Improving Mortality Through a Multihospital, Collaborative Quality Improvement Project.

Area of Science:

• Healthcare Quality Improvement
• Health Services Research
• Patient Safety

Background:

• Improving hospital mortality is a national priority for healthcare quality and safety.
• Structured interventions are crucial for assessing the sustainability of quality improvement efforts.
• The Promoting Action on Research Implementation in Health Services (PARiHS) framework aids in translating research into clinical practice.

Purpose of the Study:

• To investigate the effectiveness of the PARiHS framework in a multihospital quality improvement initiative.
• To assess the impact of PARiHS on reducing observed-to-expected mortality using Vizient's Clinical Data Base (CDB).

Main Methods:

• A quasi-experimental design was used with 34 hospitals (17 intervention, 17 control) from an Upper Midwest improvement collaborative.
• Interventions included mortality reviews, clinical documentation improvement, educational webinars, and CDB training.
• Data were collected from Q4 2016 to Q3 2020, encompassing preintervention, intervention, and postintervention periods.

Main Results:

• Both intervention and control hospitals significantly reduced their observed-to-expected mortality ratio.
• Hospitals implementing the PARiHS framework demonstrated a statistically significant greater reduction in this ratio (P < 0.0004).
• Participating hospitals achieved a 21% relative improvement in their mortality domain rank within the Vizient Quality & Accountability Study.

Conclusions:

• The PARiHS framework is an effective strategy for implementing research into practice to improve hospital mortality.
• Structured implementation support, guided by frameworks like PARiHS, can lead to sustained improvements in patient outcomes.
• This study highlights the value of the PARiHS framework in driving measurable reductions in hospital mortality.