Applying the Plan-Do-Study-Act (PDSA) approach to a large pragmatic study involving safety net clinics

Jennifer Coury, Jennifer L Schneider, Jennifer S Rivelli, Amanda F Petrik, Evelyn Seibel, Brieshon D'Agostini, Stephen H Taplin, Beverly B Green, Gloria D Coronado, Jennifer Coury, Jennifer L Schneider, Jennifer S Rivelli, Amanda F Petrik, Evelyn Seibel, Brieshon D'Agostini, Stephen H Taplin, Beverly B Green, Gloria D Coronado

Abstract

Background: The Plan-Do-Study-Act (PDSA) cycle is a commonly used improvement process in health care settings, although its documented use in pragmatic clinical research is rare. A recent pragmatic clinical research study, called the Strategies and Opportunities to STOP Colon Cancer in Priority Populations (STOP CRC), used this process to optimize the research implementation of an automated colon cancer screening outreach program in intervention clinics. We describe the process of using this PDSA approach, the selection of PDSA topics by clinic leaders, and project leaders' reactions to using PDSA in pragmatic research.

Methods: STOP CRC is a cluster-randomized pragmatic study that aims to test the effectiveness of a direct-mail fecal immunochemical testing (FIT) program involving eight Federally Qualified Health Centers in Oregon and California. We and a practice improvement specialist trained in the PDSA process delivered structured presentations to leaders of these centers; the presentations addressed how to apply the PDSA process to improve implementation of a mailed outreach program offering colorectal cancer screening through FIT tests. Center leaders submitted PDSA plans and delivered reports via webinar at quarterly meetings of the project's advisory board. Project staff conducted one-on-one, 45-min interviews with project leads from each health center to assess the reaction to and value of the PDSA process in supporting the implementation of STOP CRC.

Results: Clinic-selected PDSA activities included refining the intervention staffing model, improving outreach materials, and changing workflow steps. Common benefits of using PDSA cycles in pragmatic research were that it provided a structure for staff to focus on improving the program and it allowed staff to test the change they wanted to see. A commonly reported challenge was measuring the success of the PDSA process with the available electronic medical record tools.

Conclusion: Understanding how the PDSA process can be applied to pragmatic trials and the reaction of clinic staff to their use may help clinics integrate evidence-based interventions into their everyday care processes.

Trial registration: Clinicaltrials.gov NCT01742065 . Registered October 31, 2013.

Keywords: Colorectal cancer; Fecal immunochemical test; Plan-Do-Study-Act; Process improvement.

Figures

Fig. 1
Fig. 1
STOP CRC clinical workflow
Fig. 2
Fig. 2
PDSA Framework for STOP CRC
Fig. 3
Fig. 3
Findings from Health Center 8 PDSA that Addressed Completed but Invalid FIT kits

