How to Evaluate a Quality Improvement Project at Your Facility

pressure ulcer improvement project evaluation

When it comes to healthcare, "an ounce of prevention is worth a pound of cure." Finding ways to reduce certain injures protects patients from pain and suffering and cuts the costs of treatment, lowering expenses for the facility.

The adage is particularly true for pressure injuries. Since painful “bed sores” are most likely to occur under particular (high risk) conditions, fighting their effects begins long before they appear. That’s why hospitals and long-term care facilities are always on the lookout for new and better prevention options.

A facility might purchase a new mattress, for example, with a softer surface to reduce friction on the skin. After a while, they see that there are fewer incidents of PIs and greater patient satisfaction. The severity of pressure injuries that develop also seem to be reduced.

It looks like a smashing success! The assessment seems logical – the cause (a new and better mattress) aligns with the effect (fewer and smaller PIs).

But that assessment could also be wrong.

Maybe other factors - closer monitoring, stronger communication among caregivers, better awareness of prevention techniques - had as much to do with the improvements as the mattress itself.

Simply put, before a facility makes a major purchase or implements a significant change in treatment, it needs to know that it will work. Simply observing the results can be misleading. There are too many factors involved to rely on counting incidents and severity alone.

Dr. Jan Kottner, an expert on skin care interventions in aged and care dependent subjects, offers some practical applications to take much of the guesswork out of the question and empower facilities to measure their real progress more accurately.

Why Isolating Results is so Challenging

No two patients arrive with the same characteristics. They vary by age, severity of disease, and even types of diseases. They have different needs and different levels of care dependency. All these factors will influence their susceptibility to pressure injuries.

Medical facilities also vary widely; the number of patients they accept is different at different times, and the ratios of patient-to-caregiver shift in either direction over time.

And then there are variances in the structure, process, and outcome of any number of interventions used to prevent or treat pressure injures. These are complex interventions, often at different organizational levels. Their results are intertwined and non-linear. Sometimes small changes will have enormous impact, whereas other times, significant changes will hardly make a difference.

According to Dr. Kottner, this complex equation of factors mean that the bigger question is not whether a technique or initiative works in general but whether it works effectively in YOUR particular facility. Since it is nearly impossible to recreate conditions for a meaningful study in two different facilities, the results may not be transferable between different health facilities.

That’s why it’s important to focus on the goal – improving treatment and prevention for the people under your care – and using the information available to see if what you are doing is working, irrespective of results at other facilities.

Pragmatic Trials for Quality Measures

To overcome the unwieldy challenge of so many variables, Dr. Kottner recommends using pragmatic trials which aim to recreate real conditions as much as possible. The trials may involve relaxed eligibility requirements or other measures in order to garner real-world results.

It also makes sense to use cluster randomized control trials rather than individual RCTs. Results drawn from a range of patients is more meaningful for assessing the quality of a particular improvement project.

The goal is to collect as much data as possible in order to arrive at quality indicators. These are different than assigning numbers as results. Instead, they are a process of evaluation that provides meaningful insight into quality criteria such as relevance, feasibility, validity, reliability, or cost efficiency.

Measuring your own performance - comparative quality measurements:

  1. Compare measures of the same service at different times (measure self against self)
  2. Compare measures of different services at the same time (external comparisons)
  3. Comparing measures with predetermined standards (audits)

Because of the large number of factors, it is unrealistic to test for every one of them. That means we need to focus on the most important, such as the occurrence of pressure injuries, preventative measures, and the costs involved.

We can also draw data from a wide range of sources, including patient charts, facility statistics, even health insurance, which often contain a wealth of meaningful data. Taken together, it creates a well-rounded picture that helps isolate the important element and lead to a meaningful assessment.

The Time Factor

Along with amassing as much practical data as possible through pragmatic trials, the other critical element is time. Because conditions are under a constant state of change, it is vital to chart the data continuously. That provides the most reliable picture of the true impact of an initiative. Trials must also cover identical periods of time in order to yield meaningful results.

Put together, a clear picture emerges. Facilities can look at the data and determine if an initiative is providing the intended benefits to their patients. That makes prevention easier and more effective, improving patient health and the delivery of services for health care providers.

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