effort. METHODS: Twenty-two teams from Department of Veterans Affairs (VA) hospitals participated in a 9-month quality improvement project designed to improve safety in high-hazard areas. Participating hospitals and other regional hospitals were contacted to determine the level of dissemination of information generated during and after the project. RESULTS: While the participating hospitals benefited from the quality improvement effort, changes were implemented only 9% of the time on other units within the hospitals and only 2% of the time in other regional hospitals. After 12 months, there was no implementation within participating hospitals, and other regional hospitals were implementing changes 10% of the time. DISCUSSION: Personal commitment from senior leadership, dissemination strategies that push information to clinicians, and monitoring of progress at the regional level are all needed for dissemination of complex medical information to occur.

Cooperative Behavior↗

PubMed2003

Reduction in patient enrollment in the Veterans Health Administration after media coverage of adverse medical events.

BACKGROUND: Health care organizations may experience costs associated with preventable adverse events in the form of poor brand image and subsequent patient disenrollment. A retrospective cohort design was used to determine whether media coverage of adverse events that occurred in Veterans Health Administration (VHA) hospitals was associated with subsequent veteran disenrollment. METHODS: Twenty-four newspaper reports of medical adverse events that occurred between 1994 and 1999 within the VHA system were identified. Regionally adjusted changes in enrollment rates for VHA facilities that had reported adverse events were compared with those that had not one year before and one and three years after publication of the newspaper reports. RESULTS: Facilities that had published reports of adverse events had lower enrollment rates after publication of the report for two groups of veterans. CONCLUSIONS: Within the VHA system, health care organizations involved in adverse events that generated publicity suffered a greater rate of patient disenrollment. If safe patient care practices can reduce adverse publicity, they may enhance corporate value by maintaining enrollment of the patient population.

Bibliometrics↗

PubMed2003

Beyond community-based diabetes management and the COAG coordinated care trial.

OBJECTIVE: This article describes the patient management processes developed during the Council of Australian Governments (COAG) coordinated care trial and use of health outcome measures to monitor changes in utilisation patterns and patient well-being over time for a subgroup of 398 patients with type 2 diabetes. DESIGN: The Eyre component of the South Australian (SA) HealthPlus coordinated care trial was a matched geographically controlled study in which the outcomes for the intervention group of 1350 patients were compared with those of a similar control group of 500 patients in another rural health region in SA. SETTING: The trial was carried out on Eyre Peninsula in SA across populations in rural communities and in the main centres of Whyalla, Port Lincoln and Ceduna. Care planning was organised through general practitioner practices and services negotiated with allied health services and hospitals to meet patient needs. SUBJECTS: The SA HealthPlus trial included 1350 patients with chronic and complex illness. A subset of this group comprising 398 patients with type 2 diabetes is described in this report. Patients recruited into the three-year trial were care planned using a patient centred care planning model through which patient goals were generated along with medical management goals developed by clinicians and primary health care professionals. Relevant health services were scheduled in line with best practice and care plans were reviewed each year. Patient service utilisation, progress towards achieving health related goals and patient health outcomes were recorded and assessed to determine improvements in health and well-being along with the cost and profile of the services provided. RESULTS: Significant numbers of patients experienced improved health outcomes as a consequence of their involvement in the trial, and utilisation data showed reductions in hospital and medical expenditure for some patients. These results suggest that methods applied in the SA HealthPlus coordinated care trial have led to improvements in health outcomes for patients with diabetes and other chronic illnesses. In addition, the processes associated with the COAG trial motivated significant organisational change in the Regional Health Service as well as providing an opportunity to study the health and well-being outcomes resulting from a major community health intervention. CONCLUSIONS: The importance of the SA HealthPlus trial has been the demonstrated link between a formal research trial and significant developments in the larger health system with the trial not only leading to improvements in clinical outcomes for patients, but also acting as a catalyst for organisational reform. We now need to look beyond the illness focus of health outcome research to develop population based health approaches to improving overall community well-being.

Continuity of Patient Care↗

PubMedDate not supplied

Listserv use enhances quality and safety in multisite quality improvement efforts.

A listserv is an e-mail group to which people subscribe based upon common interests. We used a retrospective study to examine the relationship between listserv use and team success for health care quality improvement efforts. We hypothesized high listserv use would be associated with team success. Eighty-seven Department of Veterans Affairs teams participated in facilitated quality improvement efforts to address three areas: improving safety in high-hazard areas, improving the disability evaluation process, and reducing falls and related injuries. We coded messages sent to the listserv according to sender (faculty or participant), team, and content. We correlated the volume of messages sent per team with team success and with team and facility characteristics. Teams with high listserv contributions were more likely to complete their first test of change, report facility use of nonpunitive methods of investigating medical incidents, and report their information systems were useful. We found a negative correlation between listserv contribution and the number of face-to-face meetings and a physician as an active team member, but we found no relationship between team success and listserv contribution. Team listserv contribution was not associated with team success in multisite quality improvement efforts. Successful teams may be accessing information on the listserv but not sending a message to indicate use.

Cooperative Behavior↗