I see absolutely nothing here that even remotely suggests that they know what needs to be done to solve stroke to 100% recovery. You can tell they don't know what they are doing because they constantly refer to 'care'; NOT RESULTS OR RECOVERY!
1. Create a strategy that lays out the steps and research needed to solve stroke.
2. Run that strategy to completion; STROKE LEADERSHIP NEEDED HERE!
3. Don't let researchers do anything outside that strategy
Quality Improvement in Stroke Rehabilitation: A Scoping Review
Authors Shafei I, Karnon J, Crotty M
Received 23 September 2022
Accepted for publication 30 November 2022
Published 22 December 2022 Volume 2022:15 Pages 2913—2931
DOI https://doi.org/10.2147/JMDH.S389567
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Scott Fraser
Ingy Shafei,1,2 Jonathan Karnon,1,3 Maria Crotty3
1School
of Public Health, Faculty of Health and Medical Sciences, The
University of Adelaide, Adelaide, South Australia, Australia; 2College of Business, Government and Law, Flinders University, Adelaide, South Australia, Australia; 3College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
Correspondence:
Ingy Shafei, Faculty of Health and Medical Sciences, The University of
Adelaide, GPO Box 2100, Adelaide, South Australia, 5001, Australia, Tel
+61 0458715670, Email angie.abdelshafei@flinders.edu.au
Background:
Quality improvement interventions are used extensively in health care,
aiming to improve delivery and promote best practice. The impact of
quality improvement interventions implemented in stroke rehabilitation
remains unclear.
Objective: The aim of this scoping
review is to examine the different types of published quality
improvement interventions in stroke rehabilitation and their impact on
improving the quality of care.
Materials and Methods:
A scoping review was performed in the PubMed, Embase and CINAHL
databases. QI studies evaluating interventions for stroke rehabilitation
patients that were published up to August 2020 were included. The
review looked at the types of quality improvement interventions that
have been evaluated as well as the improvements/impacts reported for
quality improvement interventions for stroke patients in rehabilitation.
Results:
We reviewed 1580 studies, twelve quality improvement interventions met
inclusion criteria and were included in the current study. Six studies
involved organizational change, three studies involved provider
education and audit-feedback and three studies involved provider
education. Of the twelve quality improvement interventions that have
been included, > 90% reported improvements (91.6%). In the majority
of cases, improvements were noted through implementation of a myriad of
interventions. Several facilitators and barriers were noted during
implementation and contributed to success or failure of the
intervention.
Conclusion: There is paucity of
full-text peer-reviewed published research investigating quality
improvement interventions for improving the quality of care in stroke
rehabilitation. The current review offers value to healthcare providers
in terms of key success factors, contextual factors, barriers and
facilitators associated with improvements in stroke rehabilitation.
Keywords: scoping review, review, stroke rehabilitation, quality improvement, quality interventions
Introduction
There is clear evidence on the gap between effective practice (obtained from evidence and research) and what happens in practice. This variation in practice has a significant impact on patient outcomes and processes of care.1 Poor quality of care has attributed to nearly 60% (5 Million of the 8.6 million deaths) preventable through health care.2 Decreasing unwarranted variations in clinical practice is important both from a safety and a quality perspective.1 Healthcare leaders use quality improvement (QI) interventions to improve the delivery of healthcare services and promote best practice implementation, thus contributing significantly to greater efficiencies in healthcare delivery.1 Principles and benefits of quality improvement (QI) have been well established through literature and practice. While typically the health sector was slow in embracing quality initiatives, in the more recent years, QI approaches have become more widespread with the use of different approaches to enact change and improvement.3
Many strategies have been proposed to improve quality amongst healthcare providers, including greater standardization of processes and using a myriad of strategies ensuring evidence-based practices are applied in the organization, thus contributing significantly to greater efficiencies in healthcare delivery. Bravata et al in “Closing the Gap” series defined QI strategies as
Interventions aimed at reducing the quality gap the difference between health care processes or outcomes observed in practice and those potentially obtainable on the basis of current professional knowledge for a group of patients representative of those encountered in routine practice.