References

    1. Greene SM, Reid RJ, Larson EB. Implementing the learning health system: from concept to action. Ann Intern Med. 2012;157(3):207–210. doi: 10.7326/0003-4819-157-3-201208070-00012.
    1. Luce BR, et al. Rethinking randomized clinical trials for comparative effectiveness research: the need for transformational change. Ann Intern Med. 2009;151(3):206–209. doi: 10.7326/0003-4819-151-3-200908040-00126.
    1. Califf RM, Sanderson I, Miranda ML. The future of cardiovascular clinical research: informatics, clinical investigators, and community engagement. JAMA. 2012;308(17):1747–1748. doi: 10.1001/jama.2012.28745.
    1. Green LW. Making research relevant: if it is an evidence-based practice, where's the practice-based evidence? Fam Pract. 2008;25(Suppl 1):i20–i24. doi: 10.1093/fampra/cmn055.
    1. Chalkidou K, et al. The role for pragmatic randomized controlled trials (pRCTs) in comparative effectiveness research. Clin Trials. 2012;9(4):436–446. doi: 10.1177/1740774512450097.
    1. Nallamothu BK, Hayward RA, Bates ER. Beyond the randomized clinical trial: the role of effectiveness studies in evaluating cardiovascular therapies. Circulation. 2008;118(12):1294–1303. doi: 10.1161/CIRCULATIONAHA.107.703579.
    1. Vetter MJ. The influence of clinical decision support on diagnostic accuracy in nurse practitioners. Worldviews Evid-Based Nurs. 2015;12(6):355–363. doi: 10.1111/wvn.12121.
    1. Hendricks CB. Improving adherence with oral antiemetic agents in patients with breast cancer receiving chemotherapy. J Oncol Pract. 2015;11(3):216–218. doi: 10.1200/JOP.2015.004234.
    1. Stevens DP, et al. A multi-institutional quality improvement initiative to transform education for chronic illness care in resident continuity practices. J Gen Intern Med. 2010;25(Suppl 4):S574–S580. doi: 10.1007/s11606-010-1392-z.
    1. Malloy C, Little BB, Michael M. Improving wait times in primary care using the Dartmouth microsystem improvement curriculum. J Nurs Care Qual. 2013;28(3):250–256. doi: 10.1097/NCQ.0b013e31827e7aec.
    1. American Cancer Society . Colorectal Cancer Facts & Figures 2017–2019. Atlanta: American Cancer Society; 2017.
    1. Administration., H.S.R. 2015 Health Center Data. 2017 [cited 2017 4/28]; Available from: . Accessed 26 Apr 2017.
    1. Baker DW, et al. Comparative effectiveness of a multifaceted intervention to improve adherence to annual colorectal cancer screening in community health centers: a randomized clinical trial. JAMA Intern Med. 2014;174(8):1235–1241. doi: 10.1001/jamainternmed.2014.2352.
    1. Baker DW, et al. Two-year follow-up of the effectiveness of a multifaceted intervention to improve adherence to annual colorectal cancer screening in community health centers. Cancer Causes Control. 2015;26(11):1685–1690. doi: 10.1007/s10552-015-0650-0.
    1. Gupta S, et al. Comparative effectiveness of fecal immunochemical test outreach, colonoscopy outreach, and usual care for boosting colorectal cancer screening among the underserved: a randomized clinical trial. JAMA Intern Med. 2013;173(18):1725–1732.
    1. Coronado GD, et al. Strategies and opportunities to STOP colon cancer in priority populations: pragmatic pilot study design and outcomes. BMC Cancer. 2014;14:55. doi: 10.1186/1471-2407-14-55.
    1. Coronado GD, et al. Effectiveness of a clinic-based colorectal cancer screening promotion program for underserved Hispanics. Cancer. 2011;117(8):1745–1754. doi: 10.1002/cncr.25730.
    1. Wolcott HF. Transforming qualitative data: description, analysis, and interpretation. Thousand Oaks: Sage Publications, Inc.; 1994.
    1. Coffey A, Atkinson P. Making sense of qualitative data: Complementary research Strategies. Thousand Oaks: Sage Publications, Inc; 1996.
    1. Lofland L, Lofland J. Analyzing social settings: a guide to qualitative observation and analysis. 3. San Francisco: Wadsworth Publishing, Inc; 1995.
    1. Riessman C. Narrative analysis: qualitative research methods series 30. Newbury Park: Sage Publications; 1993.
    1. Strauss A, Corbin J. Basics of qualitative research: techniques and procedures for developing grounded theory. Third. Thousand Oaks: Sage Publications, Inc.; 2008.
    1. Patton MQ. Qualitative research and evaluation methods. Third. Thousand Oaks: Sage Publications, Inc.; 2002.
    1. Langley GJ, et al. The improvement guide—a practical approach to enhancing organizational performance. San Francisco: Jossey-Bass; 2009.
    1. Rogers E. Diffusion of innovations. 5. New York: Free Press; 2003.
    1. Scott SD, et al. Factors influencing the adoption of an innovation: an examination of the uptake of the Canadian heart health kit (HHK) Implement Sci. 2008;3:41. doi: 10.1186/1748-5908-3-41.
    1. Bowen DJ, et al. Dissemination research in cancer control: where are we and where should we go? Cancer Causes Control. 2009;20(4):473–485. doi: 10.1007/s10552-009-9308-0.
    1. Dearing JW. Evolution of diffusion and dissemination theory. J Public Health Manag Pract. 2008;14(2):99–108. doi: 10.1097/01.PHH.0000311886.98627.b7.
    1. Scoville R, Little K. Comparing Lean and quality improvement. IHI white paper. Cambridge: Institute for Healthcare Improvement; 2014. Available at: .

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa