Empowering Implementation Teams with a Learning Health System Approach: Leveraging Data to Improve Quality of Care for Transient Ischemic Attack

Nicholas A Rattray, Teresa M Damush, Edward J Miech, Barbara Homoya, Laura J Myers, Lauren S Penney, Jared Ferguson, Brenna Giacherio, Meetesh Kumar, Dawn M Bravata, Nicholas A Rattray, Teresa M Damush, Edward J Miech, Barbara Homoya, Laura J Myers, Lauren S Penney, Jared Ferguson, Brenna Giacherio, Meetesh Kumar, Dawn M Bravata

Abstract

Background: Questions persist about how learning healthcare systems should integrate audit and feedback (A&F) into quality improvement (QI) projects to support clinical teams' use of performance data to improve care quality.

Objective: To identify how a virtual "Hub" dashboard that provided performance data for patients with transient ischemic attack (TIA), a resource library, and a forum for sharing QI plans and tools supported QI activities among newly formed multidisciplinary clinical teams at six Department of Veterans Affairs (VA) medical centers.

Design: An observational, qualitative evaluation of how team members used a web-based Hub.

Participants: External facilitators and multidisciplinary team members at VA facilities engaged in QI to improve the quality of TIA care.

Approach: Qualitative implementation process and summative evaluation of observational Hub data (interviews with Hub users, structured field notes) to identify emergent, contextual themes and patterns of Hub usage.

Key results: The Hub supported newly formed multidisciplinary teams in implementing QI plans in three main ways: as an information interface for integrated monitoring of TIA performance; as a repository used by local teams and facility champions; and as a tool for team activation. The Hub enabled access to data that were previously inaccessible and unavailable and integrated that data with benchmark and scientific evidence to serve as a common data infrastructure. Led by champions, each implementation team used the Hub differently: local adoption of the staff and patient education materials; benchmarking facility performance against national rates and peer facilities; and positive reinforcement for QI plan development and monitoring. External facilitators used the Hub to help teams leverage data to target areas of improvement and disseminate local adaptations to promote resource sharing across teams.

Conclusions: As a dynamic platform for A&F operating within learning health systems, hubs represent a promising strategy to support local implementation of QI programs by newly formed, multidisciplinary teams.

Keywords: audit and feedback; care delivery; cerebrovascular disease; implementation science; quality dashboards; quality improvement; transient ischemic attack.

Conflict of interest statement

The authors declare that they do not have a conflict of interest.

Figures

Figure 1
Figure 1
Screenshot of “quality dashboard” homepage of PREVENT Hub. Note: To maintain anonymity, facility names were removed from this screenshot. In the interface, the Without-Fail Rate in the top-left box (in red) is the current year-to-date WFR and is updated monthly. The WFR rate listed below adjacent to other indicators is the running average over the prior 4 quarters.

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