Empowering Implementation Teams with a Learning Health System Approach: Leveraging Data to Improve Quality of Care for T
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Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D) Precision Monitoring to Transform Care (PRISM) Quality Enhancement Research Initiative (QUERI), Indianapolis, IN, USA; 2VA HSR&D Center for Health Information and Communication (CHIC), Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA; 3Department of Anthropology, Indiana University-Purdue University, Indianapolis, IN, USA; 4 Regenstrief Institute, Inc., Indianapolis, IN, USA; 5Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; 6 Veterans Evidence-Based Research Dissemination and Implementation Center (VERDICT), South Texas Veterans Health Care System, San Antonio, TX, USA; 7University of Texas Health San Antonio, San Antonio, TX, USA; 8Office of Healthcare Transformation (OHT), Veterans Health Administration (VHA), Washington, DC, USA; 9Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA.
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
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11606-020-06160-y) contains supplementary material, which is available to authorized users. Received September 11, 2019 Accepted August 14, 2020
development and monitoring. External facilitators used the Hub to help teams leverage data to target areas of improvement and dissem
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