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...

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Autores principales:	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
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Quality improvement collaborative Stroke Facilitators Barriers Effectiveness Systematic review Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/b1a955ca77104aad85c95aa4ca9cb918
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spelling	oai:doaj.org-article:b1a955ca77104aad85c95aa4ca9cb9182021-11-08T10:58:00ZThe effectiveness of quality improvement collaboratives in improving stroke care and the facilitators and barriers to their implementation: a systematic review10.1186/s13012-021-01162-81748-5908https://doaj.org/article/b1a955ca77104aad85c95aa4ca9cb9182021-11-01T00:00:00Zhttps://doi.org/10.1186/s13012-021-01162-8https://doaj.org/toc/1748-5908Abstract 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 ).Hayley J. LowtherJoanna HarrisonJames E. HillNicola J. GaskinsKimberly C. LazoAndrew J. CleggLouise A. ConnellHilary GarrettJosephine M. E. GibsonCatherine E. LightbodyCaroline L. WatkinsBMCarticleQuality improvement collaborativeStrokeFacilitatorsBarriersEffectivenessSystematic reviewMedicine (General)R5-920ENImplementation Science, Vol 16, Iss 1, Pp 1-16 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Quality improvement collaborative Stroke Facilitators Barriers Effectiveness Systematic review Medicine (General) R5-920
spellingShingle	Quality improvement collaborative Stroke Facilitators Barriers Effectiveness Systematic review Medicine (General) R5-920 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
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 ).
format	article
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
title	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_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_sort	effectiveness of quality improvement collaboratives in improving stroke care and the facilitators and barriers to their implementation: a systematic review
publisher	BMC
publishDate	2021
url	https://doaj.org/article/b1a955ca77104aad85c95aa4ca9cb918
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The effectiveness of quality improvement collaboratives in improving stroke care and the facilitators and barriers to their implementation: a systematic review

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