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.

Changes in authorship patterns in prestigious US medical journals.

To improve identification of contributors to manuscripts, editors of medical journals have developed authorship responsibility criteria. Some have specified an acceptable number of authors per manuscript. We wanted to examine changes in patterns of authorship in the context of the development of these specifications. Therefore, we used a retrospective cohort design to calculate the average number of authors per manuscript and the prevalence of group and corporate authorship between 1980 and 2000 for original, scientific, non-serial articles published in four prestigious medical journals: the Annals of Internal Medicine, Archives of Internal Medicine, Journal of the American Medical Association, and the New England Journal of Medicine. Group authorship identifies individual authors in the byline who are writing for a group; in corporate authorship, contributors are not individually listed in the byline. We found that the number of authors per article increased dramatically over time in each journal, from an average of 4.5 in 1980 to 6.9 in 2000 across journals. As a proportion of published manuscripts, group authorship (authors listed in the byline) increased from virtually zero to over 15%, while corporate authorship (authors not listed in the byline) remained rare and stagnant. Manuscripts published by single authors all but vanished. Group authorship was most prevalent in journals that limited the acceptable number of authors per manuscript. These findings suggest that the number of authors per manuscript continues to grow. The growth in the number of authors on bylines and the proportion of group-authored manuscripts is likely to reflect the increasing complexity of medical research.

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.