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2019 HSR&D/QUERI National Conference Abstract

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4073 — Learning health microsystems: reflecting on the quality of acute TIA care performance among newly-formed multidisciplinary teams

Lead/Presenter: Nicholas Rattray,  COIN - Indianapolis
All Authors: Rattray NA (VA HSR&D PRIS-M QUERI, Roudebush VAMC), Damush TD (VA HSR&D PRIS-M QUERI, Roudebush VAMC), Miech EJ (VA HSR&D PRIS-M QUERI, Roudebush VAMC) Homoya BJ (VA HSR&D PRIS-M QUERI, Roudebush VAMC) Murphy L (VA HSR&D PRIS-M QUERI, Roudebush VAMC) Ferguson J (VA HSR&D PRIS-M QUERI, Roudebush VAMC) Myers J (VA HSR&D PRIS-M QUERI, Roudebush VAMC) Giacherio B (VA Center for Applied Systems Engineering) Kumar M (VA Veterans Engineering Resource Center) Bravata DM (VA HSR&D PRIS-M QUERI, Roudebush VAMC)

Objectives:
Interventions that deliver timely care for transient ischemic attack (TIA) patients can reduce recurrent vascular events by 70%. Although quality dashboards have shown potential in supporting quality improvement (QI) projects, questions persist about how clinical teams pragmatically use performance data. This evaluation identified contextual factors and implementation strategies to examine how a virtual "Hub" supported quality improvement of TIA care among newly-formed multidisciplinary teams in the Protocol-guided Rapid Evaluation of Veterans Experiencing New Transient Neurological Symptoms (PREVENT) program at six VAMCs.

Methods:
Prospective data were collected from multiple sources including: Hub utilization reports; in-person interviews collected 6 months into active implementation; structured field notes capturing feedback from monthly collaborative meetings and facilitation encounters. Guided by the Consolidated Framework for Implementation Research, a trained team coded and analyzed utilization patterns and qualitative data.

Results:
The Hub supported multidisciplinary teams in implementing TIA protocols by providing tailored performance data and a resource library for local adaptation of the program. At all-day kick-off events, external facilitators presented targeted quality performance metrics, introduced the data Hub, and worked with each team to create data-driven TIA related QI action plans, including targets for improving their facility's "Without-Fail Rate," (WOF) a quality indicator including 7 key care processes linked to improved TIA outcomes. Participants where the WOF was initially low reported close monitoring compared to facilities with higher rates, calling the WOF a "tough but fair measure." Neurologists, pharmacists and other champions used the Hub to track monthly performance at team meetings, educated staff and patients. 3 of 6 facilities shared tools and educational materials with participants at other VAMCs. Providers cited access to previously unavailable benchmarking data as a key source of motivation to continue improving TIA care.

Implications:
Unlike many static dashboards, the PREVENT Hub supports teams in forming microsystems capable of learning from TIA care performance, enabling them to explore hypotheses and evaluate change over time. It likewise helps foster a sense of inter-facility community.

Impacts:
In clinical areas that lack central mandates, Hubs can facilitate local adaptation of clinical protocols while aiding in evaluation and periodic reflection on the implementation of evidence-based care among emergent teams.