Today the National Heart, Lung, and Blood Institute (NHLBI) of the United States National Institutes of Health announced the early completion of the landmark SPRINT study into recommended systolic blood pressure, which was led by researchers in my own town, at Wake Forest University School of Medicine. Therefore I am featuring a hypertension performance-improvement CME study by Marianna Shershneva, Curt Olson, and others, whose care is a quality measure in this country and elsewhere.
This PI-CME study was published in 2008, before most educational providers who now have outcomes-reporting capacities were able to study educational outcomes within a clinical context. Marianna Shershneva, M.D., Ph.D., is Building Block Leader for Quality Metrics of the Alliance's Quality Improvement Education (ACEhp QIE) Initiative, and Curtis Olson, Ph.D., has been guiding our field through his influence and tenure as Editor-in-Chief of the Journal of Continuing Education in the Health Professions. With their coauthors, Elizabeth Mullikin and Anne-Sophie Loos, we have a nice study for historical review that might have escaped attention on this day because the article title does not specify hypertension.
Consider this excerpt from the abstract, which lays out the opportunities for quality improvement professionals and clinical educators to work together for better patient care: "Although QI practices and CME approaches have been recognized for years, what emerges from their integration is largely unfamiliar, because it requires the collaboration of CME providers and stakeholders within the health care systems who traditionally have not worked together and may not have the same understanding of QI issues to close performance gaps." This was an observational case study with nine clinicians completing the study, and while we could wish for a larger sample, we should agree with the authors that "PI CME required unprecedented collaboration between CME planners and QI stakeholders to enable change in clinical practice." Let's applaud the effort and enjoy the three core findings that you'll see if you access this article.
This is a FREE article in PubMed Central, and I encourage you to review it for findings on physicians' practice patterns that have bearing on today's news from NHLBI. Thanks to the National Library of Medicine reviewers of articles for their assignments to this article's medical subject headings (MeSH terms), without which this article may not have risen to most noteworthy mention after today's NHLBI news. And by the way, proving the relevance of this sort of work to our nation, this study was also funded by two NIH grants.
References Cited: Shershneva MB, Mullikin EA, Loose A-S, Olson CA. Learning to collaborate: a case study of performance improvement CME. J Contin Educ Health Prof. 2008;28(3):140-147. doi:10.1002/chp.181.
NHLBI. Landmark NIH study shows intensive blood pressure management may save lives: lower blood pressure target greatly reduces cardiovascular complications and deaths in older adults [press release]. NHLBI Website. http://www.nih.gov/news/health/sep2015/nhlbi-11.htm. Accessed September 11, 2015.
Reboussin D, NHLBI, NIDDK, NINDS, and NIA. Systolic Blood Pressure Intervention Trial (SPRINT). NCT01206062. ClinicalTrials.gov Website. https://clinicaltrials.gov/ct2/show/NCT01206062. Accessed Accessed September 11, 2015.
MeSH *Major* Terms: Education, Medical, Continuing/standards; Hypertension/prevention & control; Physician's Practice Patterns; Quality Assurance, Health Care.
The "Back to School" Tweet Fest Twitter service campaign (#CMEtf) highlights clinical education initiatives where the outcomes data and quality improvement findings have been published in peer-reviewed journals. Topics of interest are educational research where assessments and outcomes data show which instructional designs would be most appropriate to address clinicians' knowledge, competence, and performance gaps.
Showing posts with label MeSH. Show all posts
Showing posts with label MeSH. Show all posts
Friday, September 11, 2015
Monday, September 7, 2015
Mixed-Methods Study Improves Team Communication After Non-Didactic Interprofessional Education on Cardiac Surgical Crisis
It would be hard to imagine a
more crucial setting for effective interdisciplinary clinical interactions than the cardiac surgery operating theater. Stevens and colleagues published
this 2012 pilot study on interprofessional education to “sharpen
performance of experienced cardiac surgical teams in acute crisis management.”
The educational methods support existing effectiveness research for
non-didactic education, incorporating both interactive
workshops for an entire care unit and computer-based, crisis-case simulations (whose “high-realism” scenarios improved
over time). Researchers found that 82% of the 79 participants recommended
repetition of case simulations every 6 – 12 months. Workshop participants identified
priorities in “encouraging speaking up about critical information and
interprofessional information sharing,” particularly early communication of the
surgical plan.
The mixed-methods outcomes assessment methodology is also noteworthy
because of its appropriateness to this study
of human communications and behaviors during a patient crisis: the structured interviews with study
participants added context and insights to the quantitative data that could be
gathered from periodic surveys. The surveys that were administered before, just
after, and 6 months after the educational activities noted that the “concept of
working as a team improved between surveys,” as well as “trends for improvement
in gaining common understanding of the plan before a procedure and appropriate
resolution of disagreements.” The qualitative
arm of the study found that interviewees valued the initiative’s “positive
effect on their personal behaviors and patient care, including speaking up more
readily and communicating more clearly.”
In the continuing medical
education field, we often see the Canadians leading educational research,
standards, and innovative methods. In fact, looking only at the U. S. National Library
of Medicine’s assignment of Medical Subject Headings (MeSH terms) to this
indexed article shows the relevance of
this study for medical education methods for promoting competence in decision-making,
performance-in-practice change, and quality improvement (see “major” MeSH terms
listed below, and others on the PubMed page). One hopes
to see a follow-up on this pilot study at the Centre Hospitalier Universitaire
de Montréal (Quebec, Canada).
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