Quality Improvement Toolkits: Recommendations for Development.

A burgeoning number of toolkits dedicated to improving health care exist but development guidance is lacking. The authors convened a panel of health care stakeholders, including developers, purchasers, users, funders, and disseminators of toolkits. The panel was informed by a literature review that analyzed 44 publications and 27 toolkits. A modified Delphi process established recommendations and suggestions to guide toolkit development. The panel established 12 recommendations for content and 1 recommendation for toolkit development methods. The recommendations are accompanied by 11 suggestions for toolkit content, 9 suggestions for development methods, and 6 suggestions for toolkit evaluation methods. The authors established a set of key recommendations and suggestions addressing the content, development, and evaluation methods of quality improvement toolkits, together with a ready-to use checklist. The guidance aims to advance the value of toolkits as an emerging method to effectively disseminate interventions to improve the quality of care.

Using Learning Communities to Support Adoption of Health Care Innovations.

BACKGROUND: Diffusion of innovations can be a slow process, posing a major challenge to quality improvement in health care. Learning communities can provide a rich, collaborative environment that supports the adoption of health care innovations and motivates organizational change. From 2014-2016, the Agency for Healthcare Research and Quality (AHRQ) Health Care Innovations Exchange established and supported three learning communities focused on adopting innovations in three high-priority areas: (1) advancing the practice of patient- and family-centered care in hospitals, (2) promoting medication therapy management for at-risk populations, and (3) reducing non-urgent emergency services. METHODS: Members of each learning community worked collaboratively in facilitated settings to adapt and implement strategies featured in the Health Care Innovations Exchange, receiving technical assistance from content experts. Project staff conducted a mixed methods evaluation of the initiative, both formative and summative. RESULTS: The activities and outcomes of the three learning communities provided insights about how this approach can support local implementation efforts, and about factors influencing innovation adoption. Using a qualitative synthesis method, lessons were identified related to learning community startup (recruitment and goal setting), learning community operations (engagement, collaborative decision-making, and sustainability), and innovation implementation (changing care delivery processes and/or policies). CONCLUSIONS: Findings from this work indicate that the learning community model of group learning can serve as an effective method to support dissemination and implementation of innovations, and to achieve desired outcomes in local settings.

Increased suicidality in mania complicated by alcoholism.

Objective. This retrospective study was done to assess the impact of concurrent alcohol use on the illness presentation of patients hospitalized for mania.Design. Retrospective demographic and clinical data were systematically collected from the hospital records of 122 patients hospitalized for an index episode of mania between 1988 and 1995. Comorbid alcoholism was defined as alcohol abuse/dependence, based on DSM-IV criteria. Blind to alcohol use and treatment intervention, a retrospective clinical assessment of illness severity was made by the Clinical Global Impression (CGI) at the end point of hospital discharge. Demographic and clinical differences between the alcoholic and nonalcoholic manic subjects were analyzed by chi-square and independent t-tests. Survival analyses with hospital length of stay as the dependent variable were conducted on the two groups.Setting. Tertiary care university hospital.Participants. Patients with bipolar disorder hospitalized for mania.Measurements. Clinical Global Impression (CGI), clinical variables (suicidality, polysubstance abuse, hospital length of stay).Results. Alcoholic manic and nonalcoholic manic patients differed significantly in two categorical measures: suicidality on admission (36.7 vs. 18.5%) and current polysubstance abuse/dependence (46.6 vs. 7.6%). There was no significant difference in length of hospitalization between the two groups.Conclusions. The results of this study are consistent with previous studies that have found an association between alcoholism and increased suicidality and polysubstance abuse in bipolar disorder.