Redesigning Systems to Improve Quality for Hospitalized Patients
Condition: Interdisciplinary Communication; Interpersonal Relations; Adverse Event; Interprofessional Relations
Study type: Interventional

Summary: 
      Despite recent improvements, healthcare systems are still a long way from consistently
      delivering high quality care to hospitalized patients. In this study, the research team is
      assisting hospitals in implementing a set of complementary, mutually reinforcing
      interventions to redesign care for hospitalized medical patients. The investigators
      anticipate the interventions will improve teamwork and patient outcomes and that identifiable
      factors and strategies will be associated with successful implementation.
    

Detailed description: 
      Most adults requiring hospitalization are admitted for medical conditions, yet the optimal
      model of care for these patients is yet to be established. Current care delivery models lack
      the ability to optimally coordinate care on a daily basis and improve performance over time.
      A growing body of research has tested interventions to redesign aspects of care delivery for
      hospitalized medical patients. These interventions improve processes and culture, but the
      evidence that patient outcomes have improved is equivocal. Importantly, most studies have
      examined the effect of single interventions in isolation, yet these interventions are better
      conceptualized as complementary and mutually reinforcing components of a redesigned clinical
      microsystem. Clinical microsystems are the front line care giving units where patients,
      families, and care teams meet. Our research team developed a set of complementary, mutually
      reinforcing interventions based on available evidence and anchored in a clinical microsystem
      framework. The 5 Advanced and Integrated MicroSystems (AIMS) interventions include: 1)
      Unit-based Physician Teams, 2) Unit Nurse-Physician Co-leadership, 3) Enhanced
      Interdisciplinary Rounds, 4) Unit-level Performance Reports, 5) Patient Engagement
      Activities. Our long term goal is to discover and disseminate the optimal model of care to
      improve outcomes for hospitalized patients. Our specific objective for this proposal is to
      implement a set of evidence-based complementary interventions across a range of clinical
      microsystems, identify factors and strategies associated with successful implementation, and
      evaluate the impact on quality. Our research team is using mentored implementation, i.e.,
      coaching by external professionals who are experts in the area of focus, to help facilitate
      change. The research team has enrolled 4 hospitals in this quality improvement mentored
      implementation study. Our hypothesis is that uptake of the complementary components of the
      intervention set will result in improvements in teamwork climate and patient outcomes.

      Specific Aims of the Redesigning Systems to Improve Quality for Hospitalized Patients (RESET)
      study include:

        1. Conduct a multi-site mentored implementation study in which each site adapts and
           implements complementary interventions to improve care for medical patients.

        2. Evaluate the effect of the intervention set on teamwork climate and patient outcomes
           related to safety, patient experience, and efficiency.

        3. Assess how site-specific contextual factors interact with the variation in the intensity
           and fidelity of implementation to effect teamwork and patient outcomes.

      The findings generated from this study will be directly applicable to hospitals throughout
      the U.S. and our partnership with the Society of Hospital Medicine, the American Nurses
      Association, and the Institute for Patient- and Family-Centered Care will ensure effective
      dissemination and impact.
    

Intervention name(s): Advanced and Integrated MicroSystems (AIMS) interventions
Intervention type(s): Behavioral
Intervention description(s): Each of 4 sites is receiving mentorship from nurse and physician with expertise in implementing similar interventions. The AIMS interventions consist of 1) unit-based physician teams, 2) unit nurse-physician co-leadership, 3) enhanced interprofessional rounds, 4) unit-level performance reports, and 5) patient engagement activities.
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Intervention model description: Two group pretest-posttest analysis
Masking: None (Open Label)
Primary purpose: Health Services Research