A Ten-state Cluster-randomized Controlled Trial of the Institute for Health Improvement's Project JOINTS

NCT02886741 | Completed

• 1 other identifier: 2010-0488-CR05
• Study Type: interventional
• Target: 549
• Locations: 0 countries
• Sites: N/A

Brief Summary

In 2011, IHI designed a new campaign to accelerate uptake of evidence-based practices that had been shown to prevent surgical site infections (SSI) associated with hip and knee arthroplasty. Project JOINTS (Joining Organizations IN Tackling SSIs was a multi-faceted, disciplined initiative that used the Rapid Spread Network (defined above), methods and tools developed during previous IHI campaigns to influence orthopedic practices and hospitals performing hip and knee arthroplasty. Rather than launch nationally as other campaigns have done, Project JOINTS was introduced in a cluster-randomized fashion to enable a rigorous, independent evaluation of its effectiveness in promoting uptake of new evidence-based practices.

Conditions

Disorder of Hip Region

Keywords

campaign; surgical site infection; orthopedic surgery; quality improvement; infection control

Outcome Measures

Primary Outcomes (1)

• Adherence to new evidence based practices

  The questions addressed three actions (or subcomponents) constituting the nasal screening and decolonization process (new practice 1): screening for SA (1.a.); mupirocin nasal decolonization for methicillin-resistant SA (MRSA) (1.b.) and mupirocin nasal decolonization for methicillin-sensitive SA (MSSA) (1.c.). It included a question on skin decolonization using CHG (new practice 2) and a question on alcohol-containing antiseptic in the operating room (new practice 3). Respondents were asked to indicate the frequency of use of each practice among patients undergoing hip or knee arthroplasty. Response options ranged from 0 to 100% in 10% increments and a "don't know" option. The survey separated practices one and two, but these may not be effective if not used together.

  6 months

Secondary Outcomes (1)

• Adherence to established SCIP practices

  6 months

Study Arms (2)

Quality Improvement Campaign

OTHER

IHI designed and encouraged implementation of a five-component "enhanced" surgical site infection (SSI) prevention bundle with three relatively new evidence-based practices and two Surgical Care Improvement Program (SCIP) practices. The campaign recruited state organizations to share information about evidence-based practices and publicize IHI activities and intervention materials (a "How-to Guide," evidence reviews, a summary of the "business case" for interventions, and tip sheets for surgeons, other providers, patients and families). A project website and email listserv offered learning opportunities including webinar calls, faculty-led office hours, and town hall meetings.

Other: Quality Improvement Campaign

Comparison

NO INTERVENTION

Matched state pairs received no campaign intervention and experienced usual care

Interventions

Quality Improvement Campaign OTHER

"How To Guide" addressed development of a QI plan; small-scale tests of change- ("PDSA cycles") to refine implementation approaches through iterative learning; and reliance on multi-disciplinary implementation teams. IHI recruited relevant professional organizations to identify faculty.

Quality Improvement Campaign

Eligibility Criteria

• Age: 18 Years - 70 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Surgeons, nurses, and other staff involved in direct care of patients undergoing hip or knee arthroplasty.
• Staff had to be affiliated with one of 20 hospitals selected at random from among all hospitals in each of 10 states that performed a minimum of 100 hip or knee arthroplasties for Medicare beneficiaries.

You may not qualify if:

• Per diem staff

Sponsors & Collaborators

• RAND: lead
• Institute for Healthcare Improvement: collaborator

Related Publications (1)

• Khodyakov D, Ridgely MS, Huang C, DeBartolo KO, Sorbero ME, Schneider EC. Project JOINTS: what factors affect bundle adoption in a voluntary quality improvement campaign? BMJ Qual Saf. 2015 Jan;24(1):38-47. doi: 10.1136/bmjqs-2014-003169. Epub 2014 Nov 5.

  PMID: 25376449 RESULT

MeSH Terms

Conditions

Surgical Wound Infection

Condition Hierarchy (Ancestors)

Wound Infection; Infections; Postoperative Complications; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Study Officials

• Eric C Schneider, MD

  The Commonwealth Fund

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: August 29, 2016
• First Posted: September 1, 2016
• Study Start: February 1, 2012
• Primary Completion: October 1, 2012
• Study Completion: October 1, 2012
• Last Updated: September 1, 2016

Record last verified: 2016-08

Data Sharing

• IPD Sharing: Will not share