The effectiveness of quality improvement collaboratives in improving stroke care and the facilitators and barriers to their implementation: a systematic review
Abstract Background To successfully reduce the negative impacts of stroke, high-quality health and care practices are needed across the entire stroke care pathway. These practices are not always shared across organisations. Quality improvement collaboratives (QICs) offer a unique opportunity for key...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-11-01
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| Series: | Implementation Science |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13012-021-01162-8 |
| _version_ | 1818724284526231552 |
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| author | Hayley J. Lowther Joanna Harrison James E. Hill Nicola J. Gaskins Kimberly C. Lazo Andrew J. Clegg Louise A. Connell Hilary Garrett Josephine M. E. Gibson Catherine E. Lightbody Caroline L. Watkins |
| author_facet | Hayley J. Lowther Joanna Harrison James E. Hill Nicola J. Gaskins Kimberly C. Lazo Andrew J. Clegg Louise A. Connell Hilary Garrett Josephine M. E. Gibson Catherine E. Lightbody Caroline L. Watkins |
| author_sort | Hayley J. Lowther |
| collection | DOAJ |
| description | Abstract Background To successfully reduce the negative impacts of stroke, high-quality health and care practices are needed across the entire stroke care pathway. These practices are not always shared across organisations. Quality improvement collaboratives (QICs) offer a unique opportunity for key stakeholders from different organisations to share, learn and ‘take home’ best practice examples, to support local improvement efforts. This systematic review assessed the effectiveness of QICs in improving stroke care and explored the facilitators and barriers to implementing this approach. Methods Five electronic databases (MEDLINE, CINAHL, EMBASE, PsycINFO, and Cochrane Library) were searched up to June 2020, and reference lists of included studies and relevant reviews were screened. Studies conducted in an adult stroke care setting, which involved multi-professional stroke teams participating in a QIC, were included. Data was extracted by one reviewer and checked by a second. For overall effectiveness, a vote-counting method was used. Data regarding facilitators and barriers was extracted and mapped to the Consolidated Framework for Implementation Research (CFIR). Results Twenty papers describing twelve QICs used in stroke care were included. QICs varied in their setting, part of the stroke care pathway, and their improvement focus. QIC participation was associated with improvements in clinical processes, but improvements in patient and other outcomes were limited. Key facilitators were inter- and intra-organisational networking, feedback mechanisms, leadership engagement, and access to best practice examples. Key barriers were structural changes during the QIC’s active period, lack of organisational support or prioritisation of QIC activities, and insufficient time and resources to participate in QIC activities. Patient and carer involvement, and health inequalities, were rarely considered. Conclusions QICs are associated with improving clinical processes in stroke care; however, their short-term nature means uncertainty remains as to whether they benefit patient outcomes. Evidence around using a QIC to achieve system-level change in stroke is equivocal. QIC implementation can be influenced by individual and organisational level factors, and future efforts to improve stroke care using a QIC should be informed by the facilitators and barriers identified. Future research is needed to explore the sustainability of improvements when QIC support is withdrawn. Trial registration Protocol registered on PROSPERO ( CRD42020193966 ). |
| first_indexed | 2024-12-17T21:23:58Z |
| format | Article |
| id | doaj.art-b1a955ca77104aad85c95aa4ca9cb918 |
| institution | Directory Open Access Journal |
| issn | 1748-5908 |
| language | English |
| last_indexed | 2024-12-17T21:23:58Z |
| publishDate | 2021-11-01 |
| publisher | BMC |
| record_format | Article |
| series | Implementation Science |
| spelling | doaj.art-b1a955ca77104aad85c95aa4ca9cb9182022-12-21T21:32:04ZengBMCImplementation Science1748-59082021-11-0116111610.1186/s13012-021-01162-8The effectiveness of quality improvement collaboratives in improving stroke care and the facilitators and barriers to their implementation: a systematic reviewHayley J. Lowther0Joanna Harrison1James E. Hill2Nicola J. Gaskins3Kimberly C. Lazo4Andrew J. Clegg5Louise A. Connell6Hilary Garrett7Josephine M. E. Gibson8Catherine E. Lightbody9Caroline L. Watkins10Applied Health Research hub (AHRh), University of Central Lancashire (UCLan)Applied Health Research hub (AHRh), University of Central Lancashire (UCLan)Applied Health Research hub (AHRh), University of Central Lancashire (UCLan)Applied Health Research hub (AHRh), University of Central Lancashire (UCLan)Applied