1080 — Perceptions of a Stroke QI Collaborative on Acute Stroke Care within VHA

Damush TM, Indianapolis COIN & Stroke QUERI; Bauer-Martinez C, Stroke QUERI; Rattray N, Indianapolis COIN; Williams LS, Indianapolis COIN & Stroke QUERI; Miech EJ, Indianapolis COIN and Stroke QUERI;

Objectives:
Eleven stroke teams from VAMCs volunteered to participate in a stroke QI initiative (INSPIRE) to improve acute stroke care. All teams received performance audit and feedback and half were randomized to participate in a learning collaborative followed by facilitation. In a longitudinal evaluation (RE-INSPIRE), we analyzed the providers' perceptions of the stroke QI initiative on their current acute stroke services.

Methods:
We conducted onsite, semi-structured interviews with key clinical stakeholders of acute stroke care services at 11 VAMCs one year following participation in a stroke QI initiative to evaluate the perceptions of the clinical providers of a stroke QI on their current processes. We audiotaped the interviews, transcribed verbatim, and de-identified the transcripts. Data were qualitatively coded using Nvivo software to manage the data and to tag segments of text into meaningful units. Coders met regularly to review and reconcile emergent themes.

Results:
Perceived usefulness for implementation efforts varied across the participating stroke teams. Three of the five collaborative teams which did not report any stroke QI effort at baseline reported the Stroke QI collaborative was very insightful for improving acute stroke care by establishing a Primary Stroke Care Center at a VAMC, increasing interdisciplinary consult requests for an acute stroke care process, and by providing feedback on a site's quality performance indicating where improvement was needed. Onsite facilitation visits were reported as helpful by two facilities by prompting the teams to work on QI to prepare for the site visits. For the other two teams which reported participating in an external QI program at baseline, the collaborative did not provide additional system improvements. Teams receiving data feedback alone varied their use of this data: some reviewed the data either alone or within their department and others shared their data across the facility.

Implications:
An implementation strategy which includes a learning collaborative followed with facilitation may be useful for quality improvement among healthcare teams with less QI experience.

Impacts:
Evaluating the QI experience and needs of the clinical teams at baseline may enhance successful implementation of QI efforts and ultimately improve care and the outcomes of Veteran patients.