The authors developed a taxonomy of nine QI strategies, including patient and provider education, organizational change, audit and feedback, patient and provider reminders, transfer of clinical data to providers, incentives including financial and legislative, and encouraging self-monitoring or self-management.4 In addition, developing and putting clinical guidelines and evidence-based pathways into practice also contribute towards decreasing unwanted variation and despite having guidelines in place, unwanted variation still exists.1
Furthermore, contextual factors have been ascertained to influence QI success and the Model for Understanding Success in Quality (MUSIQ) details such contextual factors for health. MUSIQ extolls QI implementers undergoing efforts throughout the QI initiatives to optimize contextual factors for the success and effectiveness of QI initiatives.5 Contextual factors are further categorized into external factors (external motivators, project sponsorships), organizational factors (leadership, senior leader sponsorship, culture, maturity of QI, physician payment structures) microsystem (leadership, culture, capability for improvement, motivation), as well as QI support and capacity (data infrastructure, resource availability, workforce focus), QI team (diversity, physician involvement, expertise, team tenure, prior experience in QI, leadership, decision-making process, QI skills and team norms), and some miscellaneous factors (eg, triggering events, importance of QI tasks).5 Implementation teams typically involve multiple stakeholders and cross-functional teams of medical teams, administration staff, consumers of health care, pharmacists and many others.6 Another key to quality improvements in health is involvement of frontline workers where health care is delivered.2
Stroke is a healthcare condition that is prevalent and disabling. It is the second most common cause of death in many countries.7 In addition, the economic consequence of stroke is enormous with annual costs estimated to be $320.1 billion globally for stroke and cardiovascular disease.8 One of the main issues with stroke is the resultant acquired disability. While most patients survive the initial stroke episode, there are usually longer term consequences and acquired adult disabilities that occur.7 The majority of post-stroke care is dependent on accessing rehabilitation, which has a significant effect in reducing mortality and dependency. Stroke rehabilitation typically follows a cyclical process that involves assessment, goal-setting, intervention and reassessment.7
Given previous studies of QI programs across many medical specialties, it is clear that rehabilitation services are particularly primed to benefit from such programs. Typically, in both acute and subacute rehabilitation facilities, outcome measurements are used for measuring quality, while many factors including multidisciplinary team members, goal setting, communication, the appropriateness of care among others are critical to patient needs.9 However, there is limited evidence in literature as to the QI initiatives and indicators for stroke rehabilitation.10,11 In addition, despite the interest in QI in healthcare context, there is a gap in research with little published literature evaluating the use of QI and its impacts within medical contexts, where success was seen and what changes have been observed due to QI.12 A search for existing reviews on this topic was performed. This included the Joanna Briggs Institute (JBI) Database of Systematic Reviews and Implementation Reports, the Cochrane Database of Systematic Reviews, MEDLINE and CINAHL. No relevant reviews (published or in progress) were identified. Thus, to address this gap in literature, the reported study aims to perform a scoping review to assess the extent to which QI interventions have been reported for stroke patients in rehabilitation, as well as the reported impacts of QI interventions on the rehabilitation of stroke patients.
Methods
Objectives
The objective of the scoping review is to identify and examine the available literature on quality improvement interventions utilized for stroke patients in rehabilitation. The review questions include:
- What QI interventions have been evaluated for stroke patients in rehabilitation?
- What improvements/impacts have been reported for quality improvement interventions for stroke patients in rehabilitation?
- What were the reported barriers and facilitators to the QI interventions improving the quality of care for stroke patients in rehabilitation?
To date, there is no review focused on quality improvement interventions for stroke rehabilitation, their impact on improving the quality of care and the facilitators and barriers to the QI interventions improving quality of care. Given the potential impacts of QI interventions on patient outcomes and processes of care, the current study aimed to address the gap.
More at link.d
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