Health Research hub (AHRh), University of Central Lancashire (UCLan)Applied Health Research hub (AHRh), University of Central Lancashire (UCLan)Faculty of Allied Health and Wellbeing, University of Central Lancashire (UCLan)National Institute for Health Research Applied Research Collaboration North West Coast (NIHR ARC NWC)Faculty of Health and Care, University of Central Lancashire (UCLan)Faculty of Health and Care, University of Central Lancashire (UCLan)Applied Health Research hub (AHRh), University of Central Lancashire (UCLan)Abstract Background To successfully reduce the negative impacts of stroke, high-quality health and care practices are needed across the entire stroke care pathway. These practices are not always shared across organisations. Quality improvement collaboratives (QICs) offer a unique opportunity for key stakeholders from different organisations to share, learn and ‘take home’ best practice examples, to support local improvement efforts. This systematic review assessed the effectiveness of QICs in improving stroke care and explored the facilitators and barriers to implementing this approach. Methods Five electronic databases (MEDLINE, CINAHL, EMBASE, PsycINFO, and Cochrane Library) were searched up to June 2020, and reference lists of included studies and relevant reviews were screened. Studies conducted in an adult stroke care setting, which involved multi-professional stroke teams participating in a QIC, were included. Data was extracted by one reviewer and checked by a second. For overall effectiveness, a vote-counting method was used. Data regarding facilitators and barriers was extracted and mapped to the Consolidated Framework for Implementation Research (CFIR). Results Twenty papers describing twelve QICs used in stroke care were included. QICs varied in their setting, part of the stroke care pathway, and their improvement focus. QIC participation was associated with improvements in clinical processes, but improvements in patient and other outcomes were limited. Key facilitators were inter- and intra-organisational networking, feedback mechanisms, leadership engagement, and access to best practice examples. Key barriers were structural changes during the QIC’s active period, lack of organisational support or prioritisation of QIC activities, and insufficient time and resources to participate in QIC activities. Patient and carer involvement, and health inequalities, were rarely considered. Conclusions QICs are associated with improving clinical processes in stroke care; however, their short-term nature means uncertainty remains as to whether they benefit patient outcomes. Evidence around using a QIC to achieve system-level change in stroke is equivocal. QIC implementation can be influenced by individual and organisational level factors, and future efforts to improve stroke care using a QIC should be informed by the facilitators and barriers identified. Future research is needed to explore the sustainability of improvements when QIC support is withdrawn. Trial registration Protocol registered on PROSPERO ( CRD42020193966 ).https://doi.org/10.1186/s13012-021-01162-8Quality improvement collaborativeStrokeFacilitatorsBarriersEffectivenessSystematic review |
| spellingShingle | Hayley J. Lowther Joanna Harrison James E. Hill Nicola J. Gaskins Kimberly C. Lazo Andrew J. Clegg Louise A. Connell Hilary Garrett Josephine M. E. Gibson Catherine E. Lightbody Caroline L. Watkins The effectiveness of quality improvement collaboratives in improving stroke care and the facilitators and barriers to their implementation: a systematic review Implementation Science Quality improvement collaborative Stroke Facilitators Barriers Effectiveness Systematic review |
| title | The effectiveness of quality improvement collaboratives in improving stroke care and the facilitators and barriers to their implementation: a systematic review |
| title_full | The effectiveness of quality improvement collaboratives in improving stroke care and the facilitators and barriers to their implementation: a systematic review |
| title_fullStr | The effectiveness of quality improvement collaboratives in improving stroke care and the facilitators and barriers to their implementation: a systematic review |
| title_full_unstemmed | The effectiveness of quality improvement collaboratives in improving stroke care and the facilitators and barriers to their implementation: a systematic review |
| title_short | The effectiveness of quality improvement collaboratives in improving stroke care and the facilitators and barriers to their implementation: a systematic review |
| title_sort | effectiveness of quality improvement collaboratives in improving stroke care and the facilitators and barriers to their implementation a systematic review |
| topic | Quality improvement collaborative Stroke Facilitators Barriers Effectiveness Systematic review |
| url | https://doi.org/10.1186/s13012-021-01162-8 |
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