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Acceptability of a complex team-based quality improvement intervention for transient ischemic attack: a mixed-methods

Teresa M Damush1,2,3,4, Lauren S Penney5,6,7, Edward J Miech5,8,9,10

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The PREVENT program for transient ischemic attack (TIA) care was acceptable to quality improvement teams. Acceptability varied by time, role, self-efficacy, and perceived effectiveness.

Keywords:
AcceptabilityComplex interventionQuality improvementTemporalityTheoretical framework of acceptability

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Area of Science:

  • Healthcare Quality Improvement
  • Clinical Interventions
  • Patient Safety

Background:

  • The Protocol-guided Rapid Evaluation of Veterans Experiencing New Transient Neurologic Symptoms (PREVENT) program aimed to improve transient ischemic attack (TIA) evidence-based care.
  • This study evaluated the acceptability of the PREVENT program among quality improvement (QI) teams and identified factors influencing it.

Purpose of the Study:

  • To assess the overall acceptability of the PREVENT QI program among participating teams.
  • To identify specific factors (e.g., time, role, self-efficacy, perceived effectiveness) associated with varying levels of program acceptability.

Main Methods:

  • A mixed-methods study involving QI teams from six Veterans Administration facilities over one year.
  • Data collection included semi-structured interviews at 6 and 12 months, debriefing meetings, and virtual collaborative calls.
  • Qualitative coding and analysis of transcribed data, alongside mixed-methods matrix analyses comparing acceptability with satisfaction and the Theoretical Framework of Acceptability (TFA).

Main Results:

  • QI teams reported the PREVENT program as acceptable, with clinical champions showing high acceptability.
  • Key useful activities included reviewing quality data, brainstorming solutions, and developing action plans during kickoff meetings.
  • Program acceptability evolved over the implementation year, correlating with increased team self-efficacy in improving care quality.

Conclusions:

  • Program acceptability was influenced by implementation time, champion role, team self-efficacy, and perceived effectiveness, aligning with the TFA.
  • A flexible, adaptable QI program supported by data, resources, and implementation strategies was found acceptable and appropriate for front-line clinicians.