Effective Communication Network Structures for Hospital Infection Prevention

预防医院感染的有效通信网络结构

• 批准号: 8031201
• 负责人: Pavani Rangachari
• 金额: $ 7.76万
• 依托单位: AUGUSTA UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-30 至 2012-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8031201
• 关键词: Effective; Communication; Network; Structures; Hospital

DESCRIPTION (provided by applicant): The successful implementation of evidence-based infection prevention practices (such as "maximum barrier precautions for central line insertion") is known to significantly reduce hospital-acquired infections (HAIs), mortality, and costs. However, while some hospitals have successfully implemented these national practice standards, others have failed in their attempts. The theoretical literature on organizational change has underscored the importance of "communication network structures," i.e., the direction and frequency of organizational communication, in enabling tacit knowledge exchange, learning, and improvement. Preliminary health services research in this area suggests that "top-down" communication network structures, where changes to work practices are initiated by those with authority (like administrators), may be most effective for tacit knowledge exchange, learning, and improvement in healthcare organizations. By contrast, recent anecdotal evidence from hospital infection prevention success stories, suggests that "peer-to-peer" communication network structures, where professionals from different subgroups (like physicians and nurses) directly communicate with each other on practice changes, with minimal interference from PIity, may be most effective for improvement on evidence-based practices. These inconsistencies suggest a lack of systematic evidence on which communication network structures are more effective for infection prevention, i.e., which are associated with higher compliance on evidence-based practices and lower HAI rates. Within the context of HAIs, this pilot/feasibility study focuses on central line blood stream infections (CLBSIs). The first aim of this study is to develop methods for measuring the "communication network structure," "content of communication," and "outcomes" related to evidence-based CLBSI prevention practices at the unit level. The "communication network structure" refers to the direction and frequency of communication on CLBSI prevention practices across various professional subgroups and hierarchical levels, including medical faculty, nurses, residents, students, unit managers and hospital administrators. The "content of communication" refers to the type of knowledge (i.e., "tacit" vs. "explicit" knowledge) exchanged on CLBSI practices. "Outcomes" include compliance with CLBSI prevention practices and hospital-acquired CLBSI rates at the unit level. The second aim of the study is to conduct an initial test of the hypothesis that "top-down communication network structures are associated with better infection prevention outcomes." The setting will be two intensive care units in an academic medical center. Data on "communication network structure" and "content of communication" will be collected weekly using "communication logs" completed by participants in each subgroup/level. Data on unit "outcomes" will be collected weekly through medical record review. All data will be collected before and after an "organizational pledge" to improve performance on CLBSI prevention practices. In all, data will be collected over 52 weeks in two units, resulting in 104 unit-week observations. Analysis will include content analysis of types of knowledge exchanged on CLBSI practices; network analysis of communication network structures (alongside unit outcomes); and regression analysis of the relationship between communication network structures and outcomes. PUBLIC HEALTH RELEVANCE: According to the Agency for Healthcare Research and Quality (AHRQ, 2009a), nearly 2 million patients develop hospital-acquired infections (HAIs), which contribute to 99,000 deaths each year and $28 billion to $33 billion in health care costs. The successful implementation of evidence-based infection prevention practices is known to significantly reduce HAIs. This study has potential to make substantive contributions to public health by enabling the successful implementation of evidence-based practice standards in healthcare organizations. In addition to the public at large, study results would be directly beneficial to a variety of stakeholders, including healthcare managers & professionals, accreditation agencies, policy makers, and health service researchers.

描述（由申请人提供）：已知成功实施基于证据的感染预防实践（例如“中央线插入的最大障碍预防措施”）可显着降低医院获得的感染（HAIS），死亡率和成本。但是，尽管一些医院成功地实施了这些国家实践标准，但其他医院的尝试却失败了。关于组织变革的理论文献强调了“通信网络结构”的重要性，即组织沟通的方向和频率，在实现默认知识交流，学习和改进方面。该领域的初步卫生服务研究表明，“自上而下”的通信网络结构，其中有权威的人（例如管理员）开始对工作实践的变化，可能对医疗保健组织的默认知识交流，学习和改善最有效。相比之下，医院感染预防成功案例的最新轶事证据表明，“点对点”的通信网络结构，来自不同亚组（例如医师和护士）的专业人员在实践上直接互动的专业人员在实践变化上直接沟通，而对PIITY的干扰可能最有效地对基于证据的实践有效。这些不一致表明，缺乏系统的证据，在这种证据上，通信网络结构对预防感染更有效，即与较高遵守循证实践和较低HAI率有关。在HAIS的背景下，这项试验/可行性研究的重点是中央血流感染（CLBSIS）。这项研究的第一个目的是开发用于测量与基于证据的CLBSI预防实践相关的“通信网络结构”，“通信内容”和“结果”的方法。 “沟通网络结构”是指跨各种专业亚组和等级级别的CLBSI预防实践的通信方向和频率，包括医学院，护士，居民，学生，单位经理和医院管理人员。 “交流的内容”是指在CLBSI实践上交换的知识类型（即“ Tacit”与“明确”知识）。 “结果”包括遵守单位级别的CLBSI预防实践和医院获得的CLBSI率。该研究的第二个目的是对“自上而下的通信网络结构与更好的感染预防结果相关联”的假设进行初步检验。该设置将是学术医学中心的两个重症监护病房。 “通信网络结构”和“通信内容”的数据将每周使用每个子组/级别的参与者完成的“通信日志”收集。单位“结果”的数据将每周通过病历审查收集。所有数据将在“组织承诺”之前和之后收集，以提高CLBSI预防实践的绩效。总共将在两个单位的52周内收集数据，从而导致104个单位的观察结果。分析将包括对CLBSI实践交换的知识类型的内容分析；通信网络结构的网络分析（以及单位结果）；以及对通信网络结构和结果之间关系的回归分析。 公共卫生相关性：根据医疗保健研究与质量机构（AHRQ，2009a）的说法，近200万患者患有医院获得的感染（HAIS），每年造成99,000人死亡，医疗保健费用280亿至330亿美元。已知成功实施基于证据的感染预防实践可显着降低HAI。这项研究有可能通过成功实施医疗组织中的循证实践标准来为公共卫生做出实质性贡献。除了整个公众外，研究结果还将直接有益于各种利益相关者，包括医疗保健经理和专业人员，认证机构，政策制定者和卫生服务研究人员。